This document provides a comprehensive care plan for a 71-year-old female patient admitted for right shoulder pain. She has a history of multiple medical issues including lung cancer, diabetes, and hypertension. On admission, she was found to have a fractured right clavicle due to cancer metastasis. Lab work showed abnormalities including anemia. The plan identifies interventions to address issues such as spiritual distress, diabetes management, and pain control. Goals are set to improve spiritual well-being and engage in cancer treatment. Nursing will provide support, hope, and a therapeutic relationship.
This case report describes a 75-year-old man with prostate cancer undergoing watchful waiting who was found to have pernicious anemia, a severe vitamin B12 deficiency. Over 10 months, his prostate cancer progressed more rapidly than expected based on Gleason score and PSA levels. After starting vitamin B12 injections for pernicious anemia treatment, the patient's PSA and prostatic acid phosphatase levels initially increased rapidly before stabilizing. The authors propose that the patient's vitamin B12 deficiency may have modulated the growth and progression of his prostate cancer, and that B12 replacement accelerated cancer marker levels initially before stabilization. They recommend screening prostate cancer patients undergoing watchful waiting for vitamin B12 deficiency.
A 27-year-old woman presented with fatigue, shortness of breath, easy bruising, and a syncopal episode. Laboratory workup revealed hemolytic anemia. A bone marrow biopsy showed hypocellular marrow consistent with aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH). She was treated with immunosuppression but later developed multiple thromboses. Testing confirmed PNH diagnosis. She received eculizumab therapy which stabilized her hemoglobin levels and reduced transfusion requirements. PNH causes hemolytic anemia due to lack of protective proteins on blood cells, predisposing to complement-mediated destruction and thrombosis.
Management of CLL in elderly patients asco 2014Jeff Sharman
This document discusses the management of a 86-year-old male patient with chronic lymphocytic leukemia (CLL) who presents with increasing lymphocytosis, lymphadenopathy, and splenomegaly over two years. The patient's fluorescence in situ hybridization (FISH) results show trisomy 12 and unmutated immunoglobulin heavy chain variable region (IgVH). The document reviews treatment options for CLL and evidence from clinical trials regarding chemoimmunotherapy regimens and novel targeted therapies such as ibrutinib, idelalisib, and obinutuzumab. It concludes by recommending obinutuzumab plus chlorambucil as the most appropriate treatment for this fra
1. The patient is a 68-year-old male admitted with a subacute occlusion of his right femoral popliteal bypass graft and ischemic leg. He has a history of peripheral vascular disease, atrial fibrillation, hypertension, hyperlipidemia, and smoking.
2. His plan includes a CT/angiogram, angioplasty with stent placement, and anticoagulant therapy. During his hospital stay he undergoes the procedure and is started on medications including anticoagulants, pain medications, and nutritional support.
3. Lab results show abnormalities consistent with alcoholic liver disease including elevated liver enzymes and low albumin. The patient is discharged after 12 days with signs of revascularization and
Anemia and Preemies: Contemporary Approach to Diagnostics, Preventive Measure...MCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
This case report describes a 75-year-old man with prostate cancer undergoing watchful waiting who was found to have pernicious anemia, a severe vitamin B12 deficiency. Over 10 months, his prostate cancer progressed more rapidly than expected based on Gleason score and PSA levels. After starting vitamin B12 injections for pernicious anemia treatment, the patient's PSA and prostatic acid phosphatase levels initially increased rapidly before stabilizing. The authors propose that the patient's vitamin B12 deficiency may have modulated the growth and progression of his prostate cancer, and that B12 replacement accelerated cancer marker levels initially before stabilization. They recommend screening prostate cancer patients undergoing watchful waiting for vitamin B12 deficiency.
A 27-year-old woman presented with fatigue, shortness of breath, easy bruising, and a syncopal episode. Laboratory workup revealed hemolytic anemia. A bone marrow biopsy showed hypocellular marrow consistent with aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH). She was treated with immunosuppression but later developed multiple thromboses. Testing confirmed PNH diagnosis. She received eculizumab therapy which stabilized her hemoglobin levels and reduced transfusion requirements. PNH causes hemolytic anemia due to lack of protective proteins on blood cells, predisposing to complement-mediated destruction and thrombosis.
Management of CLL in elderly patients asco 2014Jeff Sharman
This document discusses the management of a 86-year-old male patient with chronic lymphocytic leukemia (CLL) who presents with increasing lymphocytosis, lymphadenopathy, and splenomegaly over two years. The patient's fluorescence in situ hybridization (FISH) results show trisomy 12 and unmutated immunoglobulin heavy chain variable region (IgVH). The document reviews treatment options for CLL and evidence from clinical trials regarding chemoimmunotherapy regimens and novel targeted therapies such as ibrutinib, idelalisib, and obinutuzumab. It concludes by recommending obinutuzumab plus chlorambucil as the most appropriate treatment for this fra
1. The patient is a 68-year-old male admitted with a subacute occlusion of his right femoral popliteal bypass graft and ischemic leg. He has a history of peripheral vascular disease, atrial fibrillation, hypertension, hyperlipidemia, and smoking.
2. His plan includes a CT/angiogram, angioplasty with stent placement, and anticoagulant therapy. During his hospital stay he undergoes the procedure and is started on medications including anticoagulants, pain medications, and nutritional support.
3. Lab results show abnormalities consistent with alcoholic liver disease including elevated liver enzymes and low albumin. The patient is discharged after 12 days with signs of revascularization and
Anemia and Preemies: Contemporary Approach to Diagnostics, Preventive Measure...MCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Raymond Wong is a consultant at the Department of Medicine & Therapeutics at Prince of Wales Hospital in Hong Kong. He received his medical degree and training in hematology and internal medicine from the Chinese University of Hong Kong. Dr. Wong has published over 70 articles in peer-reviewed journals on hematology and therapeutics. The presentation discusses the revised classification of myeloproliferative neoplasms and prognostication based on mutations in CALR, JAK2, and MPL. CALR mutations are found in the majority of essential thrombocythemia and primary myelofibrosis patients without JAK2 or MPL mutations. Patients with CALR mutations tend to have less severe disease characteristics compared to those with JAK2
This document summarizes antiphospholipid antibody syndrome (APS), also known as Hughes syndrome. It is an autoimmune disorder characterized by blood clots and/or pregnancy complications associated with high levels of antiphospholipid antibodies. The document discusses the diagnostic criteria for APS, types of antiphospholipid antibodies, mechanisms of thrombosis and pregnancy loss, management during pregnancy including anticoagulation therapy, and pregnancy outcomes. It provides details on laboratory testing, maternal and fetal complications, and postnatal management for patients with APS.
1. Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by arterial or venous thrombosis or pregnancy morbidity in the presence of antiphospholipid antibodies.
2. The diagnosis requires one clinical criterion of vascular thrombosis or pregnancy complications and one laboratory criterion of positive testing for antiphospholipid antibodies on two occasions at least 12 weeks apart.
3. Treatment during pregnancy involves low-dose aspirin and heparin starting at a positive pregnancy test through 34 weeks gestation to reduce the risk of pregnancy complications like miscarriage, preeclampsia, and intrauterine growth restriction.
The document provides an overview of antiphospholipid antibody syndrome (APS). It defines APS as a systemic autoimmune disease characterized by vascular thrombosis or adverse obstetric outcomes in patients with persistent antiphospholipid antibodies. The classification criteria for APS requires at least one clinical criterion (vascular thrombosis or pregnancy morbidity) and one laboratory criterion (presence of lupus anticoagulant or antiphospholipid antibodies). Common clinical manifestations of APS include venous thromboses, arterial thromboses, obstetric complications, and valvular heart disease. Treatment involves anticoagulation to prevent future thrombotic events.
This document discusses renal complications associated with hematologic malignancies and their treatment. It provides 3 key points:
1) Lymphomatous infiltration of the kidneys is a common but under-recognized complication of malignant lymphomas, seen in up to one-third of patients on autopsy. Bilateral symmetrical kidney enlargement is the most common imaging finding.
2) Chemotherapies used to treat hematologic malignancies can cause acute kidney injury through tumor lysis syndrome or direct nephrotoxicity. Ifosfamide, in particular, is associated with proximal tubule dysfunction and Fanconi syndrome.
3) Long-term renal complications of chemotherapy include chronic kidney disease, which may progress even after
This document provides definitions and diagnostic criteria for acute kidney injury (AKI) according to the Acute Kidney Injury Network and RIFLE criteria. It discusses causes of AKI including prerenal azotemia, intrinsic renal disease, and postrenal obstruction. It also reviews biomarkers for early AKI detection and outcomes associated with AKI. Treatment is largely supportive though some promising pharmacologic approaches are discussed.
Ohio State's 2016 ASH Review - Updates in Myeloproliferative Disorders, inclu...OSUCCC - James
The document discusses updates in the diagnosis and treatment of myeloproliferative disorders and chronic myeloid leukemia. It summarizes long-term data from the COMFORT-II trial showing that ruxolitinib provided durable spleen reductions and potential survival benefit compared to best available therapy in myelofibrosis patients. It also reviews investigational agents being studied for myeloproliferative disorders including pacritinib, which showed consistent efficacy across patient subgroups in the PERSIST-1 trial, and PRM-151, a recombinant human pentraxin-2 that aims to reduce bone marrow fibrosis.
Steven M. Kornblau is a professor of medicine at UT MD Anderson Cancer Center who specializes in hematology and oncology. He completed his medical training at MD Anderson from 1988-1991 and has been a faculty member there since 1991. Dr. Kornblau's research focuses on protein expression patterns in blood cancers. He also runs one of the largest tissue repositories for leukemia and myeloma in the world. The document discusses myelofibrosis, its diagnosis, prognosis, driver mutations, complications, and traditional and newer treatment options like ruxolitinib.
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent blood clots and pregnancy complications. It is associated with antibodies that cause blood clots by interfering with phospholipids. Pregnancy risks include miscarriage, preeclampsia, and fetal growth problems. Diagnosis requires both clinical criteria like blood clots or pregnancy loss and laboratory tests to detect antibodies. Treatment involves low-dose aspirin plus anticoagulants like heparin to prevent clots during pregnancy. Close monitoring is also needed to watch for complications.
This document discusses moving beyond the traditional Framingham Risk Score for assessing individual coronary heart disease risk. It outlines three areas showing promise: (1) biomarkers like hsCRP and LpPLA2 that can identify pre-clinical disease, (2) vascular imaging like CIMT and CACS that provide more direct measures of atherosclerosis, and (3) genomics though the effects of common gene variants on risk are small and replication has been difficult. Biomarkers and imaging allow refining risk assessment, especially for those at intermediate Framingham risk, while challenges remain in applying genetics to individual risk prediction.
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
Here are the key points regarding antenatal care for a patient with sickle cell disease:
- Regular antenatal visits are important for monitoring the mother and fetus. Visits should be more frequent in the third trimester.
- Folic acid supplementation is recommended throughout pregnancy.
- Good hydration and avoiding triggers for sickle cell crises like dehydration, overexertion, and extreme temperatures.
- Monitor for complications like pre-eclampsia, intrauterine growth restriction, and infections.
- Offer pain management early for sickle cell crises.
- Consider prophylactic antibiotics in late pregnancy and during labor if patient is splenectomized.
The document discusses HELLP syndrome, which is characterized by hemolysis, elevated liver enzymes, and low platelet count. It is considered by some to be a variant of preeclampsia, but may be a separate entity. HELLP syndrome has a maternal mortality rate of 2-24% and perinatal mortality of 9-39%. Diagnosis requires meeting laboratory criteria of hemolysis, elevated liver enzymes, and low platelet count. Management includes corticosteroids, magnesium sulfate, antihypertensive drugs, blood products, and delivery. Complications include disseminated intravascular coagulation, liver and kidney failure, and infant growth restriction and respiratory distress.
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by blood clots in arteries and veins, pregnancy complications, and the presence of antiphospholipid antibodies. The syndrome can occur alone or in association with other autoimmune diseases like lupus. Treatment involves long-term anticoagulation with blood thinners and aspirin to prevent new clots from forming. Management of pregnancy in APS patients depends on their history and involves low-dose aspirin with or without low or high dose blood thinners.
1. A 74-year-old man presented with continuous left upper abdominal pain for 3 days that worsened when lying on his left side. He had been fatigued for a year and was diagnosed with anemia.
2. On examination, he had pale conjunctiva and tenderness in his left hypochondriac region with splenomegaly. Laboratory tests found hemoglobin of 7.8 g/dL and normocytic normochromic anemia.
3. Abdominal ultrasound revealed splenomegaly. He was assessed as having normocytic normochromic anemia suspected to be due to a myeloproliferative disorder.
Prof hanan anti phospholipid syndrome with highlights on criteria and seronegative antiphospholipid
Head of internal medicine, faculty of medicine, Beni-Suef University
First lupus day October 2018
This document provides information about a case study on cholelithiasis. It includes an assessment of a 24-year-old male patient admitted for abdominal pain, fever, and vomiting. The assessment consists of the patient's health history, physical exam findings, lab results, imaging studies, and blood transfusion details. It also reviews the anatomy and physiology of the liver, gallbladder, duodenum, and pancreas as well as their functions related to bile production and fat digestion.
This case discusses an 18-year-old female patient presenting with easy fatigability and other symptoms over several months. After examination and investigations, she was diagnosed with systemic lupus erythematosus affecting multiple organs including the lungs, skin, kidneys, and central nervous system. She was started on treatment including steroids, antibiotics, and other medications. The case highlights the approach to diagnosing and managing SLE, a chronic autoimmune disease with diverse clinical manifestations and organ involvement.
BMS 561, Hematology Fall 2016 Case studiesThe following case .docxAASTHA76
BMS 561, Hematology Fall 2016 Case studies
The following case studies are not actual patients. They combine elements from different cases to emphasize important aspects
Case 1
HISTORY: Patient Presentation
A four-year-old African American male diagnosed with sickle cell disease in the newborn period was admitted to the hospital with abdominal pain. Two days prior to admission, he was seen in the emergency room for abdominal pain and sent out on pain medicine.
PHYSICAL EXAM
Height
100 cm (25th percentile on growth chart)
Weight
15 kg (25th percentile on growth chart)
Temperature:
38.9ºC
Heart Rate:
135
Respiratory Rate:
40
Blood Pressure
100/60 mmHg
Oxygen Saturation Level:
87% (normal range: 92%-98%)
HEENT:
Normocephalic, pupils reactive, tympanic membranes clear, oropharynx clear
Neck:
No adenopathy
Chest:
Mild subcostal retractions. Audible rales at lung bases.
Heart:
Tachycardic with III/VI murmur
Abdomen:
Mild distension, diffusely tender to palpation
Genitourinary:
Circumcised male, no priapism
Extremities:
Warm
Neurologic:
Crying, alert boy. Face was symmetric. Moved all extremities.
LABORATORY DATA
Patient Value
Normal Value
WBC
15,000
4,000-12,000/μL
HGB
6.3
11.5-13.5 g/dL
HCT
18
34%-40%
PLT
560,000
140,000-440,000/μL
MCV
89.0
75-87 fl
Retic %
14%
0.5%-1.5%
Rectic Absolute
0.2125
0.024-0.084 M/μL
1 What history, including symptoms, would be most helpful in evaluating this patient?
2 What does a prior history of abdominal pain reflect? What does Bone pain and swollen, painful fingers (dactylitis) reflect in this disease?
3 He had a temperature of 101 degrees Fahrenheit yesterday.what does that indicate?
4 He has been coughing 2-3 times a day and intermittently through the night.what does that indicate??
5 Does family history indicate sickle disease?
6 What additional physical findings might occur in patients with sickle cell disease? Discuss Jaundice and Splenomagaly??
7 What other labs would you request? Compare the lab findings with normal ranges
Discuss Peripheral smear, hemoglobin electrophoresis,
Blood culture; Blood Type and screen for antibodies
LDH; Haptoglobin levels
Amylase and Lipase
8 Discuss MCV, MCH, RDW, ESR, Hematocrit and red cell morphology in this disease
9 What was your differential diagnosis when you first saw the patient? Discuss the following in diagnosing the disease
Cholecystitis; Pneumonia; Upper respiratory tract infection; Vaso-occlusive pain crisis
10 what are the differences between sickle cell disease, HbC, HbE and Thalassemia diseases?
11 Discuss Iron deficiency anemia, thalassemia syndromes and sickle cell anemia
12 How would you treat this patient?
Case 2
On review of symptoms, The patient reports difficulty concentrating, fatigue, feeling faint when she stands quickly, and vague gastrointestinal discomfort with some decrease in appetite.
She denies any history of previous trauma, diplopia, dysphagia, vertigo, vision loss, loss of consciousne ...
Raymond Wong is a consultant at the Department of Medicine & Therapeutics at Prince of Wales Hospital in Hong Kong. He received his medical degree and training in hematology and internal medicine from the Chinese University of Hong Kong. Dr. Wong has published over 70 articles in peer-reviewed journals on hematology and therapeutics. The presentation discusses the revised classification of myeloproliferative neoplasms and prognostication based on mutations in CALR, JAK2, and MPL. CALR mutations are found in the majority of essential thrombocythemia and primary myelofibrosis patients without JAK2 or MPL mutations. Patients with CALR mutations tend to have less severe disease characteristics compared to those with JAK2
This document summarizes antiphospholipid antibody syndrome (APS), also known as Hughes syndrome. It is an autoimmune disorder characterized by blood clots and/or pregnancy complications associated with high levels of antiphospholipid antibodies. The document discusses the diagnostic criteria for APS, types of antiphospholipid antibodies, mechanisms of thrombosis and pregnancy loss, management during pregnancy including anticoagulation therapy, and pregnancy outcomes. It provides details on laboratory testing, maternal and fetal complications, and postnatal management for patients with APS.
1. Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by arterial or venous thrombosis or pregnancy morbidity in the presence of antiphospholipid antibodies.
2. The diagnosis requires one clinical criterion of vascular thrombosis or pregnancy complications and one laboratory criterion of positive testing for antiphospholipid antibodies on two occasions at least 12 weeks apart.
3. Treatment during pregnancy involves low-dose aspirin and heparin starting at a positive pregnancy test through 34 weeks gestation to reduce the risk of pregnancy complications like miscarriage, preeclampsia, and intrauterine growth restriction.
The document provides an overview of antiphospholipid antibody syndrome (APS). It defines APS as a systemic autoimmune disease characterized by vascular thrombosis or adverse obstetric outcomes in patients with persistent antiphospholipid antibodies. The classification criteria for APS requires at least one clinical criterion (vascular thrombosis or pregnancy morbidity) and one laboratory criterion (presence of lupus anticoagulant or antiphospholipid antibodies). Common clinical manifestations of APS include venous thromboses, arterial thromboses, obstetric complications, and valvular heart disease. Treatment involves anticoagulation to prevent future thrombotic events.
This document discusses renal complications associated with hematologic malignancies and their treatment. It provides 3 key points:
1) Lymphomatous infiltration of the kidneys is a common but under-recognized complication of malignant lymphomas, seen in up to one-third of patients on autopsy. Bilateral symmetrical kidney enlargement is the most common imaging finding.
2) Chemotherapies used to treat hematologic malignancies can cause acute kidney injury through tumor lysis syndrome or direct nephrotoxicity. Ifosfamide, in particular, is associated with proximal tubule dysfunction and Fanconi syndrome.
3) Long-term renal complications of chemotherapy include chronic kidney disease, which may progress even after
This document provides definitions and diagnostic criteria for acute kidney injury (AKI) according to the Acute Kidney Injury Network and RIFLE criteria. It discusses causes of AKI including prerenal azotemia, intrinsic renal disease, and postrenal obstruction. It also reviews biomarkers for early AKI detection and outcomes associated with AKI. Treatment is largely supportive though some promising pharmacologic approaches are discussed.
Ohio State's 2016 ASH Review - Updates in Myeloproliferative Disorders, inclu...OSUCCC - James
The document discusses updates in the diagnosis and treatment of myeloproliferative disorders and chronic myeloid leukemia. It summarizes long-term data from the COMFORT-II trial showing that ruxolitinib provided durable spleen reductions and potential survival benefit compared to best available therapy in myelofibrosis patients. It also reviews investigational agents being studied for myeloproliferative disorders including pacritinib, which showed consistent efficacy across patient subgroups in the PERSIST-1 trial, and PRM-151, a recombinant human pentraxin-2 that aims to reduce bone marrow fibrosis.
Steven M. Kornblau is a professor of medicine at UT MD Anderson Cancer Center who specializes in hematology and oncology. He completed his medical training at MD Anderson from 1988-1991 and has been a faculty member there since 1991. Dr. Kornblau's research focuses on protein expression patterns in blood cancers. He also runs one of the largest tissue repositories for leukemia and myeloma in the world. The document discusses myelofibrosis, its diagnosis, prognosis, driver mutations, complications, and traditional and newer treatment options like ruxolitinib.
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent blood clots and pregnancy complications. It is associated with antibodies that cause blood clots by interfering with phospholipids. Pregnancy risks include miscarriage, preeclampsia, and fetal growth problems. Diagnosis requires both clinical criteria like blood clots or pregnancy loss and laboratory tests to detect antibodies. Treatment involves low-dose aspirin plus anticoagulants like heparin to prevent clots during pregnancy. Close monitoring is also needed to watch for complications.
This document discusses moving beyond the traditional Framingham Risk Score for assessing individual coronary heart disease risk. It outlines three areas showing promise: (1) biomarkers like hsCRP and LpPLA2 that can identify pre-clinical disease, (2) vascular imaging like CIMT and CACS that provide more direct measures of atherosclerosis, and (3) genomics though the effects of common gene variants on risk are small and replication has been difficult. Biomarkers and imaging allow refining risk assessment, especially for those at intermediate Framingham risk, while challenges remain in applying genetics to individual risk prediction.
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
Here are the key points regarding antenatal care for a patient with sickle cell disease:
- Regular antenatal visits are important for monitoring the mother and fetus. Visits should be more frequent in the third trimester.
- Folic acid supplementation is recommended throughout pregnancy.
- Good hydration and avoiding triggers for sickle cell crises like dehydration, overexertion, and extreme temperatures.
- Monitor for complications like pre-eclampsia, intrauterine growth restriction, and infections.
- Offer pain management early for sickle cell crises.
- Consider prophylactic antibiotics in late pregnancy and during labor if patient is splenectomized.
The document discusses HELLP syndrome, which is characterized by hemolysis, elevated liver enzymes, and low platelet count. It is considered by some to be a variant of preeclampsia, but may be a separate entity. HELLP syndrome has a maternal mortality rate of 2-24% and perinatal mortality of 9-39%. Diagnosis requires meeting laboratory criteria of hemolysis, elevated liver enzymes, and low platelet count. Management includes corticosteroids, magnesium sulfate, antihypertensive drugs, blood products, and delivery. Complications include disseminated intravascular coagulation, liver and kidney failure, and infant growth restriction and respiratory distress.
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by blood clots in arteries and veins, pregnancy complications, and the presence of antiphospholipid antibodies. The syndrome can occur alone or in association with other autoimmune diseases like lupus. Treatment involves long-term anticoagulation with blood thinners and aspirin to prevent new clots from forming. Management of pregnancy in APS patients depends on their history and involves low-dose aspirin with or without low or high dose blood thinners.
1. A 74-year-old man presented with continuous left upper abdominal pain for 3 days that worsened when lying on his left side. He had been fatigued for a year and was diagnosed with anemia.
2. On examination, he had pale conjunctiva and tenderness in his left hypochondriac region with splenomegaly. Laboratory tests found hemoglobin of 7.8 g/dL and normocytic normochromic anemia.
3. Abdominal ultrasound revealed splenomegaly. He was assessed as having normocytic normochromic anemia suspected to be due to a myeloproliferative disorder.
Prof hanan anti phospholipid syndrome with highlights on criteria and seronegative antiphospholipid
Head of internal medicine, faculty of medicine, Beni-Suef University
First lupus day October 2018
This document provides information about a case study on cholelithiasis. It includes an assessment of a 24-year-old male patient admitted for abdominal pain, fever, and vomiting. The assessment consists of the patient's health history, physical exam findings, lab results, imaging studies, and blood transfusion details. It also reviews the anatomy and physiology of the liver, gallbladder, duodenum, and pancreas as well as their functions related to bile production and fat digestion.
This case discusses an 18-year-old female patient presenting with easy fatigability and other symptoms over several months. After examination and investigations, she was diagnosed with systemic lupus erythematosus affecting multiple organs including the lungs, skin, kidneys, and central nervous system. She was started on treatment including steroids, antibiotics, and other medications. The case highlights the approach to diagnosing and managing SLE, a chronic autoimmune disease with diverse clinical manifestations and organ involvement.
BMS 561, Hematology Fall 2016 Case studiesThe following case .docxAASTHA76
BMS 561, Hematology Fall 2016 Case studies
The following case studies are not actual patients. They combine elements from different cases to emphasize important aspects
Case 1
HISTORY: Patient Presentation
A four-year-old African American male diagnosed with sickle cell disease in the newborn period was admitted to the hospital with abdominal pain. Two days prior to admission, he was seen in the emergency room for abdominal pain and sent out on pain medicine.
PHYSICAL EXAM
Height
100 cm (25th percentile on growth chart)
Weight
15 kg (25th percentile on growth chart)
Temperature:
38.9ºC
Heart Rate:
135
Respiratory Rate:
40
Blood Pressure
100/60 mmHg
Oxygen Saturation Level:
87% (normal range: 92%-98%)
HEENT:
Normocephalic, pupils reactive, tympanic membranes clear, oropharynx clear
Neck:
No adenopathy
Chest:
Mild subcostal retractions. Audible rales at lung bases.
Heart:
Tachycardic with III/VI murmur
Abdomen:
Mild distension, diffusely tender to palpation
Genitourinary:
Circumcised male, no priapism
Extremities:
Warm
Neurologic:
Crying, alert boy. Face was symmetric. Moved all extremities.
LABORATORY DATA
Patient Value
Normal Value
WBC
15,000
4,000-12,000/μL
HGB
6.3
11.5-13.5 g/dL
HCT
18
34%-40%
PLT
560,000
140,000-440,000/μL
MCV
89.0
75-87 fl
Retic %
14%
0.5%-1.5%
Rectic Absolute
0.2125
0.024-0.084 M/μL
1 What history, including symptoms, would be most helpful in evaluating this patient?
2 What does a prior history of abdominal pain reflect? What does Bone pain and swollen, painful fingers (dactylitis) reflect in this disease?
3 He had a temperature of 101 degrees Fahrenheit yesterday.what does that indicate?
4 He has been coughing 2-3 times a day and intermittently through the night.what does that indicate??
5 Does family history indicate sickle disease?
6 What additional physical findings might occur in patients with sickle cell disease? Discuss Jaundice and Splenomagaly??
7 What other labs would you request? Compare the lab findings with normal ranges
Discuss Peripheral smear, hemoglobin electrophoresis,
Blood culture; Blood Type and screen for antibodies
LDH; Haptoglobin levels
Amylase and Lipase
8 Discuss MCV, MCH, RDW, ESR, Hematocrit and red cell morphology in this disease
9 What was your differential diagnosis when you first saw the patient? Discuss the following in diagnosing the disease
Cholecystitis; Pneumonia; Upper respiratory tract infection; Vaso-occlusive pain crisis
10 what are the differences between sickle cell disease, HbC, HbE and Thalassemia diseases?
11 Discuss Iron deficiency anemia, thalassemia syndromes and sickle cell anemia
12 How would you treat this patient?
Case 2
On review of symptoms, The patient reports difficulty concentrating, fatigue, feeling faint when she stands quickly, and vague gastrointestinal discomfort with some decrease in appetite.
She denies any history of previous trauma, diplopia, dysphagia, vertigo, vision loss, loss of consciousne ...
Celiac common presentation of a uncommon disease saved with dateMuhammad Arshad
A 38-year-old female presented with abdominal distention, leg edema, and loose motions for 4-6 months. Her history revealed multiple hospital admissions for anemia. Testing showed liver cirrhosis, hypothyroidism, and iron deficiency anemia. Upper endoscopy found flattened duodenal folds and villous atrophy. Biopsy revealed celiac disease. She was started on a gluten-free diet with improvement in symptoms. Celiac disease causes villous atrophy and malabsorption from intolerance to gluten, presenting variably from anemia to osteoporosis. Diagnosis requires biopsy showing villous atrophy after gluten exposure.
2012 anemo inghelmo - criteri trasfusionali in pediatriaanemo_site
This document provides guidelines for pediatric transfusion criteria and strategies to avoid transfusion in children. It discusses that neonates and infants have impaired coagulation and platelet function compared to adults. Younger children are also at greater risk of adverse events from transfusion. The guidelines recommend maintaining normovolemia and tissue oxygenation to minimize transfusion needs. They also provide transfusion thresholds for red blood cells and strategies to predict the rise in hemoglobin from transfusion. The document stresses approaches to reduce transfusion risks such as improved protocols, education and only transfusing when clinically indicated.
The most common lysosomal storage disease,
Incidence: approximately 1 in 40,000 for non-Jewish populations
Caused by a deficiency of the enzyme glucocerebrosidase
The glycolipid glucocerebroside accumulates in lysosomes of macrophages
Lipid-filled Gaucher cells displace normal cells in
Bone marrow
Spleen
Liver
Lungs
CNS
Skeletal disease is slow to respond to ERT and widely varies.
Some patients describe symptomatic improvement within the first year of treatment, although a much longer period of ERT is required to achieve a radiologic response.
The document discusses three case studies of neonates presenting with various medical conditions. For each case, clinical details are provided about the neonate's condition, vital signs, lab results, and treatments administered. The reader is then prompted to indicate the next appropriate action or intervention in each case. The document also reviews various methods for monitoring hemodynamics and end-organ perfusion in neonates.
The document describes a case report of an 80-year-old male who presented with abdominal pain for 4 days. On examination, he had tenderness in the epigastric and right upper quadrant regions. Laboratory tests showed elevated lipase, amylase and CRP, consistent with acute pancreatitis. CT imaging revealed a relatively enlarged pancreas. He was admitted and treated supportively with IV fluids, antibiotics and pain medications. His condition gradually improved and he was discharged. Common scoring systems for evaluating severity of acute pancreatitis like Ranson's criteria and BISAP score are discussed.
This document discusses anemia, including its causes, types, symptoms, and diagnosis. It begins by defining anemia as an insufficient level of hemoglobin to supply tissues with adequate oxygen. Anemia is then classified based on red blood cell size (microcytic, normocytic, macrocytic), hemoglobin content (hypochromic, normochromic, hyperchromic), and pathophysiology (decreased red blood cell production, increased destruction, blood loss). Common causes are also listed for each type. The document concludes by outlining the process for diagnosing anemia, which involves patient history, physical exam, and laboratory tests such as complete blood count and blood smear analysis.
A 22-year-old female presented with 3 months of fever, productive cough, and shortness of breath. Examination found pallor, lymphadenopathy, and hepatomegaly. Testing showed pancytopenia, blasts in the peripheral smear, and an enlarged liver and spleen on ultrasound. Bone marrow biopsy confirmed the diagnosis of acute myeloid leukemia (AML). Treatment for AML typically involves induction chemotherapy with cytarabine and an anthracycline, followed by consolidation chemotherapy or stem cell transplant to prevent relapse. Supportive care including transfusions, antibiotics, and managing complications is also important.
approach to a bleeding child with blood disorders.pptxtsholanangmaoka
This document describes the approach to three cases of bleeding in children. Case 1 involves a 5-month-old male with intracranial bleeding and seizures who was found to have a subdural hematoma requiring surgery. Despite resuscitation efforts, the child did not survive the surgery. Case 2 is a 2-year-old male with bruising and a very low platelet count, consistent with thrombocytopenia. Case 3 involves a 1-year-old male with knee swelling and fever, who was found to have a low platelet count, consistent with disseminated intravascular coagulation. The document provides definitions of types of bleeding, the stages of hemostasis, differential diagnoses, and management strategies for bleeding
Laboratory diagnostic tests are important tools for clinicians to obtain additional information about a patient's status beyond a physical exam and history. Tests are used for screening, diagnosis, monitoring treatment response, and evaluating disease severity. Common tests include complete blood count, lipid profile, blood sugars, liver function tests, urine analysis, and pregnancy testing. Proper specimen collection and handling is important to obtain accurate results. Clinicians must explain the purpose and implications of tests to patients.
dengue fever murag final na why title need to be long.pptxkaydeear
Dengue fever is a viral illness transmitted through mosquito bites. It is caused by any of four distinct serotypes of dengue virus and is a major public health problem in tropical and subtropical regions of the world. The document outlines the pathogenesis, clinical manifestations, diagnosis, management and prevention of dengue fever. It describes the disease process, symptoms and classifications including dengue fever, dengue hemorrhagic fever and dengue shock syndrome. Treatment involves fluid management and recognizing warning signs that may require hospitalization and emergency care. Prevention focuses on mosquito control measures and personal protection against bites.
This document discusses childhood leukemia. It notes that leukemia is the most common form of childhood cancer, occurring in 3-4 cases per 100,000 children under 15 years old. Symptoms include fatigue, bone/joint pain, fever, weight loss, abnormal masses, bruising, and infection. Tests to diagnose include blood counts, bone marrow aspiration/biopsy, and cytogenetics. Treatment involves supportive care like blood transfusions, chemotherapy drugs like allopurinol, and potentially stem cell transplant in high risk cases. Nursing care focuses on monitoring for infection, proper handwashing, skin checks, neutropenic diet, isolation, and fever/nausea management.
The document provides information about a complete blood count (CBC) test. It discusses the various cellular components of blood that are evaluated in a CBC like red blood cells, white blood cells, and platelets. For each cell type, it describes their normal ranges, clinical significance of abnormal values, and what conditions they may indicate. The CBC provides important clues about a person's overall health by examining the number and types of circulating cells in their blood.
The patient is a 71-year-old female who presented to the emergency room with shortness of breath, feeling faint, and dizziness. She has a history of diabetes, hypertension, chronic kidney disease, and myelodysplastic syndrome. Laboratory tests showed low red blood cell counts and hemoglobin due to bone marrow failure from her myelodysplastic syndrome. She was given two units of red blood cells due to her anemia. Her diagnoses is symptomatic anemia from her myelodysplastic syndrome, which carries a poor prognosis including a high risk of developing leukemia.
The patient is a 40-year-old female who presented with breathlessness, fatigue, arthralgia, weight loss, and swelling in the legs. Investigations revealed hypothyroidism, pulmonary hypertension, anemia, and signs of autoimmune disease. Over time she developed additional symptoms affecting multiple organs. Based on her symptoms and test results, she was diagnosed with POEMS syndrome, a rare paraneoplastic condition characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma proliferation, and skin changes. She was treated with steroids, thyroid medication, diuretics, and pain medications.
1. AZUSA PACIFIC UNIVERSITY
SCHOOL OF NURSING
GNRS 555: MEDICAL SURGICAL CARE OF THE ADULT
COMPREHENSIVE CARE PLAN #: 2
Student: Priscilla Martinez
Instructor: ProfessorBrenda Jerez-Aguilar
Date of Care: 11/18/15
Date of Submission: 11/25/15
2. Nursing Clinical Worksheet
Student Name: PriscillaMartinez Date: 11/18/15
Patient Initials:
AW
Age:
71
Sex:
F
Isolation and Type:
None
Code Status:
Full
Admit Date:
11/17/15
Allergies:
None
Diet:
Diabetic
Fall Risk:
Morse Scale: 45
Low Risk
Braden
Score:
17
Activity:
Bed rest
LOC:
Alert and oriented
X3
PrimaryMD: Marquez, F
Consulting MD: Mary Rinko Oefelein
AdmittingDiagnosis:Rightshoulderpain
SecondaryDiagnosis:
(Past Medical Hx and surgical Hx)
HTN(2006),DM withCKD stage 3 (2008),osteoarthritis (2009),recentRULmasswith lungcancerdx,carpeltunnel(2004),Severe
obesity(2011), Chronic anemia(2012),Gaitabnormality(2012),Hip jointpain(2012), Pseudophakos(2006),Colonoscopy(2008),
Cararactremoval(1995),Left leglipomaexcision(1992),Cataractextraction(1997),Oriffracture(1998),Totalkneereplacement(2014)
Patient’sHospitalCourse (referto progressnotes):
Patient presentedto ED on 11/17/15with complaintsofdizziness, swellingof chest,and paininR arm. Pt admitsthat she cannotmoveher
R arm without pain.Saw PCP on 11/05/15for complaintsofR arm shoulderpainand subsequentCT scanshowedmassandnodules on
RULof lung indicatinglungcancer.Transferred from KaiserRiversidefor in-patienttreatmentof radiation.Chestx-ray conductedyesterday
showedevidencethat R clavicleisfractureddueto cancermetastasizingandweakeningthebone.
Prioritized To Do List (refer to patient’s orders) :
SuperiorVena Cava CompressionSyndrome DM2withdiabetic CKD
– repeatCT scan,checkecho,avoidtoo muchIVF, – continueto monitorelectrolytesandcreatinine,continue
radiation/oncologyconsultationinthemorning to monitorbloodglucosebeforemealsandbeforebedtime
NauseaandVomiting Osteoarthritisof left knee
– supportive careIVF, antiemetics,checkMRIformalignancy – supportive care
EssentialHTN Leukocytosis
– conductoutpatientmedicalregimen – continueto monitor
Hyperlipidemia Anemia
– checklipidlevel,continueStatin – continueto monitorserialH/H, transfuse PRN, monitorvitals
Diagnostic tests and procedures
Tests (Date completed) Results
1) MRI brain with or without contrast
(11/17/15)
2) CTA Chest
(11/17/15)
3) Chest X-Ray
(11/15/15)
1) Mild cerebral volume loss. Noevidence of metastasis. Lesion is seen. Gray and white matter
differentiation is preserved. Nointracranial hemorrhage, mass-effect, or midline shift identified. No
suspicious T1 or T2 signal abnormalities in brain. Noareas of restricted diffusion. Nointra or extra-
axial collections. Unremarkable paranasal sinuses, marrow, or muscle structures.
2) Results not present
3) Fracture on R clavicle found. Bone weakened due to nearby lung cancer
Abnormal / Pertinent Lab Values
Test Range Valueat
Admission
Recentvalue
(Date)
Why thistestwas ordered and whatisthesignificanceof
thevalue?
CBC –WBC 4 – 11 x 1000/mcL 19.3 x 1000/mcL 13.1 x 1000/mcL Part of the CBC. Usedto determine the amount of WBC in the blood. Level
is high. May indicate infection.
CBC –RBC 4.2 – 5.4 mil/mcL 3.88 mil/mcL 3.6 mil/mcL Part of the CBC. Usedto determine if body cells are getting enough
blood/oxygen. Level is low. May indicate anemia
CBC –HGB 12 – 16 g/dL 9.5 g/dL 8.8 g/dL Part of the CBC. Usedto determine if there is enough tissue oxygenation.
Level is low. May indicate anemia.
CBC –HCT 37% – 47% 30.5% 28.3% Part of the CBC. Usedto determine the percentage of blood that are
RBCs. Level is low. May indicate low O2 supply.
CBC –MCV 81 – 99 fL 78.6 fL 78.6 fL Part of the CBC. Usedto determine the average volume of RBCs in the
blood. Level is low. May indicate smaller than normal or anemia.
CBC –MCH 27 – 35 g/dL 24.5 g/dL 24.5 g/dL Part of the CBC. Usedto determine the average mass of HGB per RBC.
Level is low. May indicate RBCs smaller than normal or anemia
CBC –MCHC 11.5 – 37 g/dL 31.2 g/dL 31.1 g/dL Part of the CBC. Usedto measure the concentration of HGB in a given
volume of packed RBCs. Levels are low. May indicate anemia.
3. Blood RDW 11.5% – 14.5% 14.7% 15.0% Used to measure the range of variation of RBC volume. Level is high. May
indicate anemia.
Platelets 130 – 400 x 1000/mcL 467 x 1000/mcL 426 x 1000/mcL Used to determine the amount of platelets in the blood. Level is high. May
indicate thrombocytosis.
Glucose, fasting 70 – 99 mg/dL n/a 275 mg/dL Used to determine the amount of glucose in the blood. Level is high. May
indicate hyperglycemia d/t pt being diabetic
Electrolyte – Cl 101 – 111 mEq/L 96 mEq/L 97 mEq/L Part of the electrolyte panel. Used to determine concentration of chlorine in
blood. Level is low. May indicate dehydration
Protein – Albumin 3.3 – 4.8 g/dL 3.4 g/dL 2.4 g/dL Part of the protein serum. Used to determine the amount of albumin in
blood plasma. Level is low. May indicate underproduction of globulins r/t
liver or kidney problems
WBC – Neutrophils 1.8 – 3.6 x 1000/mcL 17.3 x 1000/mcL 12.1 x 1000/mcL Part of the WBC count. Used to determine the amount of neutrophils in the
blood. Level is high. May indicate inflammation and/or infection.
WBC - lymphocytes 1 – 3.6 x 1000/mcL 0.7 x 1000/mcL 0.4 x 1000/mcL Part of the WBC count. Used to determine amount of lymphocytes in the
blood. Level is low. May indicate lower immune system
WBC - Monocytes 0.1 – 1 x 1000/mcL 1.2 x 1000/mcL 0.6 x 1000/mcL Part of the WBC count. Used to determine the amount of monocytes in the
blood. Level was high at admission. May indicate inflammation or infection
Doc Flowsheet Data
Vital Signs 0800 1200 1600 Blood Glucose (POC) IV fluids
B/P 146/74 166/67 171/78 Time Value Type Rate ( ml / hr)
Pulse 69 77 73 0630 241 mg/dL NS 0.9% IV Premix 50 mL/hr
RR 14 16 18 1000 235 mg/dL
Oxygen Sat % 96 96 94 1600 300 mg/dL
Pain Level 2 0 5
Temp 96.2 96.8 96.3
Intake/Output
Intake ( ml per shift) Output (ml per shift)
Oral Enteral IV TOTAL Urine Output BM Emesis Drains TOTAL
450 0 500 950 1050 0 0 0 1050
If any,pleasestatewhythereisa significant differencein theI/O : total input-total output= 100 mls
No significancedifferenceintheI/O
Complete Head-To-Toe Assessment
General
Survey
Physical
Appearance:
Pt appears well groomed and clean. Dress is appropriate to situation
Mood: Pt’s mood and affect are appropriate to situation
Signs of Acute
Distress:
Pt showed sign of distress and worry d/t news that her cancer had caused her clavicle to
become fractured but was determined to get better
Neurologic
Orientation Pt is alert and orientated to person, place, and time
Speech Speech is clear and understandable
Pupil (L) Pupil is 3mm, equal, round, reactive to light
Pupil (R) Pupil is 3mm, equal, round, reactive to light
GCS score GCS = 15; eye open spontaneously (4), normal conversation (5), obey command (6)
Abnormal
Muscles
Location None
Strength Muscles able to resist push and pull
Pain
Assessment
Provocation/
palliation
Movement and lifting of R arm
Quality Sharp at times
Region/
Radiation
Radiates to upper arm
Severity 7/10 to 10/10
Time Continuous
Pulmonary
Oxygenation Room Air ☐Device: n/a Flow rate: n/a FiO2:n/a O2Sat: 96%
Respiration Quality: symmetrical expansion, bilateral chest rise and fall, unlabored _
Rate: 16 BPM
Rhythm: Regular _
R. Lung Clear lobes all around, unlabored breathing, no grunting or nasal flaring present
L. Lung Clear lobes all around, unlabored breathing, no grunting or nasal flaring present
Cardio- Capillary Refill < 3 seconds all extremities
4. vascular SkinColor/
Temp
Pink, warm, dry
Apical Pulse Location in fifth intercostal space left midclavicular line. Regular rate and rhythm.
Heart Sounds S1/S2 noted, no murmurs or gallop
Peripheral
Pulses
R/L radial pulses 2+
R/L pedal pulses 2+
Gastro-
intestinal
Oral Mucosa Intact, moist, pink
Tongue Pink, moist, midline
Abdomen Normoactive all four quadrants, unremarkable sounds
Nutrition Diabetic diet
Tube Feeding Current Rate: Goal Rate: __________
Residuals: ________ml Type: ☐ N/A ☐ NGT ☐ PEG ☐ J-tube
Bowel Sounds Normoactive all four quadrants, unremarkable sounds
Bowel
Movement
Last BM date: 11/14/15; unremarkable amount and consistency
Genito-
urinary
Urination Unremarkable, no burning or frequency
Urine Color Yellow
Urine
Character
Clear, no sediments
Urine (ml) 1050 mL
Urinary
Catheter
Insertion date: ______________
Skin
(wounds)
SkinColor Very light brown, as expected for ethnicity
SkinIntegrity Skin warm,dry, and intact. No lesions, ulcers, or incisions
Wound/
Ostomy
None
Insertion Site(s) R forearm
IV Assessment IV dressing dry and intact, no signs of redness or infiltration
IV Fluids NS 0.9% IV Premix (50 mL/hr)
Musculo-
skeletal
Describe
abnormalities:
Fractured clavicle causing pain and decreasing mobility of R arm
Psychosocial Assessment
Psychosocial
History
Marital status Divorced 40 years ago
Education level Associates Degree
Social resources Family (3 sons and 3 daughters in law), friends
Spiritual resources Strong faith (nondenominational Christian)
Occupation Retired (worked for the San Bernardino County housing department)
Employment Retired 8 years ago but highly involved at her apartment home community
Smoking Former smoker: ½ pack a day for 5 years. Quit in 1986
Alcohol Denies
Recreational Drugs Denies
Spiritual Assessment
Spiritual Integrity 1) Look: (Signs of Meaning, Relationships, Hope and Joy) Spiritual Distress
Presence of….. Provide checkmark in either box for each criteria Absence of….
Family, friends, visitors, wedding ring, photographs
Cards, letters, phone calls, flowers, pets
Attention to personal care and appearance
Work, projects, hobbies, music, books, tapes
Newspapers, magazines, television, radio
Special dress, prayer cap, head scarf, cross
Articles of faith, pictures, statues, rosary, star
Books of faith, Bible, Koran, Torah prayers
Smiles, motivation, coping skills, healthy lifestyle
5. Uses the observations listed above to begin your Spiritual Assessment
No flowers, gifts, or photographs found in room
Pt stated that she enjoys working at her community center at her apartment home and organizing events
Pt is very proud of the work she did before she retired and expressed strength and desire to fight her cancer
Pt stated she was nondenominational Christian and that she has strong faith
While her current mood was distressed and worried, she expressed resilience and determination to fighter her cancer
With your client as your guide, and after a sense of trust and connectedness have been established, continue with the
assessment. Phrase your questions and indirect statement in ways that convey your genuineness, style, and comfort.
Pt stated that all her sons are grown with children and that they visit her periodically
Pt stated she lives alone with her dog Jessie whom she loves and values very much.
Pt stated her dog brings her a lot of joy in her life as well as spending time with her family
Pt expressed having her sons grow to be good people and helping to relocate homeless illegal immigrants and veterans as
some of her biggest accomplishments and senses of pride in her life
Pt stated her next goal in life is to beat her lung cancer
Pt stated her personality and self-reliance are what gives her strength
Pt stated that she turns to her sons in tough times
Pt did not verbalize desire to pray
Spiritual Integrity
Listen: (Actively listen for signs of meaning, relationships, hope, and
joy)
Spiritual Distress
Pt verbalizes... **Provide checkmark in each box that is applicable Pt verbalizes…
Sense of purpose and meaning My life has no meaning
Source of pride & accomplishment Guilt, if only….I should have
Source of joy & happiness Sense of sadness and despair
Future Goals and desires Lack of motivation
Hope and Courage Hopelessness “What is the use?”
Interest in world & concern for others Lack of concern for others
Personal Strengths Powerlessness I am useless.
Connection to others Loneliness and isolation
Connection to a higher source Helplessness, anxiety, fear
Religious affiliation “This is not fair. Why me?”
Request for special diets, clergy “Why am I being punished?”
Appreciation for nature Apathy
Ability to adapt to changes Inflexibility
2. Nursing Diagnosis: Analyze the data, and if appropriate, select one of the following nursing diagnoses.
Potential for Enhanced Spiritual Well-Being
Spiritual Distress
Hopelessness
Other_______________________________________________________
3. Plan: Develop a short-term goal and a long term goal for your client.
ST Goal: The Client will verbalize what she will do at her apartment community center once she goes back home
LT Goal: The Client will take active steps to fight her cancer, such as changing diet, doing exercise, and medication treatments
4. Interventions: Identify the specific nursing interventions you will use with your client.
Be present.
Establish a therapeutic relationship conveying respect, warmth, empathy and genuineness
Active listening.
Assist client to identify strengths, supports, and interconnections.
Instill hope.
Use of touch, if client is comfortable with closeness.
Provide an environment conductive to reflection, prayer, and spiritual growth.
Provide an environment conductive to client’s beliefs (food, ceremonies.)
Provide religious articles as requested.
Support client in search for meaning and purpose in life, illness, and death
Support client in search for a relationship with a higher power.
Pray with the client.
6. Pray for the client.
Promote private time with people who are significant in client’s life.
Be available and approachable to assist client with meeting spiritual needs, and making spiritual choices.
Collaborate with chaplain or spiritual leader.
Other:______________________________________________
Other:______________________________________________
5. Evaluation: Evaluate the client’s progress towards the goals.
(Note: Each person’s spirituality is highly variable, individual, and ever changing!)
ST Goal: Goal not met by the end of the shift due to having done spiritual care late in the shift
LT Goal: Goal not met due to not enough time having passed for the client to take active steps to fight her cancer
Scheduled Medications and PRN Medication Given
(Also include all saline flushes and IVFs)
Generic Name : Amlodipine Trade Name : Norvasc
Classification : Antianginal,anti-HTN, Ca+2 channel
blocker,dihydropyridine
Dose: 10 mg Route: PO Frequency/ Rate: Qday
Pt. Specific Indications: To control blood pressure
Mechanism of Action: Inhibits transmembraneinflux of extracellular calciumions acrossmembranes of myocardial cellsand vascular
smooth muscle cells withoutchangingserum calciumconcentrations.This inhibits cardiacand vascularsmooth musclecontraction,
thereby dilatingmain coronary and systemic arteries.Italso increases myocardial oxygen delivery in patients with vasospastic angina
Contraindications: Hypersensitivity to Ca+2 channel blockers or antianginal agents
Side Effects: Edema, pulmonary edema, headache, fatigue, palpitations, dizziness,nausea,flushing,abdominal pain,somnolence,
drowsiness,puritus, skin rash,musclecramps,muscleweakness
Patient Family Education: Use with caution in pts with hypertrophic cardiomyopathy becauseitmay worsen symptoms. Make sure to
titrate slowly if the pt has hepatic impairment. Symptomatic hypotension with or without syncope is possibleto make sureto tell the pt
to call thenurseif they want to get out of bed.
Generic Name : Aspirin Trade Name : N/a
Classification : Antiplatelet agents, NSAID, Salicylate Dose: 81 mg Route: PO Frequency/ Rate: Qday
Pt. Specific Indications: To prevent DVT and acute coronary syndromes
Mechanism of Action: Inhibits synthesisof prostaglandin by cyclooxygenase.Inhibitsplateletaggregation.Has antipyretic and analgesic
activity
Contraindications: Hypersensitivity to aspirin or NSAIDS, allergy to tartrazinedye, bleeding disorders
Side Effects: Angioedema, bronchospasm,CNS alteration,GI pain/ulceration/bleeding,hepatotoxicity,hearingloss,nausea,premature
hemolysis,pulmonary edema, rash,renal damage, tinnitus,uticaria,vomiting
Patient Family Education: Discontinueif tinnitus develops, should be taken with food or 8-12oz of water to avoid any adverseGI effects.
Generic Name : Atenolol Trade Name : Tenormin
Classification : Antianginal,anti-HTN, beta
blocker
Dose: 100 mg Route: PO Frequency/ Rate: Qday
Pt. Specific Indications: to treat HTN
Mechanism of Action: Blocks responseto beta adrenergic stimulation.Cardioselectivefor beta1 receptors atlow doses, with littleor no
effect on beta2 receptors
Contraindications: Pulmonary edema, cardiogenic shock, sinus bradycardia,2˚ or 3˚ heart block without a pacemaker, uncompensated
congestive heart failure,sinusenodedysfunction
Side Effects: Bradycardia,chestpain,cardiac failure,cold extremities,Reynaud’s syndrome, hypotension, tiredness,nausea,diarrhea,
lethargy, lightheadedness
Patient Family Education: Use with caution in anesthesia or surgery because can causemyocardial depression.This may also mask effects
of hyperthyroidism.Avoid abruptwithdrawal becauseit can exacerbate angina and lead to MI. This medication may also increaserisk for
developing DM and causeor exacerbate CNS depression (usewith caution with pts that have psychiatric illness)
Generic Name : Atorvastatin Trade Name : Lipitor
Classification : Antilipemic,Statins,HMG- Dose: 40 mg Route: PO Frequency/ Rate: QDay
7. CoA reductase inhibitors
Pt. Specific Indications: To lower cholesterol and keep arteries open
Mechanism of Action: Hypersensitivity to atorvastatin,liver disease,pregnancy,breastfeeding
Contraindications: HMG-CoA reductaseinhibitor.Inhibitsratelimitingstep in cholesterol biosynthesisby competitively inhibitingHMG-
CoA reductase
Side Effects: Diarrhea,nasoparyngitis,arthralgia,insomnia,UTI,nausea,dyspepsia,musclespasms,musculoskeletal pain,myalgia,limb
pain,pharynogolaryngeal pain
Patient Family Education: There is a risk for myopathy in elderly patients. Use with caution In pts with hepatic impairment or who’ve had
a recent stroke. May causeincreased blood sugar so make sureto monitor the pts glucoselevels
Generic Name : Fenofibrate Trade Name : Triglide
Classification : Fibric acid agent Dose: 160 mg Route: PO Frequency/ Rate: QDay
Pt. Specific Indications: Used to decrease cholesterol and triglyceridelevels
Mechanism of Action: Increases VLDL catabolism,fatty acid oxidation,and elimination of triglyceriderich particles by enhancingsynthesis
of lipoprotein lipase,which in turn results in 30-60%decrease in total plasma triglycerides.
Contraindications: Hypersensitivity to fenofibrate, severe renal impairment, activeliver disease,gallbladder disease,nursingmothers
Side Effects: Name
Patient Family Education: Can causecholelithiasisso makesureto look for the signs of it and encourage diet with lowlevels of fat to
prevent it. Monitor blood counts periodically becausethe medication can causethrombocytopenia and agranulocytosis.Monitor renal
function in pts at risk of renal impairmentbecause it can increaseserumcreatininelevels.
Generic Name : Heparin Trade Name : N/A
Classification : Cardiovascular and
hematologic anticoagulant
Dose: 5000 units Route: Sub Q Frequency/ Rate: Q12H
Pt. Specific Indications: Prevent DVT
Mechanism of Action: Inactivates factor Xa and inhibits conversion of prothrombin to thrombin; inhibits activation of factor VIII.At high
doses,it also inactivates factors IX,X,XI,and XII and thrombin and inhibits conversion of fibrinogen to fibrin
Contraindications: hypersensitivity to heparin,pork products,corn, or sulfites;thrombocytopenia, uncontrolled activebleeding,
hemorrhage, coagulation problems
Side Effects: Hemorrhage, thrombocytopenia, HIT/HITT, bleeding, prolonged clottingtime, uticaria,fever, rigots,osteoporosis
Patient Family Education: Since this medication helps thin your blood,try not to get any cuts,lesions,bruises,etc.because they will take
longer to heal. If it does occur,make sureto apply pressurefor a prolonged period of time to ensure proper clottingwill occur
Generic Name : Ondansetron Trade Name : Zofran
Classification : Antiemetic, selective 5-HT3
antagonist
Dose: 8 mg Route: IV Frequency/ Rate: Q6H
Pt. Specific Indications: Used to treat nausea and vomiting
Mechanism of Action: Medication binds to 5-HT3 receptors both in periphery and in CNS, with primary effects in GI tract. Has no effect
on dopamine receptors and therefore does not causeextrapyramidal symptoms.
Contraindications: Hypersensitivity to ondansetron, coadministration with apomorphine(combination reported to causeprofound
hypotension and loss of consciousness,reducedosewith severe hepatic impairment, do not use instead of NG suction
Adverse Effects: Headache, malaise/fatigue,constipation,hypoxia,drowsiness,diarrhea,dizziness,fever, anxiety, urinary retention,
puritus,paresthesia,cold sensation,elevated liver function test results
Patient Family Education: Inform the pt that this medication will begiven accordingto a schedule, not PRN. Inform the pt that he will be
monitored usingECG monitoring sincehe has electrolyte abnormalities.Sincethe route of this medication is IV, educate the pt on proper
positioningto keep IV linepatent.
Source:(Medscape,2015)
Present History and Relevant Past History:
(Provide a synopsis of patient’s history leading to hospitalization)
8. On 11/05/15, pt wasdiagnosedwithlungcancerinherRUL and startedradiationtreatmentforit. Patientpresentedto
ED 11/17/15 withcomplaintsof dizziness,swellingof chestandpaininthe R arm.11/18/15, after a CXR wasconducted
on the affectedarea,itwasshownthat herclavicle wasfractureddue to cancerouscellsbreakingdownherbone andthis
was whatwas causingherpainand decreasedROM.Pt wasdx withosteoporosisin2009 whichmeansthather bonesare
alreadyfragile andare more susceptibletobeinginfiltratedwiththe damagingcancerouscells. The ptalsohas DM2 and
anemia,which impairsherhealingability.Thiscanmake iteasierforherlungcancer to damage her lungtissue since her
bodywill notbe able to heal itself inatimelymanner.
Pathophysiology of Admitting Diagnosis:
(Describe pathophysiology as you would explain it to the patient.)
What youwere recentlydiagnosedwithwaslungcancer. Asyouknow,there are differenttypesof cancerandtheyall
affectthe bodyindifferentways.The waythatlungcancer affectsyourbodyisthat there are certaincellsinthe toppart
of yourrightlungthat are growingandmultiplyingtooquickly. Thesecellseventuallyformamass,or a tumor, whichcan
cause you to have chestpain. Lungcancer can alsocause you to have othersymptoms,like shortnessof breath,cough,
bone pain,andweightlos. If the cancer isnot controlledthroughtreatment,likechemotherapy,thenthe cancerouscells
will have enoughtime totravel tootherareasof yourbody,especiallyyourlymphnoes,liver,bones,adrenalglands
(whichare on topof your kidneys),andbrain. Whenthe cancerspreadsto otherareas,thisiscalledmetastasis.Thishas
unfortunatelyalreadystartedtohappensince the cancerouscellswereable togetinthe bone inyour clavicle andcause
it to become weakandthenfracture.
Source: (Cady & Jackowski,2014) & (Tan & Maghfoor, 2015)
Patient’s Plan of Care:
(Briefly describe patient’scurrentplanof care duringhospitalization,discussrelevantprocedures,therapies,tests,etc.)
To helpwiththe pts superiorvenacava compressionsyndrome,highamountsof IVFare tobe avoidedandan
echocardiogramwasscheduled.Zofranhasbeenprescribedtohelpwithanynauseathe patientmayhave.The patient
has HTN so hermedicationof amlodipineandatenolol isbeingcontinued.Tocontrol herhyperlipidemia,the patientwas
prescribedstatinmedication.The patientisonbedrestsoheparinhasbeenprescribedtopreventDVT andnurse has
beenmade aware to be cautiousof potential deliriumandfall risk.Patent wasalsogivenaslingtoholdup herrightarm
to helprelieve stressonherfracturedclavicle.Nocastisgoingto be made for furtherhealingof the fracturedclavicle.
List 4 Nursing Diagnosis In Order Of Highest Priority:
(Based on your patient’s specific needs, identify four nursing diagnosis and rank them in order of importance,
be sure to include at least one psychosocial diagnosis)
9. 1) Acute Pain R/T immobility of right arm AEB pain when lifting right arm, guarding and protection of right
arm 2˚ to fractured clavicle
2) Impaired Physical Mobility R/T limb immobilization AEB inability to move purposefully within the
physical environment with the right arm, reluctance to move the right arm, decreased ROM 2˚ to
fractured clavicle
3) Fear/Anxiety R/T change in health status AEB verbal expression of fear, shock at new diagnosis, concern
for future health 2˚ to diagnosis of lung cancer metastasis
4) Self-Care Deficit R/T musculoskeletal impairment AEB decreased strength in R arm, pain in R arm,
intolerance of activity on R arm 2˚ to fractured clavicle and lung cancer
Daily Care Plan
Assessment: (briefly discuss relevant assessment findings, labs, diagnostic tests, etc)
Objective: inability to lift or move right arm well, guarding and protection of right arm
Subjective: pain when lifting right arm, apprehension to move arm
Nursing Diagnosis:
Acute Pain
Goal: (specific to your patient’s needs)
• Report pain is relieved or controlled; pain reduced from 5/10 to 2/10
• Participate in desired/needed activities
Intervention Rationales
1) Note possible causes of pain
2) Evaluate effectiveness of pain control
3) Provide comfort measures
4) Assist with self-care activities
1) Knowing what causes pain will help the patient and nurse
prevent those aggravating factors in the future
2) To ensure that medication is working as expected or if
another pain management method is needed
3) Promotes relaxation and helps relieve discomfort
4) Prevents possible further injury and allows pt to continue to
do activities they need to do
Evaluation:
Patient is able to participate in activities of daily living and reports pain has decreased from 5/10 to 2/10
Source: (Ackley & Ladwig, 2014)
References
10. Ackley,B.J.,& Ladwig,G. B. (2014). Nursing diagnosishandbook (10thEditioned.).MarylandHeights,Missouri:Elsevier.
Cady,J., & Jackowski,J.A.(2014). Medical-surgicalnursing:Assessmentand managementof clinical problems. St.Louis,
Missouri:Elsevier.
Medscape.(2015, January1). MedscapeReference.RetrievedNovember16,2015, from Drugsand Diseases:
http://reference.medscape.com/
Tan, W. W., & Maghfoor,I. (2015). Smallcell lung cancer: Pathophysiology.RetrievedNovember24,2015, fromDrugs and
Diseases:http://emedicine.medscape.com/article/280104-overview#a3