NCM 112 Finals

Problem 1 Scenario 1
Case of Willy

Willy, a 35 year old male came to the ER hospital where you are working as a staff nurse. He
came for admission with complaints of low grade fever and body malaise for 10 days. The
physician on duty evaluated his history and did not reveal any significant medical conditions.
Initial assessment shows the patient’s complete blood count is elevated with total white blood
cell (WBC) count of 100,000 cells/μL with 75% blast cells.

On the 2nd day of confinement there was an abrupt increase in Willy’s temperature to
39.5degrees centigrade. He also developed small, shallow oral ulcers, which tested negative for
cytomegalovirus (CMV) and for herpes simplex virus (HSV) by polymerase chain reaction
(PCR). Willy was then prescribed cefepime for neutropenic fever. He developed diarrhea, losing
around 700 mL per day. A stool examination did not detect the presence of red blood cells, WBC
or pathogens like bacteria or fungi. A PCR test further confirmed that there was no Clostridium
difficile present in the stool samples. However, blood cultures detected Enterococcus faecium.
His antibiotic regimen was subsequently switched to treatment with imipenem and vancomycin.

What do you think is happening to Willy? 

What are the significance of the laboratory exams done to him? 
 
Develop a plan of care (2 Physiologic) for Willy
Make a drug study on the medications given to Willy
Chart Data:

After 5 days in the hospital

V/S – BP 100/70
T- 38.5
PR- 108 beats/min
RR – 32/min
O2 Sat – 95
CBC results:
WBC -120,000 cells/μL with 85% blast cells
RBC – 3.0 million cells/mcL
Platelet count – 80,000/mcL

2 weeks later:

Ultrasound – (+) emlarged lymph node in the abdomen

Computed tomography (CT) (+)diffuse thickening of small bowel and ascending colon wall
No signs of lung parenchymal abnormalities