The lady who lost mobility after 5 days of nausea & vomiting

HPI

A 68-year old female was admitted to Oncology service via ED with c/o intractable nausea & vomiting for about 6 days. Made NPO with NGT for GIT decompression & Gastroenterology consulted.

Within 1-day of admit she developed acute new symptoms of severe weakness, as evidenced by inability to move in or out of bed. Her husband reported the functional decline to the rounding oncologists in the morning of the second day during rounds. PT was consulted for rehab needs

On approach: Husband reported all new symptoms onset since admission, 2 days back. Patient was barely conversant, preferring to lie on the right lateral side throughout. She also had no facial expression even while she conversed. Husband was indignant that patient had laid in bed all of 2 days and therefore she was unable to move.

Physical Examination

Observation:

Lethargic-appearing, side-lying, poorly interactive. Did not smile or offer greetings. Some restlessness noted. However in no acute distress. NG tube to suction for gastric decompression.

Vitals: T: 98.4˚ F, P: 89, R: 17, BP: 127/81, SpO2 97% on room air

Systems Review

Cardiac: S1, S2, No murmurs, no bruits.

Lungs: CTAB

Motor: Intact ROM (passive), Very limited Active ROM – generally stiff all over

Neurologic: Uniformly increased flexor tone, Poor motor control, Difficult to extend at neck, lower spine, hips, knees

Integumentary: Slightly sluggish skin turgor test. No wounds

Function

Difficulty in initiating movements: Unable to Roll, or Sit-up. Unable to stand, except w/Max Assist

Assessment

At this time, please list every possible reason you can think of of WHY do you find the patient in the current situation?

To do this, you will need to have a verifiable PROBLEM LIST.

So, What are the PROBLEMS? >>> WHY are the problems present (i.e. Causation).

You may or may not need to request specific confirmatory tests or review history – but you have to be clear in your mind on what specific test or historical review you would want in this situation.

If you can arrive at plausible WHYs, you have solved the problem. The treatment of the underlying CAUSE (the so called “WHY”), is the resolution of the patient’s symptoms.

Everything else as a part of PT is supportive measures – Education, and Prophylactic.

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