The patient is a 64-year-old female who is relatively healthy, except for her history of asthma.She is reported to have pale yellow tinged skin and eye sclera, mild non-specific upper rightquadrantsensitivity, and a positive Murphy sign that points to pain during inhalation. The patient also shows disorientation, anxiousness, and signs of confusion. While the patient vital signs BP 145/85, HR 95, RR 24 are slightly higher than normal, for a 64-year-old female with the other additional symptoms, they could be acceptable and not indicative of the presence of a disease. The revelation by the husband concerning the taking of a “cleaning substance” is also significant.The key information in the patient’s assessmentincludes indications of the pale yellow skin and eye sclera, mild non-specific right upper quadrant tenderness, and the positive Murphy sign, and the signs of anxiety, disorientation, and confusion by the patient. The BP, HR, and RR could also be useful in supporting a diagnosis.

Provisional Diagnoses

The symptoms reported by the patient point towards many different diagnoses.This is because most of the symptomsare manifested in most diseases that involve the liver. However, thefollowing are the most probable diagnoses.

1. Acute gallbladder inflammation
2. Acute cholecystitis
3. Gallstones
4. Jaundice
5. Hepatitis

Final Diagnosis and the Pathophysiology Behind the Diagnosis

The most plausible diagnosis for the patient is Jaundice.This is in consideration of the key information of symptoms presented by the patient.First, the pale yellow skin and sclera of the eye are usually a direct indication of jaundice the yellowing of the eyes and skins is usually caused by an excess of bilirubin in the blood.However, the yellowing of these body organs could also be attributed to having too much beta carotene-an antioxidant, in her system,which can be explained by the patient’s intake of “cleansing substance” as revealed by her husband. However, the presence of this symptom coupled withthe upper right quadrant pain and tenderness further points to jaundice. However, the pain in the upper abdomen points towards a gallbladderand gallstone attack, but the absence of fever and shivering, and severe nausea and vomiting rules the two diagnoses out.

The anxiety, disorientation and confusion symptoms evidenced on the patient points towards hepatic encephalopathy which is a discriminating symptom that confirmed jaundice. None of the identified diagnosesischaracterized by any changes in the mental functioning of the patient. Sherlock & Dooley(2008)state that Hepatic encephalopathy occurs when brain functions deteriorate due to a malfunctioningof the liver allowing toxic substances to enter and buildup in the bloodstream, reaching the brain and causing mental functions such asagitation, drowsiness, and confusion.According toAitken, Marshall, & Chaboyer (2016), the occurrence of Hepatic encephalopathy coupled with yellowing of the eyes and skin is indicative of jaundice.The positive Murphy sign points to pain during inhalation which could be an indication of ascites, a common problem of jaundice in adults.

Implications for Paramedic Practice

The case assessment of the patient has the implicationthat diseases of the liver can be manifestedin a variety of ways. Therefore it is imperative that any personnel involved in the paramedic field should familiarize themselves with Hepatobiliary diseases and be conversant with various ways of providing emergency care to patients when faced with an emergency case with a patient exhibiting symptoms of Hepatobiliary diseases.

References

Aitken, L., Marshall, A., & Chaboyer, W. (2016). ACCCN’s Critical Care Nursing. Chatswood, NSW: Elsevier Health Sciences.

Sherlock, S., & Dooley, J. (2008). Diseases of the Liver and Biliary System. Hoboken, New Jersey: John Wiley & Sons.

 
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