CLINICAL REASONING An elderly man years with chronic.docx
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An elderly man with chronic obstructive pulmonary disease (COPD) relies on home oxygen treatment. During a home visit, the community nurse notices the man using his oxygen with a packet of cigarettes nearby, putting himself at risk. He has a long history of smoking and poor health factors, but wishes to remain independent in his home. The nurse must determine the best way to address the safety issue while respecting the man's autonomy and right to make his own choices.
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Instructions· This week’s case study will introduce concepts r.docx
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management guidelines and recommendations. Sources such as Wikipedia or other generic websites are not considered professional references and should not be used to complete the case studies.
· Reason for Consultation:
Desaturation to 64% on room air 1 hour ago with associated shortness of breath.
History of Present Illness:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found to be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 20, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91-92% on 4L NC. The patient was seen and examined at 10:10 a.m. She reported that she has had mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of this visit was 20 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiatio.
Clinico Pathological Conference
ARDS, Adult Respiratory Distress Syndrome, Berlin definition of ARDS, Lung Protective ventilation strategies, Prone Positioning, VV ECMO, Higher PEEP
Case Of Make a Care Cardiology Clinical Case.docx
This patient is a 52-year-old male who presented to the emergency room with chest pain and was diagnosed with angina. He underwent a stent placement and was discharged from the hospital. He has several major cardiac risk factors including hypertension, hypercholesterolemia, diabetes, obesity, smoking history, and a family history of heart disease. His social situation and lifestyle further increase his risk, as he lives in poverty, has high stress levels, eats an unhealthy diet, and does not exercise. His care plan will focus on medication management, risk factor reduction through lifestyle changes, follow up care, and addressing his psychosocial needs.
Case Of Make a Care Cardiology Clinical Case.docx
This patient is a 52-year-old male who presented to the emergency room with chest pain and was diagnosed with angina. He underwent a stent placement and was discharged from the hospital. He has several major cardiac risk factors including hypertension, hypercholesterolemia, diabetes, obesity, smoking history, and a family history of heart disease. His social situation and lifestyle further increase his risk, as he lives in poverty, has high stress levels, eats an unhealthy diet, and gets little exercise. His care plan will focus on medication management, risk factor reduction through lifestyle changes, follow up care, and addressing his psychosocial needs.
Day of Discharge Progress Note CC I am breathing a little .pdf
Day of Discharge Progress Note CC: I am breathing a little bit better. can I go home now? History
of Present Illness: The patient, Linda Brown, is a 63-year-old female who was admitted to the
hospital 4 days ago with the complaint of increased dyspnea, a terrible cough with some sputum
production, and feeling weak and tired. Her symptoms began one day prior to admission after she
went to a concert in a smoky bar. When she was unable to climb the stairs in her home while
carrying her laundry basket without stopping every few steps to catch her breath, she had her
daughter bring her to the hospital. In the emergency department, her O2 saturation was in the high
80s, and a CXR showed hyperinflation of bilateral lungs and a flattened diaphragm. A chest CT
scan showed emphysema in both lungs with evidence of damage to the alveoli in the bilateral lung
bases. She was started on oxygen via nasal cannula, ordered nebulizer treatments of a
bronchodilator every 4 hours and admitted for a course of antibiotics and steroids. Since her
admission, her breathing has improved, and her energy has increased. She is anxious for
discharge to home as she states that she isnt sleeping well in the hospital, and the food is terrible.
Past medical history: -Hypertension -Asthma as a child -Postmenopausal -Vaginal delivery x3 -
Gallbladder removed in her 40s Social history: -Works full time as a manager at Target. -Divorced,
lives alone. She has three adult children who live in the area. -Smokes 1 pack of cigarettes daily,
began smoking when she was 24. -Reports social alcohol use-2-3 drinks per day on the weekends
and 1-2 drinks during happy hour several times a week with her co-workers. -Reports occasional
marijuana use. Medications: Lisinopril Physical Examination: Vital signs: Temperature: 98.2F.
Heart Rate: 97 beats per minute. Respiratory Rate: 20 breaths per minute. Blood Pressure 126/74
mmHg. Oxygen saturation: 96% on 4 liters O2 via nasal cannula HEENT Head: No sinus
tenderness, normocephalic, atraumatic. Ears: Tympanic membranes intact; no erythema Eyes:
PERRLA, Conjunctiva without erythema. Nose: Mucous membranes intact, without congestion.
Throat/mouth: Mucous membranes moist without exudate, teeth within normal limits. No cervical
adenopathy. Respiratory: On 4 liters O2 per minute via nasal Scattered rhonchi in the bilateral
lung bases. Occasional cough without any sputum production. Heart: Normal sinus rhythm, no
murmurs Abdomen: Nontender to palpation, + bowel sounds Extremities: No lower extremity
edema bilaterally. No evidence of clubbing in bilateral hands. Neurological: Awake, alert, oriented
to time, place, and person. Skin: Without rashes or ecchymosis. Laboratory evaluation: Blood
cultures negative Assessment: Patient has a new diagnosis of COPD with features of
emphysema, admitted with a COPD exacerbation. Plan: COPD exacerbation, currently stable, and
patient is ready for discharge to home -Ordered short-acting bronchodilator, ipratropium bromi.
pneumocystispneumonia-140513155717-phpapp01-2.pdf
A 30-year-old man from Yemen presented with fever and dyspnea for three weeks. He had a history of occasional smoking and unclear sexual history. On examination, he had rapid breathing and oxygen saturation of 91% on room air. Initial tests showed leukopenia and elevated LDH. Chest X-ray showed diffuse bilateral infiltrates. Given his symptoms and risk factors, Pneumocystis pneumonia was suspected. Treatment with trimethoprim-sulfamethoxazole was recommended, with alternatives available for those with sulfamethoxazole allergy.
Pneumocystis Pneumonia
A 30-year-old man from Yemen presented with fever and dyspnea for three weeks. He had a history of occasional smoking and unclear sexual history. On examination, he had rapid breathing and oxygen saturation of 91% on room air. Initial tests showed leukopenia and elevated LDH. Chest X-ray showed diffuse bilateral infiltrates. Given his symptoms and test results, Pneumocystis pneumonia was suspected as the cause of his dyspnea. Treatment with trimethoprim-sulfamethoxazole was recommended, with alternatives available for patients with sulfamethoxazole allergy.
Mr Ahmad is a 65-year-old male who was admitted to the medical ward as.pdf
Mr Ahmad is a 65-year-old male who was admitted to the medical ward as a suspected
case of Tuberculosis (TB). He reports feeling tired, and weak, and having a persistent
cough with mucus production for the past several weeks. He also reports having a
significant amount of weight loss and a low-grade fever. Mr Ahmad is a known case of
COPD, and he has been keeping the head of the bed elevated for most of the day and
night to facilitate his breathing which has resulted in lower back pain. Mr. Ahmad is on 2
lityes of oxygen by nasal cannula. He recolves respiratory treatments of albuterol
(AccuNeb, Proventil, Ventolin) overy six hours as neded. The medical team also started
Mr. Ahmad on Multiple antibiotics includes isoniazid, rifampin, pyrazinamide, ethambutol
hydrochloride, and Streptomycin. Mr. Ahmad needs someone to walk beside him when
he ambulates because he has an unsteady gait and often needs to stop to catch his
breath.
--> What are the nursing considerations that should be taken to address safety
concerns for Mr. Ahmad upon his admission to medical wards? "List at 5
considerations"
--> What are the nursing considerations that should be taken to address safety concerns for Mr.
Ahmad upon his admission to medical wards? "List at 5 considerations".
Recommended
Instructions· This week’s case study will introduce concepts r.docx
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management guidelines and recommendations. Sources such as Wikipedia or other generic websites are not considered professional references and should not be used to complete the case studies.
· Reason for Consultation:
Desaturation to 64% on room air 1 hour ago with associated shortness of breath.
History of Present Illness:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found to be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 20, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91-92% on 4L NC. The patient was seen and examined at 10:10 a.m. She reported that she has had mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of this visit was 20 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiatio.
Clinico Pathological Conference
ARDS, Adult Respiratory Distress Syndrome, Berlin definition of ARDS, Lung Protective ventilation strategies, Prone Positioning, VV ECMO, Higher PEEP
Case Of Make a Care Cardiology Clinical Case.docx
This patient is a 52-year-old male who presented to the emergency room with chest pain and was diagnosed with angina. He underwent a stent placement and was discharged from the hospital. He has several major cardiac risk factors including hypertension, hypercholesterolemia, diabetes, obesity, smoking history, and a family history of heart disease. His social situation and lifestyle further increase his risk, as he lives in poverty, has high stress levels, eats an unhealthy diet, and does not exercise. His care plan will focus on medication management, risk factor reduction through lifestyle changes, follow up care, and addressing his psychosocial needs.
Case Of Make a Care Cardiology Clinical Case.docx
This patient is a 52-year-old male who presented to the emergency room with chest pain and was diagnosed with angina. He underwent a stent placement and was discharged from the hospital. He has several major cardiac risk factors including hypertension, hypercholesterolemia, diabetes, obesity, smoking history, and a family history of heart disease. His social situation and lifestyle further increase his risk, as he lives in poverty, has high stress levels, eats an unhealthy diet, and gets little exercise. His care plan will focus on medication management, risk factor reduction through lifestyle changes, follow up care, and addressing his psychosocial needs.
Day of Discharge Progress Note CC I am breathing a little .pdf
Day of Discharge Progress Note CC: I am breathing a little bit better. can I go home now? History
of Present Illness: The patient, Linda Brown, is a 63-year-old female who was admitted to the
hospital 4 days ago with the complaint of increased dyspnea, a terrible cough with some sputum
production, and feeling weak and tired. Her symptoms began one day prior to admission after she
went to a concert in a smoky bar. When she was unable to climb the stairs in her home while
carrying her laundry basket without stopping every few steps to catch her breath, she had her
daughter bring her to the hospital. In the emergency department, her O2 saturation was in the high
80s, and a CXR showed hyperinflation of bilateral lungs and a flattened diaphragm. A chest CT
scan showed emphysema in both lungs with evidence of damage to the alveoli in the bilateral lung
bases. She was started on oxygen via nasal cannula, ordered nebulizer treatments of a
bronchodilator every 4 hours and admitted for a course of antibiotics and steroids. Since her
admission, her breathing has improved, and her energy has increased. She is anxious for
discharge to home as she states that she isnt sleeping well in the hospital, and the food is terrible.
Past medical history: -Hypertension -Asthma as a child -Postmenopausal -Vaginal delivery x3 -
Gallbladder removed in her 40s Social history: -Works full time as a manager at Target. -Divorced,
lives alone. She has three adult children who live in the area. -Smokes 1 pack of cigarettes daily,
began smoking when she was 24. -Reports social alcohol use-2-3 drinks per day on the weekends
and 1-2 drinks during happy hour several times a week with her co-workers. -Reports occasional
marijuana use. Medications: Lisinopril Physical Examination: Vital signs: Temperature: 98.2F.
Heart Rate: 97 beats per minute. Respiratory Rate: 20 breaths per minute. Blood Pressure 126/74
mmHg. Oxygen saturation: 96% on 4 liters O2 via nasal cannula HEENT Head: No sinus
tenderness, normocephalic, atraumatic. Ears: Tympanic membranes intact; no erythema Eyes:
PERRLA, Conjunctiva without erythema. Nose: Mucous membranes intact, without congestion.
Throat/mouth: Mucous membranes moist without exudate, teeth within normal limits. No cervical
adenopathy. Respiratory: On 4 liters O2 per minute via nasal Scattered rhonchi in the bilateral
lung bases. Occasional cough without any sputum production. Heart: Normal sinus rhythm, no
murmurs Abdomen: Nontender to palpation, + bowel sounds Extremities: No lower extremity
edema bilaterally. No evidence of clubbing in bilateral hands. Neurological: Awake, alert, oriented
to time, place, and person. Skin: Without rashes or ecchymosis. Laboratory evaluation: Blood
cultures negative Assessment: Patient has a new diagnosis of COPD with features of
emphysema, admitted with a COPD exacerbation. Plan: COPD exacerbation, currently stable, and
patient is ready for discharge to home -Ordered short-acting bronchodilator, ipratropium bromi.
pneumocystispneumonia-140513155717-phpapp01-2.pdf
A 30-year-old man from Yemen presented with fever and dyspnea for three weeks. He had a history of occasional smoking and unclear sexual history. On examination, he had rapid breathing and oxygen saturation of 91% on room air. Initial tests showed leukopenia and elevated LDH. Chest X-ray showed diffuse bilateral infiltrates. Given his symptoms and risk factors, Pneumocystis pneumonia was suspected. Treatment with trimethoprim-sulfamethoxazole was recommended, with alternatives available for those with sulfamethoxazole allergy.
Pneumocystis Pneumonia
A 30-year-old man from Yemen presented with fever and dyspnea for three weeks. He had a history of occasional smoking and unclear sexual history. On examination, he had rapid breathing and oxygen saturation of 91% on room air. Initial tests showed leukopenia and elevated LDH. Chest X-ray showed diffuse bilateral infiltrates. Given his symptoms and test results, Pneumocystis pneumonia was suspected as the cause of his dyspnea. Treatment with trimethoprim-sulfamethoxazole was recommended, with alternatives available for patients with sulfamethoxazole allergy.
Mr Ahmad is a 65-year-old male who was admitted to the medical ward as.pdf
Mr Ahmad is a 65-year-old male who was admitted to the medical ward as a suspected
case of Tuberculosis (TB). He reports feeling tired, and weak, and having a persistent
cough with mucus production for the past several weeks. He also reports having a
significant amount of weight loss and a low-grade fever. Mr Ahmad is a known case of
COPD, and he has been keeping the head of the bed elevated for most of the day and
night to facilitate his breathing which has resulted in lower back pain. Mr. Ahmad is on 2
lityes of oxygen by nasal cannula. He recolves respiratory treatments of albuterol
(AccuNeb, Proventil, Ventolin) overy six hours as neded. The medical team also started
Mr. Ahmad on Multiple antibiotics includes isoniazid, rifampin, pyrazinamide, ethambutol
hydrochloride, and Streptomycin. Mr. Ahmad needs someone to walk beside him when
he ambulates because he has an unsteady gait and often needs to stop to catch his
breath.
--> What are the nursing considerations that should be taken to address safety
concerns for Mr. Ahmad upon his admission to medical wards? "List at 5
considerations"
--> What are the nursing considerations that should be taken to address safety concerns for Mr.
Ahmad upon his admission to medical wards? "List at 5 considerations".
Pedia anubhutidave21grp
Pediatric History Taking Project above 3 years
case used is an example
Perfect for bachelor students
Mr Ahmad is a 65-year-old male who was admitted to the medical ward as (1).pdf
Mr Ahmad is a 65-year-old male who was admitted to the medical ward as a suspected case of
Tuberculosis (TB). He reports feeling tired, and weak, and having a persistent cough with mucus
production for the past several weeks. He also reports having a significant amount of weight loss
and a low-grade fever. Mr Ahmad is a known case of COPD, and he has been keeping the head
of the bed elevated for most of the day and night to facilitate his breathing which has resulted in
lower back pain. Mr. Ahmad is on 2 lityes of oxygen by nasal cannula. He recolves respiratory
treatments of albuterol (AccuNeb, Proventil, Ventolin) overy six hours as neded. The medical
team also started Mr. Ahmad on Multiple antibiotics includes isoniazid, rifampin, pyrazinamide,
ethambutol hydrochloride, and Streptomycin. Mr. Ahmad needs someone to walk beside him
when he ambulates because he has an unsteady gait and often needs to stop to catch his breath. 1.
List five immediate nursing assessments that the nurse would have conducted on Mr Ahmad
upon his arrival to the medical ward. (CLO1 and CLO2) (3 marks for each action 15 marks)..
End Stage Pulmonary Disease | VITAS Healthcare
Define and understand the types of advanced lung disease (ALD)
Discuss the impact of ALD on patients, family, and the health system
Describe the symptom burden of ALD
Appreciate factors associated with a poorer prognosis in ALD
Identify guidelines for referral to Hospice
Review the medical management of ALD
A case study on cerebrovascular disease
Group case study. Our CI corrected us that CVD is cerebrovascular disease and not cardiovascular, enjoy browsing.
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docx
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
Example of a complete history and physical write
This 83-year-old woman presented with chest pain and was found to be having a heart attack. She has a history of hypertension but was previously well-controlled. Her current presentation included toothache-like chest pain, EKG changes, and elevated cardiac enzymes consistent with a heart attack. Her past medical history also includes prior admissions for chest pain and heart failure. She received thrombolytic therapy and was admitted to the intensive care unit.
SampleWriteUp.pdf history and physical examination
1. This 83-year-old woman presented to the emergency room with substernal chest pain and was diagnosed with an acute anterolateral myocardial infarction based on EKG changes and elevated cardiac enzymes. She has a history of hypertension and congestive heart failure.
2. On examination, she was tachycardic with bibasilar rales and edema suggestive of congestive heart failure. Laboratory results showed evidence of a heart attack and mild left ventricular dysfunction.
3. The plan is to continue medical management for the heart attack and congestive heart failure while also treating her for a suspected urinary tract infection based on dysuria and pyuria.
Cardiology Clinical Case Study.docx
A 52-year-old male with a history of hypertension, high cholesterol, and type 2 diabetes presented to the emergency room with chest pain and was found to have angina. He underwent a stent placement and was discharged from the hospital. His follow-up visit discusses managing his cardiovascular risk factors through lifestyle changes and medication adherence to prevent future cardiac events.
An 80-year-old White male was admitted s-p L hemiarthroplasty yesterda.docx
An 80-year-old White male was admitted s/p L hemiarthroplasty yesterday after a fall. No other acute injuries were treated. Patient is married and his wife and daughter are at the bedside. Patient has a history of type 2 diabetes but does not require medication normally, though he is currently on a sliding scale of insulin since surgery. He had an Ivor-Lewis esophagectomy secondary to adenocarcinoma of the esophagus and stomach 9 months ago. He also had gamma knife radiation for a left temporal mass ( 7 months agol which was found coincidentally when diagnosed with a CVA. He has a port-a-cath in his right upper chest which is not accessed. He has a left-hand peripheral IV of normal saline at 100 cc / hour and the pump that is alarming (which is what brought you into the room). His IV site is swollen and red. He is alert and oriented X s 3. HOB must be at 30 degrees at all times. Patient is 6 feet 6 inches tall and weighs 168 pounds. Skin is extremely fragile and tears easily. He currently has a reddened area over his coccyx, though skin is intact. Patient must not drink fluids within 30 minutes of meals, must eat a small, high-protein meal every 2 to 3 hours, and must rest at least 20 minutes after eating; otherwise he experiences dumping syndrome. Vitals: BP 150/68 (supine); P 70; R 24; O2 at 97% on room air. Breath sounds diminished in lower lobes bilaterally. Bowel sounds are decreased in all quadrants. Left hip dressing is dry and intact. Client states his pain is a 6 out of 10; he was last medicated 4 hours ago and has asked to have pain medicine and nausea medicine at the next opportunity. Pedal pulses are present bilaterally, no swelling. Blood work indicates Hgb of 8.1. When PT attended earlier, patient stood at bedside with walker and assistance, but quickly became nauseous and weak and was unable to transfer to the chair. Client lives with wife of 60 years. There are two steps into the residence, and patient was independent with all ADLs prior to the fall. He is currently resting; a soft meal was brought in, but patient has refused to eat or drink since he fell 2 days ago. Based on this case answer the following tasks and questions: 1. List the relevant cues. 2. What additional information do you need? 3. Which cues require immediate attention, and which need attention, but are not urgent? 4. Which are the most likely hypotheses? Which of these are serious? 5. Generate solutions based on evidence. 6. What actions should be taken and in what order? 7. How and when would you evaluate the outcomes?
.
Mr Reed John was broaght to the ED at 0430 this moening Hi.pdf
Mr. Reed John was broaght to the ED at 0430 this moening. His wife menticned that Mr. Reod had
diarthea for the past 3 days and that be had a lor of "dark red" diarrhea last night. This moming he
becarse very dizay, disoriented, and physically weak. Mr. Reed Joh, who is 70 years old, 72
inches, 86.4kg. with of BMI 23, Me. Reed has had itioputhe dilated sardiemyopathy for several
years. The onset was insidious, but cardiomyoguthy is now severe, as evidenced by an ejoction
fractico of 13% found daring a reeent eardiac catheterurutien. Experienced frequent peotlems with
HF because of cardiomyopathy and had a cardiac armet that was aceredited to bypokalemia. He
las a loeg listory of HIN, Arthritis, and had a peptic alcer since 15 years ago. His current
medications are: cnalaptil (Veotec) 5 mg PO bid, warfarin (Coumadin) 5 me day PO, digosin 0.125
me lay PO, KCT 20 mEq PO bid, and solnctin (an NSNID) 400 ang PO bid. Me. Reed VS: syssolic
70 f diastolic inuodile, HR: 120, RR: 20, Temp: 101'F, and Prin 5/10. A 16.gauge IV cathetcr was
insertod, and a lactalod Ringer's infusice was started. When counecting Mr. Reed to the cardiac
monitoc, it was sesm that he was in A-fich. His skint is pale; at this monsent is sicqping but
arousable and oricnted. Still mentiges heing dizxy, hypolensive, and tachypecic. Able to hear $3
and $4 sounds at a grade of 265 syadolic nurner. Peripheral pulses are 2+ bilaterally, and thene is
a trace of pedal colema prevent. The lungs are clear bilstenlly. Bowal sounds are peesent with
mid-epigatrie hendemess, and the liver margin is 4 cm below the contal margin. Sean-Ganz
catheter and an anterial line are cumently inserted. I think that Mr. Williarns is in hypenolentic
stock and that be would necd proper blood work and assessment troem the doctor on call, I feel
he should have maximum exygen delivery, noods to be able to control blood loss, and needs fluid
resuscitatice Results and Symptoens seem that Mer Reed is in hypowolemic shock, and he would
neod peoper blood work and assessment from the doctor ea call. He should have maximum
Orygen delivery as well as fluid resuscitation to be able to custrol blisod loss..
Approach to Chronic Obstructive Pulmonary Disease
A 66-year-old man with a 47-year smoking history of one pack per day presents with progressive shortness of breath and chronic cough producing yellow sputum for two years. On examination, he has signs of respiratory distress, barrel chest, poor air entry, and wheezing. Spirometry shows airflow limitation consistent with COPD. Tobacco smoking is the main risk factor for COPD, causing inflammation, cilia dysfunction, and oxidative injury in the lungs. Differential diagnoses include asthma, congestive heart failure, bronchiectasis, and tuberculosis.
Fever with cough and chest pain.
An atypical case of lung abscess, where the work up was done hoping for Ca lung, but instead, lung abscess was found as dx.
Week 4Problem Assignment Time Value of Money1If you deposit $15,0.docx
Week 4Problem Assignment: Time Value of Money1If you deposit $15,000 today and earn 8% annual interest, how much will you have in 9 years?Answer:$29,985.072Tiffany will receive a graduation gift of $10,000 from her parents in 3 years. If the discount rateis 7%, what is this gift worth today?Answer:$8,162.983What is the present value of a 20-year ordinary annuity of $30,000 using a 6% discount rate?Answer:$344,097.644You deposit $5,000 in an account that pays 8% interest per annum. How long will it take to double your money?Answer:9 years5The Johnsons have $60,000 to use as a down-payment on a house, and they want to borrow $240,000from the bank. The current mortgage interest rate is 5%. If they make equal monthly payments for 30 years,how much will the monthly payment be?Answer:$1,288.376Tim paid $250 per month into his 401K retirement plan. After 30 years, he had accumulated $500,000. Whataverage annual rate of interest had he earned over the 30 years?Answer:9.42%7Charlotte's firm had sales of $525,000 in the year 2001. By 2012, sales had increased to $1,200,000. What wasthe average annual rate of increase?Answer:7.80%8Alan had saved up $500,000. How much more must he save each year over the next 10 years in order to have atotal of $2 million? Alan earns 5% interest, compounded annually.Answer:$94,257
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management g.
Approach to Cough And Hemoptysis (Medicine)
Cough Physiology, mechanism. Approach to cough. Acute vs chronic cough. Types of cough. Sputum Color, History and Examination. Hemoptysis Physiology, common causes. Hemoptysis vs Hematemesis. Case scenarios. Cardiac vs Respiratory cause of cough
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Nac in copd india experience_pmm_2018
COPD; a chronic, progressive airway obstruction; is directly linked with persistent inflammation and high oxidative stress. Airway obstruction is added on by plugging of airways with thick mucus. Role and efficacy of N-acetyl cysteine is reviewed with clinical cases.
you interviewed the CEO and evaluated the organization to gain.docx
You interviewed the CEO and evaluated the organization to gain insight into their perspective and strategic priorities. This information will help develop a strategic plan to assist the CEO and leaders in encouraging future success. The summary will help leaders and managers understand how their roles, philosophies, and leadership styles can either hinder or encourage growth, and how to better align organizational goals with corporate social responsibility.
Write a to paper about genetically vigorous.docx
Genetic diversity is important for long-term population viability and supports biodiversity. A lack of genetic diversity threatens survival, as seen in populations like the Florida panther which faces health issues due to inbreeding. Population management considers conservation values and aims to balance costs and benefits through efforts like reintroducing invasive species. Conservation methods include ex situ options like zoos and botanical gardens which support genetics but can also reduce diversity, as well as in situ protections under the Endangered Species Act which helps preservation but faces challenges in enforcement.
When you talk about the meaning of which sense.docx
When discussing the meaning of life, one must consider whether they refer to external or internal meaning. External meaning relates to a purpose imposed by some higher authority, while internal meaning involves finding personal fulfillment and satisfaction through experiences and interpersonal relationships. This distinction is explored in Lewis Vaughn's book "Philosophy here and now: Powerful ideas in everyday life."
Virtualization and cloud services continue to gain momentum as more.docx
Virtualization and cloud services are gaining popularity as organizations seek to reduce costs and improve efficiency. As cited by Portnoy (2012), companies typically adopt virtualization first before purchasing new physical servers. Under virtualization policies, new projects are satisfied using virtual resources instead of physical servers unless a need cannot be met virtually. Organizations begin to virtualize infrastructure services and realize fiscal benefits, leading to migrating more workloads from expiring servers to the growing virtual environment.
Your name Brief background Your profession What you hope to.docx
This document requests information about the applicant including their name, brief background, profession, and what they hope to gain from the course. It also asks about instances when the applicant felt extremely anxious about giving a public presentation and what steps they took to decrease their apprehension, and what methods worked or did not work.
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Mr Ahmad is a 65-year-old male who was admitted to the medical ward as a suspected case of
Tuberculosis (TB). He reports feeling tired, and weak, and having a persistent cough with mucus
production for the past several weeks. He also reports having a significant amount of weight loss
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treatments of albuterol (AccuNeb, Proventil, Ventolin) overy six hours as neded. The medical
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when he ambulates because he has an unsteady gait and often needs to stop to catch his breath. 1.
List five immediate nursing assessments that the nurse would have conducted on Mr Ahmad
upon his arrival to the medical ward. (CLO1 and CLO2) (3 marks for each action 15 marks)..
End Stage Pulmonary Disease | VITAS Healthcare
Define and understand the types of advanced lung disease (ALD)
Discuss the impact of ALD on patients, family, and the health system
Describe the symptom burden of ALD
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A case study on cerebrovascular disease
Group case study. Our CI corrected us that CVD is cerebrovascular disease and not cardiovascular, enjoy browsing.
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docx
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
Example of a complete history and physical write
This 83-year-old woman presented with chest pain and was found to be having a heart attack. She has a history of hypertension but was previously well-controlled. Her current presentation included toothache-like chest pain, EKG changes, and elevated cardiac enzymes consistent with a heart attack. Her past medical history also includes prior admissions for chest pain and heart failure. She received thrombolytic therapy and was admitted to the intensive care unit.
SampleWriteUp.pdf history and physical examination
1. This 83-year-old woman presented to the emergency room with substernal chest pain and was diagnosed with an acute anterolateral myocardial infarction based on EKG changes and elevated cardiac enzymes. She has a history of hypertension and congestive heart failure.
2. On examination, she was tachycardic with bibasilar rales and edema suggestive of congestive heart failure. Laboratory results showed evidence of a heart attack and mild left ventricular dysfunction.
3. The plan is to continue medical management for the heart attack and congestive heart failure while also treating her for a suspected urinary tract infection based on dysuria and pyuria.
Cardiology Clinical Case Study.docx
A 52-year-old male with a history of hypertension, high cholesterol, and type 2 diabetes presented to the emergency room with chest pain and was found to have angina. He underwent a stent placement and was discharged from the hospital. His follow-up visit discusses managing his cardiovascular risk factors through lifestyle changes and medication adherence to prevent future cardiac events.
An 80-year-old White male was admitted s-p L hemiarthroplasty yesterda.docx
An 80-year-old White male was admitted s/p L hemiarthroplasty yesterday after a fall. No other acute injuries were treated. Patient is married and his wife and daughter are at the bedside. Patient has a history of type 2 diabetes but does not require medication normally, though he is currently on a sliding scale of insulin since surgery. He had an Ivor-Lewis esophagectomy secondary to adenocarcinoma of the esophagus and stomach 9 months ago. He also had gamma knife radiation for a left temporal mass ( 7 months agol which was found coincidentally when diagnosed with a CVA. He has a port-a-cath in his right upper chest which is not accessed. He has a left-hand peripheral IV of normal saline at 100 cc / hour and the pump that is alarming (which is what brought you into the room). His IV site is swollen and red. He is alert and oriented X s 3. HOB must be at 30 degrees at all times. Patient is 6 feet 6 inches tall and weighs 168 pounds. Skin is extremely fragile and tears easily. He currently has a reddened area over his coccyx, though skin is intact. Patient must not drink fluids within 30 minutes of meals, must eat a small, high-protein meal every 2 to 3 hours, and must rest at least 20 minutes after eating; otherwise he experiences dumping syndrome. Vitals: BP 150/68 (supine); P 70; R 24; O2 at 97% on room air. Breath sounds diminished in lower lobes bilaterally. Bowel sounds are decreased in all quadrants. Left hip dressing is dry and intact. Client states his pain is a 6 out of 10; he was last medicated 4 hours ago and has asked to have pain medicine and nausea medicine at the next opportunity. Pedal pulses are present bilaterally, no swelling. Blood work indicates Hgb of 8.1. When PT attended earlier, patient stood at bedside with walker and assistance, but quickly became nauseous and weak and was unable to transfer to the chair. Client lives with wife of 60 years. There are two steps into the residence, and patient was independent with all ADLs prior to the fall. He is currently resting; a soft meal was brought in, but patient has refused to eat or drink since he fell 2 days ago. Based on this case answer the following tasks and questions: 1. List the relevant cues. 2. What additional information do you need? 3. Which cues require immediate attention, and which need attention, but are not urgent? 4. Which are the most likely hypotheses? Which of these are serious? 5. Generate solutions based on evidence. 6. What actions should be taken and in what order? 7. How and when would you evaluate the outcomes?
.
Mr Reed John was broaght to the ED at 0430 this moening Hi.pdf
Mr. Reed John was broaght to the ED at 0430 this moening. His wife menticned that Mr. Reod had
diarthea for the past 3 days and that be had a lor of "dark red" diarrhea last night. This moming he
becarse very dizay, disoriented, and physically weak. Mr. Reed Joh, who is 70 years old, 72
inches, 86.4kg. with of BMI 23, Me. Reed has had itioputhe dilated sardiemyopathy for several
years. The onset was insidious, but cardiomyoguthy is now severe, as evidenced by an ejoction
fractico of 13% found daring a reeent eardiac catheterurutien. Experienced frequent peotlems with
HF because of cardiomyopathy and had a cardiac armet that was aceredited to bypokalemia. He
las a loeg listory of HIN, Arthritis, and had a peptic alcer since 15 years ago. His current
medications are: cnalaptil (Veotec) 5 mg PO bid, warfarin (Coumadin) 5 me day PO, digosin 0.125
me lay PO, KCT 20 mEq PO bid, and solnctin (an NSNID) 400 ang PO bid. Me. Reed VS: syssolic
70 f diastolic inuodile, HR: 120, RR: 20, Temp: 101'F, and Prin 5/10. A 16.gauge IV cathetcr was
insertod, and a lactalod Ringer's infusice was started. When counecting Mr. Reed to the cardiac
monitoc, it was sesm that he was in A-fich. His skint is pale; at this monsent is sicqping but
arousable and oricnted. Still mentiges heing dizxy, hypolensive, and tachypecic. Able to hear $3
and $4 sounds at a grade of 265 syadolic nurner. Peripheral pulses are 2+ bilaterally, and thene is
a trace of pedal colema prevent. The lungs are clear bilstenlly. Bowal sounds are peesent with
mid-epigatrie hendemess, and the liver margin is 4 cm below the contal margin. Sean-Ganz
catheter and an anterial line are cumently inserted. I think that Mr. Williarns is in hypenolentic
stock and that be would necd proper blood work and assessment troem the doctor on call, I feel
he should have maximum exygen delivery, noods to be able to control blood loss, and needs fluid
resuscitatice Results and Symptoens seem that Mer Reed is in hypowolemic shock, and he would
neod peoper blood work and assessment from the doctor ea call. He should have maximum
Orygen delivery as well as fluid resuscitation to be able to custrol blisod loss..
Approach to Chronic Obstructive Pulmonary Disease
A 66-year-old man with a 47-year smoking history of one pack per day presents with progressive shortness of breath and chronic cough producing yellow sputum for two years. On examination, he has signs of respiratory distress, barrel chest, poor air entry, and wheezing. Spirometry shows airflow limitation consistent with COPD. Tobacco smoking is the main risk factor for COPD, causing inflammation, cilia dysfunction, and oxidative injury in the lungs. Differential diagnoses include asthma, congestive heart failure, bronchiectasis, and tuberculosis.
Fever with cough and chest pain.
An atypical case of lung abscess, where the work up was done hoping for Ca lung, but instead, lung abscess was found as dx.
Week 4Problem Assignment Time Value of Money1If you deposit $15,0.docx
Week 4Problem Assignment: Time Value of Money1If you deposit $15,000 today and earn 8% annual interest, how much will you have in 9 years?Answer:$29,985.072Tiffany will receive a graduation gift of $10,000 from her parents in 3 years. If the discount rateis 7%, what is this gift worth today?Answer:$8,162.983What is the present value of a 20-year ordinary annuity of $30,000 using a 6% discount rate?Answer:$344,097.644You deposit $5,000 in an account that pays 8% interest per annum. How long will it take to double your money?Answer:9 years5The Johnsons have $60,000 to use as a down-payment on a house, and they want to borrow $240,000from the bank. The current mortgage interest rate is 5%. If they make equal monthly payments for 30 years,how much will the monthly payment be?Answer:$1,288.376Tim paid $250 per month into his 401K retirement plan. After 30 years, he had accumulated $500,000. Whataverage annual rate of interest had he earned over the 30 years?Answer:9.42%7Charlotte's firm had sales of $525,000 in the year 2001. By 2012, sales had increased to $1,200,000. What wasthe average annual rate of increase?Answer:7.80%8Alan had saved up $500,000. How much more must he save each year over the next 10 years in order to have atotal of $2 million? Alan earns 5% interest, compounded annually.Answer:$94,257
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management g.
Approach to Cough And Hemoptysis (Medicine)
Cough Physiology, mechanism. Approach to cough. Acute vs chronic cough. Types of cough. Sputum Color, History and Examination. Hemoptysis Physiology, common causes. Hemoptysis vs Hematemesis. Case scenarios. Cardiac vs Respiratory cause of cough
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
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General: + fatigue sinc.
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Chapter 3
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