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Case Report A 32-year-old man was referred to the emergencies of our hospital because of a right lower limb critical limb ischemia. Past medical history included chronic alcoholism and a three- month history of bilateral intermittent claudication. He did not report any episode of superficial thrombophlebitis. He smoked about 10 cigarettes since the age of ten and 10 cannabis joints daily since the age of twelve. He had no other cardiovascular risk factors.

Case Report A 32-year-old man was referred to the emergencies of our hospital because of a right lower limb critical limb ischemia. Past medical history included chronic alcoholism and a three- month history of bilateral intermittent claudication. He did not report any episode of superficial thrombophlebitis. He smoked about 10 cigarettes since the age of ten and 10 cannabis joints daily since the age of twelve. He had no other cardiovascular risk factors.

Understanding Health Insurance: A Guide to Billing and Reimbursement
Understanding Health Insurance: A Guide to Billing and Reimbursement
14th Edition
ISBN:9781337679480
Author:GREEN
Publisher:GREEN
Chapter6: Icd-10-cm Coding
Section: Chapter Questions
Problem 199R
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10:28 NCM 112 RLE Case Report A 32-year-old man was referred to the emergencies of our hospital because of a right lower limb critical limb ischemia. Past medical history included chronic alcoholism and a three- month history of bilateral intermittent claudication. He did not report any episode of superficial thrombophlebitis. He smoked about 10 cigarettes since the age of ten and 10 cannabis joints daily since the age of twelve. He had no other cardiovascular risk factors. At clinical examination, his right leg was extremely painful and pale. He had absent pedal pulses on both sides, and a mild sensory loss on the right side. Allen's test of upper extremities was negative. Echo Doppler was suggestive of a bilateral common iliac occlusion and of a three-vessel occlusion on the right leg. A computerized tomography (CT) angiography detected the presence of an intraluminal aortic and iliac clot and a bilateral stal ibial essels occlusion. The patient was fully anticoagulated with intravenous heparin. A transthoracic echocardiogram was also performed and did not detect any proximal source of emboli. The patient was then operated on: under general anesthesia, a right iliofemoral embolectomy associated to a selective right popliteal, tibial, and peroneal embolectomy and intraoperative intraarterial thrombolysis of tibial vessels. During the operation, no thrombus was found in the infrapopliteal vessels, but intraoperative arteriography showed a diffuse narrowing associated to total occlusion at the ankle with the typical "corkscrew" collateral arteries suggestive of a chronic vasculitis BD was then suspected. The postoperative period was uneventful, with complete remission of symptoms. The aortoiliac embolus was sent to bacteriology and some Micrococci were found. Subsequently, the patient was treated with medical therapy including full dose low molecular weight heparin, antiplatelets, and pentoxifylline, and a smoking-cessation program was started. A control thoracic and abdominal angio-CT scan, done also in order to detect a proximal source of embolism, showed the absence of residual aortoiliac clot, but the chronic occlusion of the anterior tibial and peroneal arteries bilaterally. The contralateral lower limb did not require any operation. After discharge the patient underwent laboratory tests looking for diabetes and thrombophilia that were unremarkable. These included factor II and V mutation, disorders of plasminogen activation, ATIII deficiency, protein C and protein S deficiency, and homocysteine serum levels. Extensive autoimmune testing looking for autoimmune disorders potentially responsible for thrombotic including antimitochondrial, anti-lupus erythematosus, anti-phospholipids events antinuclear, antibodies were all negative. We then concluded that the patient was affected by BD. and 1. Develop your top 3 Nursing Care Plan of the patient above.
Transcribed Image Text:10:28 NCM 112 RLE Case Report A 32-year-old man was referred to the emergencies of our hospital because of a right lower limb critical limb ischemia. Past medical history included chronic alcoholism and a three- month history of bilateral intermittent claudication. He did not report any episode of superficial thrombophlebitis. He smoked about 10 cigarettes since the age of ten and 10 cannabis joints daily since the age of twelve. He had no other cardiovascular risk factors. At clinical examination, his right leg was extremely painful and pale. He had absent pedal pulses on both sides, and a mild sensory loss on the right side. Allen's test of upper extremities was negative. Echo Doppler was suggestive of a bilateral common iliac occlusion and of a three-vessel occlusion on the right leg. A computerized tomography (CT) angiography detected the presence of an intraluminal aortic and iliac clot and a bilateral stal ibial essels occlusion. The patient was fully anticoagulated with intravenous heparin. A transthoracic echocardiogram was also performed and did not detect any proximal source of emboli. The patient was then operated on: under general anesthesia, a right iliofemoral embolectomy associated to a selective right popliteal, tibial, and peroneal embolectomy and intraoperative intraarterial thrombolysis of tibial vessels. During the operation, no thrombus was found in the infrapopliteal vessels, but intraoperative arteriography showed a diffuse narrowing associated to total occlusion at the ankle with the typical "corkscrew" collateral arteries suggestive of a chronic vasculitis BD was then suspected. The postoperative period was uneventful, with complete remission of symptoms. The aortoiliac embolus was sent to bacteriology and some Micrococci were found. Subsequently, the patient was treated with medical therapy including full dose low molecular weight heparin, antiplatelets, and pentoxifylline, and a smoking-cessation program was started. A control thoracic and abdominal angio-CT scan, done also in order to detect a proximal source of embolism, showed the absence of residual aortoiliac clot, but the chronic occlusion of the anterior tibial and peroneal arteries bilaterally. The contralateral lower limb did not require any operation. After discharge the patient underwent laboratory tests looking for diabetes and thrombophilia that were unremarkable. These included factor II and V mutation, disorders of plasminogen activation, ATIII deficiency, protein C and protein S deficiency, and homocysteine serum levels. Extensive autoimmune testing looking for autoimmune disorders potentially responsible for thrombotic including antimitochondrial, anti-lupus erythematosus, anti-phospholipids events antinuclear, antibodies were all negative. We then concluded that the patient was affected by BD. and 1. Develop your top 3 Nursing Care Plan of the patient above.
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