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PATIENT PRESENTATION

Chief Complaint

“My right knee hurts really bad.”

History of Present Illness

AD is a 66-year-old female who had a right total knee arthroplasty (TKA) and has been experiencing right knee pain that has increased gradually in severity since 2 weeks ago. The pain is persistent and moderate to severe. She also has been having trouble walking around the block. Of note, the right knee is swollen and red. She followed up in clinic with her surgeon yesterday and was told she needed to be admitted to the hospital.

Past Medical History

Obesity, type 2 diabetes, osteoarthritis, hypertension, hyperlipidemia, depression

Surgical History

Right TKA 3 weeks ago, C-section

Family History

Father died at age 62 from a heart attack; mother died at age 70 from breast cancer

Social History

No alcohol, tobacco, or IV drug use; lives at home with her husband; she is retired

Allergies

Septra (“bad rash”)

Home Medications

Metformin 1000 mg PO BID

Desvenlafaxine 50 mg PO daily

Ibuprofen 600 mg PO TID PRN

Lisinopril 40 mg PO daily

Hydrochlorothiazide 25 mg PO daily

Simvastatin 80 mg PO daily

Physical Examination

Vital Signs

Temp 100°F, P 78, RR 16 breaths per minute, BP 148/92 mm Hg, pO2 98% on room air, Ht 5′4″, Wt 90.7 kg

General

Well-groomed female in moderate distress

HEENT

PERRLA, EOMI

Pulmonary

Clear to auscultation, no crackles or wheezing

Cardiovascular

RRR, no m/r/g

Abdomen

Normal BS, abdomen soft and tender

Neurology

A&O ×3, CN II-XII grossly intact

Extremities

Right knee is edematous and erythematous; knee feels stable but warm to the touch

Laboratory Findings

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Na = 140 mEq/L

Hgb = 14.1 g/dL

AST = 20 IU/L

K = 4.3 mEq/L

Hct = 42%

ALT = 24 IU/L

Cl = 102 mEq/L

Plt = 167 × 103/mm3

T Bili = 1.5 mg/dL

CO2 = 27 mEq/L

WBC = 9 × 103/mm3

Alk Phos = 86 IU/L

BUN = 24 mg/dL

Scr = 1.01 mg/dL

Glu = 158 mg/dL

QUESTIONS

1....

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