...Case Study Three CC: Jose Santa Cruz (JS) is a 68 y/o Native American male and retired construction worker. JS no longer works at this time, except to watch his grandchildren occasionally. ID: 68 y/o Native American Male, retired construction worker. CC: Rt knee pain x many years; epigastric burning with food x 2 weeks with dark stools. HPI: Pt c/o previous history rt knee pain for many years. He also c/o epigastric burning over past 2 weeks, and newly noted dark stools with no other prior history. Onset of rt knee pain approximately 7-8 years ago and increasing at this time. Epigastric burning onset is described as 2 weeks ago with dark stools noticed over past couple days. The location of his knee pain is centered over knee joint. Epigastric pain is focused in the mid to rt upper abd per Pt. Characteristics of his rt knee pain include occasional sharpness with an ongoing ache. His epigastric pain is characterized as burning which occasionally wakes him at night. He describes his stools over the past 1-2 days as dark-black in color, but not tarry in texture. JS denotes aggravating knee pain with movement especially getting up and down, or any activities which put pressure on his knee. He states his epigastric burning is aggravated by certain foods, especially high spice foods. His stools are recently dark- no aggravating of the color change noted. Relief of rt knee pain has been attempted with Advil 800mg po tid without good pain control. JS has also tried...
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...Acute Fatty Liver of Pregnancy: Case series Introduction Severe liver function disorders in late pregnancy are relatively rare but extremely dangerous, as they may quickly develop into a fulminant disease and become a life-threatening disorder for the mother and the fetus. Acute fatty liver of pregnancy is a potentially fatal metabolic disorder unique to the third trimester of pregnancy. Incidence of AFLP is 1 in 7,000 to 16,000 pregnancies and is associated with micro vesicular fatty infiltration of the liver, hepatic failure, and encephalopathy.1 We present case series of Acute Fatty Liver of Pregnancy reported in our institute. Case 1 was a 22-year-old primagravida, 39 weeks of gestation presented with nausea, vomiting, high colored urine, pedal edema, polyuria and jaundice. Her blood pressure was 110/70 mm Hg and pulse rate was 86/min. Taken for emergency LSCS....
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...Running head: PAIN CASE STUDY Case Study: Pain Amit Dhir, Omeid Heidari, Sean Mayer, Ololade Ikuomola & Adam Boyce NR110.542 Physiological/Pathophysiological Basis for Advanced Nursing Practice I 09/29/2015 Johns Hopkins University School of Nursing On our honor, we pledge that we have neither given nor received any unauthorized assistance on this assignment. 1 Running head: PAIN CASE STUDY CASE STUDY Pain Use this document in documenting your response to the Patient Case Questions. CHIEF COMPLAINT “My back is killing me. The pain is mostly sharp and stabbing, and sometimes it’s a dull ache. You’ve got to do something. Those Tramadol pills aren’t cutting it and they’ve bound me up.” “I am not sleeping because of the pain.” MEDICAL HISTORY P.M. is a retired, 81yearold male being seen for a routine health maintenance visit. He has a history of lower back pain, morbid obesity, hypertension, hypothyroid, occipital lobe stroke, bilateral total knee arthroplasty, GERD and sleep apnea. Now reporting pain in feet. He has been a smoker for the past 64 years, reporting 12 ppd. He is accompanied by his wife of 62 years. CURRENT MEDICATIONS Tramadol 50100 mg p.o. Q 12 hrs prn back pain Atenolol 25 mg p.o. Q a.m. Levothyroxine sodium 125 mcg p.o. Q a.m. Clopidogrel 75 mg p.p. Q a.m. Ibuprofen 600 mg ii p.o. prn knee pain Aspirin 650 mg p.o. prn “when I can’t get to sleep” ...
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...BSBMED301B: Assignment 1 What you have to do Using the learning resource provided answer the following questions: Question 1 Using your knowledge of word components, give the correct medical term for each of the definitions below. Definition Medical Term 1. rectal hernia Rectocele 2. excision of the stomach Gastrectomy 3. inflammation of the kidney Nephritis 4. enlargement of the liver Hepatomegaly 5. incision to remove a stone Lithotomy 6. fixation of the intestine Enteropexy 7. artificial opening in the colon Colostomy 8. incision into the abdomen Laparotomy 9. absence of one or both testes Anarchism 10. rupture of the uterus Hysterorrhexis 11. excision of the prostate gland Prostatectomy 12. visual examination of the vagina Colposcopy 13. surgical repair of a testicle Orchiopexy 14. discharge of milk Galactorrhea 15. difficult labour or delivery Dystocia 16. suture of the tongue Glossorrhaphy 17. surgical puncture of the abdomen Abdominocentesis 18. pus in the urine Pyuria 19. pertaining to above the kidney Suprarenal 20. narrowing of the urethra Urethral Stricture Question 2 Give the meaning of each of the abbreviations below. Abbreviation Medical Meaning 1. LUQ Left upper quadrant 2. GI Gastrointestinal 3. OGD Oesophago-gastro duedenoscopy 4. CVS Chorionic villus sampling 5. STD Sexually transmitted disease 6. IUD Intrauterine device 7. TURP Transurethral resection of the prostate 8. DRE Digital rectal...
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...occurring in persons who are obese, who have high cholesterol, or who are on cholesterol lowering drugs. In most cases, gallbladder and bile duct diseases occur during middle age. Between ages 20 and 50, they're six times more common in women, but incidence in men and women becomes equal after age 50. Incidence rises with each succeeding decade. Diseases of the gallbladder and biliary tract are common and painful conditions that may be life threatening and mostly require surgery. They are generally associated with deposition of calculi and inflammation. B. CLIENT CENTERED Patient R.D. is a 24 year old female, was admitted at Candelaria District Hospital on 17th of August, 2011 with a reported history of recurring right upper quadrant pain for the past 4 months and complaining of severe RUQ abdominal pain that radiates to her back. She nauseated and has had a few episodes of vomiting at home. The pain is less intensed if she walks around bent forward. An ultrasound revealed stones in the gallbladder. She was admitted for the gallbladder stone removal. C. STUDENT CENTERED We, group 2, students of Columban College would like to thank Candelaria District Hospital, and also our Clinical Instructor, Ma’am Charmaine Abdon, for her patience in teaching us and making sure we learn the most from our clinical exposure. The purpose of this case study is to be familiar with a patient that undergo Cholecystectomy; How it starts, what are the causes and what are the...
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...Digestive Case Study: A Case Of Acute Pancreatitis Describe the Anatomical location of the Pancreas relative to the other organs in the upper portion of the abdominal cavity. The pancreas is an “elongated, tapered” organ that sits behind the stomach, across the back of the abdomen. The widest part of the pancreas is called the head and lies in the curve of the duodenum (1st section of s. intestine). The body of the pancreas extends slightly upward, and the tail of the pancreas ends near the spleen. (n.d.). Retrieved from http://medicalcenter.osu.edu/patientcare/healthcare_services/liver_biliary_pancreatic_disease/pancreas_anatomy_function/Pages/index.aspx Describe the functional anatomy of the duct system that conveys bile from the liver and digestive juice from the pancreas to the lumen of the duodenum. Pancreatic juice is a mixture of sodium bicarbonate and digestive enzymes that travel through the pancreatic ducts directly into the lumen of the duodenum. Chyme is partially digested food that travels from the stomach into the duodenum, and trypsm, amylase, and lipase are the digestive enzymes which break down proteins, starches, and fats and are carried to the duodenum from the stomach. The liver manufactures and secretes Bile, which is a fluid released into the duodenum that aids in digestion of fat. (n.d.). Retrieved from http://www.visualhistology.com/products/atlas/VHA_Chpt14_Pancreas_Liver_And_Gallbladder.html Briefly outline the endocrine and exocrine...
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...Case Study 5—Coronary Artery Disease It is midmorning on the cardiac unit where you work, and you are getting a new patient. G.P., a 60- year-old retired businessman, is married and has 3 grown children. As you take his health history, he tells you that he began feeling changes in his heart rhythm about 10 days ago. He has hypertension and a 5-year history of angina pectoris. During the past week he has had more frequent episodes of midchest discomfort. The chest pain has awakened him from sleep but does respond to NTG, which he has taken sublingually about 8 to 10 times over the past week. During the week he has also experienced increased fatigue. He states, “I just feel crappy all the time anymore.” A cardiac catheterization done several years ago revealed 50% occlusion of the right coronary artery (RCA) and 50% occlusion of the left anterior descending (LAD) coronary artery. He tells you that both his mother and father had CAD. He is taking amlodipine, metoprolol, lipitor, and baby ASA qd. Setting: Hospital, outpatient cardiac rehabilitation Index Words: coronary artery disease (CAD), hypertension, angina, lifestyle modification, medications, laboratory values, assessment, risk factors, pacemaker 1. What other information are you going to ask about his episodes of chest pain? [k] Use the following memory aid to obtain information from the patient who has chest pain. FACTOR QUESTIONS TO ASK PATIENT P Precipitating events What events or activities precipitated...
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...------------------------------------------------- Peptic ulcer A peptic ulcer, also known as PUD or peptic ulcer disease,[1] is the most common ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm. As many as 70–90% of such ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach; however, only 40% of those cases go to a doctor. Ulcers can also be caused or worsened by drugs such as aspirin, ibuprofen, and other NSAIDs.[2] Four times as many peptic ulcers arise in the duodenum—the first part of the small intestine, just after the stomach—as in the stomach itself. About 4% of gastric ulcers are caused by a malignant tumor, so multiple biopsies are needed to exclude cancer. Duodenal ulcers are generally benign. ------------------------------------------------- ------------------------------------------------- [edit]Classification By Region/Location * Duodenum (called duodenal ulcer) * Oesophagus (called esophageal ulcer) * Stomach (called gastric ulcer) * Meckel's diverticulum (called Meckel's diverticulum ulcer; is very tender with palpation) Modified Johnson Classification of peptic ulcers: * Type I: Ulcer along the body of the stomach, most often along the lesser curve at incisura angularis along the locus minoris resistantiae. * Type II: Ulcer in the body in combination...
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... and congenital disorders. The greatest incidence of acute cholecystitis occurs in adults 30 to 80 years of age. There is a 2 times greater incidence of gallstones in women than in men.1 Cholecystitis is characterized by a recurring mild-tomoderate, right upper quadrant and epigastric abdominal pain. Pain often radiates to the right posterior scapula and back. Nausea, vomiting, low-grade fever, and leukocytosis are often present. Symptoms are commonly associated with consumption of high-fat meals 1 or more hours prior to the onset of pain.1-4 Murphy’s sign may be a useful tool in establishing the diagnosis of cholecystitis. Confirmation of the diagnosis depends on a combination of physical findings and laboratory and imaging studies. A corollary, the sonographic Murphy’s sign, may be useful as well.1-5 SIGNS OF CHOLECYSTITIS MURPHY’S SIGN Elicitation: Palpate the right subcostal area while the patient inspires deeply Positive response: The patient feels pain upon this maneuver and may have an associated inspiratory arrest SONOGRAPHIC MURPHY’S SIGN Elicitation: Palpate the right subcostal area using an ultrasound transducer while the patient inspires deeply Positive response: The patient feels pain upon this maneuver, and the ultrasound transducer can confirm that the gallbladder is being pushed when the patient experiences inspiratory arrest HISTORIC PERSPECTIVE John B. Murphy (1857–1916) was a prominent Chicago surgeon from the 1880s through the early 1900s. He was...
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...hallmark traits of the syndrome which are Hemolysis, Elevated Liver enzymes and Low Platelet count. (Davidson et al., 2012, p. 463). The hemolysis that occurs is thought to be red blood cells that are distorted during passage throughout damaged blood vessels. The body’s platelets aggregate at sites of vascular damage, which results in low platelet counts. The elevated liver enzymes occur from blood flow that is obstructed because of fibrin deposits. These fibrin deposits cause obstruction and result in hepatocellular injury. This leads to the classic hepatic lesion associated with HELLP. (Davidson et al., 2012, p. 463). Symptoms for HELLP syndrome include headache; nausea/vomiting/indigestion with pain after eating; abdominal or chest tenderness and upper right pain; shoulder pain or pain when breathing deeply; bleeding; changes in vision and swelling. Signs to look for include high blood pressure, protein in the urine, low platelet count and high liver enzymes (HELLP Syndrome). The symptoms HELLP syndrome can present with can easily lead to a misdiagnosis of the flu, gallbladder disease, hepatitis, ITP or thrombotic thrombocytopenic purpura. Mortality of HELLP syndrome can be as high as 25% so the possibility of HELLP syndrome should be seriously considered (Davidson et al., 2012, p. 463). Preeclampsia and HELLP syndrome are very stressful for the mother and the family to cope with. The mother could be in danger of developing intracerebral hemorrhage, which is the most common...
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...Administration and Pain Management in the Terminally Ill Cancer Patient: Case study of a patient in the terminal phase of breast cancer. This case study is based on Ms. D, a 48-year-old married woman diagnosed with Bilateral Breast Cancer. She underwent a bilateral mastectomy 4 years ago. Lymph involvement was noted at the time of the surgery. Recent metastases of the bone has been diagnosed and she is in the terminal phase of the disease process. Up to this point, she has been on a regimen of Oxycodone 5 mg P.O. every 6 hours as needed for pain, Zantac 150mg P.O daily for heartburn, Docusate 100mg P.O. twice a day to promote bowel movements, Celexa 40mg PO daily for depression and enteric coated aspirin 81mg PO daily for prophylaxis of transient ischemic attacks and MI. She remains in her home and is receiving care at home. Ms. D has complained recently of significant increased pain and trouble sleeping, most likely due to the bone metastases in the area of the lumbar spine. She has stated that the pain has dramatically decreased her quality of life recently also. She has expressed the desire to remain at home during the terminal phase of her disease, but needs more adequate pain management to preserve her quality of life for as long as possible. She is married and her husband is very loving and supportive of her desire to stay in the home during this phase. He has voiced some concerns about drug dependency if the patient were to receive stronger pain medication. I have...
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...J. A. Care Plan Tamara Parker South College Medical Dx: Depression Allergies: Demerol, Oxycodone Hx: 91 y/o female brought to Shannondale from Blount Memorial with multiple fractures which she sustained from falling out of her bed. Patient suffers from chronic back pain and has hx of osteoporosis, muscle weakness, glaucoma, hyperlipidemia, kyphoplasty with bone fusion, back fusion, stemi, OA, and depression. |Neuro: |GU: | |Alert and oriented x3. Little confusion |No bowel movement since 3/2/16. Urine x1. | | | | |EENT: |MS: | |PERRLA, normocephalic, presbyopia. |Generalized weakness, uses wheelchair, needs little assistance with ADL’s. | | ...
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...effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM.Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Contraindications Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Adverse effects Bradycardia, AV...
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...Gross Anatomy allen SUPERFICIAL FASCIA Under the skin, similarly found in the other parts of the body. In obese individuals, heavily laid with fats Thin above the umbilicus, continuous with the superficial fascia of the thorax Below the umbilicus, there are 2 distinct parts o Camper’s Fascia –fatty superficial layer of the superficial fascia, wherein superficial blood vessels and nerves are found o Scarpa’s Fascia –deeper membranous layer of the superficial fascia. Provided with greater amount of elastic tissue. After crossing the inguinal ligament anteriorly, will blend with the FASCIA LATA of the thigh. In the pubis, it is continued over the spermatic cord, penis and the scrotum, and blends with the COLLE’S FASCIA of the perineum ABDOMEN ABDOMINAL WALL SURFACE ANATOMY LINEA ALBA Median band of a tendinous raphe between the two rectus abdominis muscles, formed by the fusion of the aponeurosis of the external oblique, internal oblique, and transverse abdominal muscles. Represented by a depression that extends from the xiphoid process to the pubic symphysis in pregnancy, it becomes a dark brown or black pigmented vertical line (linea nigra), probably due to hormone stimulation to produce more melanin. Infraumbilical part is very narrow Supraumbilical part gradually widens towards the sternal end NAVEL/ UMBILICUS Not a good landmark, variations due to obesity and beer drinkers Depression along the linea alba and indicates the site of the...
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...Focussed Assessment In the given case study patient has persistence vomiting for eight days and she took Antaacids to relieve the symptoms. She is dehydrated, and her lab results shows she has metabolic alkalosis. In focused assessment, detailed nursing assessment of particular body system(s) connected to the current problem is required. One or more body system may be involved.Nausea and vomiting can ocurr due to different reasons like food poisoning,chloecystitis or intestinal obstruction..For the patient with vomitting,intially the health care provider need to pay attention to signs of dehydration. Like assessing monitoring blood pressure and observing for hypotension, skin turgour and mucous membranes changes (McCance, Huether, Brashers, & Neal, 2014). General Assessment: Patient had dark circles under the eyes. She looked worn out. She was feeling anxious. Her energy level was very low. She was speaking very slowly. Abdominal Examination: Abdomen is soft to touch. Patient has some epigastric pain. Bowel sounds are decreased.No bloating or acidity. Signs of hypo-motility may indicate an increased risk for nausea and vomiting. Cardiovascular system: Patient is hypotensive with tachycardia. No heart regurgitation or murmur. Heart rhytm is regular. Patient is feeling tired and dizzy. Pulmonary system: Patient is in metabolic alkalosis. Respirations rate is low 12 breaths per minute. Patient is taking deep regular breaths. Lungs are clear to ausculation...
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