Gibbs Reflective Analysis

Gibbs Reflective Analysis
This is a reflective essay that will be focusing on my experience and feeling on how writer related
with a patient who was complaining of severe pain in the surgical ward during writer posting there.
Writer will be using the Gibbs (1998) reflective cycle as a guide on this essay. The Gibbs (1998)
Reflective Cycle which is one of the most popular models of reflections consists of six steps such as
description which describes as a matter of fact the situation and what happened during the incident.
For writer in the management of the patient who was admitted and was being managed pre–
operatively for intestinal obstruction.Secondly, feelings which is the description or the analysis of
what writer thoughts and feeling were at the time of this incident. Thirdly, the evaluation of writer
experience what was good and bad about writer experience. ... Show more content on
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Conclusion is the sixth step and it is about what else writer could have done and what could writer
not have done. The final step is the action plan. The action plan will be about what writer will do if
this situation arose again or what writer will do differently bearing in mind writer experience from
the steps above (Jasper 2003).Reflective practice writing is a way of expressing and explaining one's
own and others stories crafting and shaping to and understanding and development and it enables
practice development because the outcomes of reflection are taken back into practice, improving and
developing (Bolton 2005). Reflection "is a way of learning from your direct experiences, rather than
from the second–hand experiences of others" (Cottrel 2003, p6). There are several other models of
reflective practice. In addition to the Gibbs (1998) models, there are the Johns' model of reflection
(1995); Kolb's Learning Cycle (1984) and the Atkins and Murphy's model of reflection
... Get more on HelpWriting.net ...

Small Bowel Obstruction (SBO)
Small bowel obstruction (SBO) is a blockage that keeps food or liquid from passing through the
small intestine or large intestine. It can be partial or complete. This disorder is very irritable and
causes many discomforts like abdominal cramping, fever, "Abdominal pain, abdominal distention,
nausea, and vomiting are the usual signs and symptoms of SBO" (Barzegari, et al. 2016, p. 201).
According to Buttaro et al. (2013), the three differential diagnoses that can be included with this
disorder are ischemic colitis, paralytic ileus, and gastroenteritis. Bowel obstruction occurs when the
normal flow of intraluminal contents is interrupted. According to Bordeianou, et al. (2016), the
pathology that causes the obstruction may be external to the

Admission Diagnosis : The Emergency Room ( Er )
Admission Diagnosis:
Patient N.L. was brought into the emergency room (ER) and was admitted to the medical–surgical
unit on Tuesday at 1700 complaining of sudden onset of diffuse contraction–like peri–umbilical pain
radiating all over her abdomen on and off for an hour after having lunch at home. Patient was a 9/10
on a pain scale with nausea and vomiting x 2. Her admitting diagnosis was small bowel obstruction
and systemic inflammatory response with leukocytosis.
History of Present Illness:
N.L. has history of constipation and fecal impaction several years ago. Patient also has history of
Diabetes Mellitus type 2 for 9 years, Hypertension for 15 years, and Chronic Obstructive Pulmonary
Disease (COPD) for 5 years. Patient has also had laparoscopic appendectomy 5 years ago for
erupted appendicitis and total hysterectomy 3 years ago due to uterine fibroids. N.L. smoked half a
pack of cigarettes for 20 years and recently cut down to 2 cigarettes per day. N.Ll also drinks
alcohol occasionally, approximately 2 drinks per month. Chest X–Ray Result: Normal
A picture of the chest taken to show the heart, lungs, airway, blood vessels, and lymph nodes. It's
used to search for problems inside the chest that relate to symptoms such as cough, shortness of
breath, or chest pain. Problems such as pneumonia, enlarged heart, and lung cancer may also be
detected. (John Hopkins Medicine Health Library).
Family History:
Patient's younger brother also has Diabetes Mellitus type 2 as well

History and Physical
HISTORY AND PHYSICAL – CASE 2
Patient: Benjamin Engelhart
Patient ID: 112592
DOB: 10/5/1966
Age: 46
Sex: Male
Date of Admission: 11/14/2012
Emergency Room Physician: Alex McClure, M.D. Admitting Diagnosis: Acute Appendicitis
HISTORY OF PRESENT ILLNESS: This 46–year–old gentleman with past medical history
significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the
emergency room after having had three days of abdominal pain. It initially started three days ago
and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and
radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate
p.o. earlier around ... Show more content on Helpwriting.net ...
The pain is 8 out of 10.
HEENT: Normocephalic atraumatic. Pupils equally round and reactive to light, extraocular motions
intact. Oral cavity shows oropharynx clear but slightly dried mucosal membranes. TM (tympanic
membranes) clear. Neck, supple. There is no thyromegaly, no JVD. No cervical supraclavicular,
axillary, or inguinal lymphadenopathy.
Heart: Regular rate and rhythm. No thrills or murmurs heard.
Lungs: Clear to auscultation bilateral.
Abdomen: Obtuse with minimal bowel sounds, slightly distended. There is RLQ (right lower
quadrant) tenderness with guarding and with pinpoint rebound. Positive McBurney and obturator
signs with a negative psoas sign.
Rectal exam: Revealed no evidence of blood or masses. Prostate, WNL (within normal limits).
Extremities: No clubbing, cyanosis, clots, or edema. There are 1+ pedal pulses bilaterally.

Neural: Cranial nerves 2–12 grossly intact.
DIAGNOSTIC DATA: White count was 13.4, hemoglobin and hematocrit 15.4 and 45.8, platelets
206, with an 89% shift. Sodium 133, potassium 3.7, chloride 99, bicarb 24, BUN and creatinine are
18 and 1.1, respectively. Glucose 146, albumin 4.3, total bilirubin 1.7. The remainder of the LFTs is
within normal limits. Urinalysis reveals trace ketones with 100mg per decilitre protein and a small
amount of blood. CT scan was performed revealing evidence of acute appendicitis with pericecal
inflammation, as well as, dilatation of the appendix and

Pancreatic Cancer Case Study
Informant: Patient and her daughter who appear to be reliable Chief complaint: Persistent nausea
and vomiting with accompying decreased PO intake History of Present Illness: Ms. BH is a 70 year
old female with a history of recently diagnosed pancreatic adenocarcinoma with hepatic lesions,
multifocal PEs s/p IVC filter placement on lovenox, and HTN who presents with persistent nausea
and vomiting. She was diagnosed with pancreatic adenocarcinoma on her last admission to CUMC
in 12/2017 when she presented with epigastric pain, loss of appetite due to nausea and vomiting,
dark, tarry stools, and a reported 20 lb weight loss in the course of a month. An abdominal
ultrasound performed 12/18 showed numerous hepatic lesions and a pancreatic

Jorgen Leth Constraints
Constraints, or obstructions, offer a new form of a piece of art work. They are a way of creative
innovation. In the film The Five Obstructions, constraints were used to combat Jorgen Leth's writer's
block. Depending on the constraint, it can focus an artist's work. Like Anti–art, constraints can offer
a different perspective through potential forms of art, which is the basis of Oulipo. Restriction of
what an artist can work with actually opens doors of creativity and new art forms.
In The Five Obstructions, Director Lars von Trier advises Jorgen Leth on his work. Von Trier creates
the first two obstructions for Leth. Leth proficiently completes the first constraint. However, von
Trier criticizes Leth for using a translucent screen in the second constraint. I found Leth's use of the
screen to be creative, but von Trier stuck to his guns and did not want any people to be shown from
Mumbai, India. I found that the rigor that von Trier had to stick to his constraints was so that there
was a consistency within the film. However, I appreciated Leth's creativity with the screen. This
type of creativity are evidence of the value of constraints. Counterintuitive approaches can creative
productive results!
The third obstruction was punishment for Leth. ... Show more content on Helpwriting.net ...
It would take 200,000,000 years to read all of Queneau's poems (Wikipedia). One Hundred Million
Billion sonnets almost take constraints to a new level. The one less persuasive aspect of constraints
is the lack of human conception. These large creations of work often have been tampered with by
machines or other texts. One may consider this as a hindering of the persona of the author. To
generate so many poems like Queneau, one would have to utilize some sort of tool that takes away
from the human aspect of creating art. Queneau embraces the potential that constraints offer, which
is crucial to the Oulipo

Bowel Obstruction Research Paper
An intestinal obstruction is a blockage of the intestine. It can be caused by a physical blockage or by
a problem of abnormal function of the intestine. CAUSES Adhesions from previous surgeries.
Cancer or tumor. A hernia, which is a condition in which a portion of the bowel bulges out through
an opening or weakness in the abdomen. This sometimes squeezes the bowel. A swallowed object.
Blockage (impaction) with worms is common in third world countries. A twisting of the bowel or
telescoping of a portion of the bowel into another portion (intussusceptions). Anything that stops
food from going through from the stomach to the anus. SYMPTOMS Symptoms of bowel
obstruction may include abdominal bloating, nausea, vomiting, explosive diarrhea, or ... Show more
content on Helpwriting.net ...
Often, lab studies (blood work) and X–rays may be used to find the cause. TREATMENT The main
treatment for this condition is to rest the intestine. Often, the obstruction may relieve itself and allow
the intestine to start working again. Think of the intestine like a balloon that is blown up (filled with
trapped food and water that has squeezed into a hole or area that it cannot get through). If the
obstruction is complete, a nasogastric (NG) tube is passed through the nose and into the stomach. It
is then connected to suction to keep the stomach emptied out. This also helps treat the nausea and
vomiting. If there is an imbalance in the electrolytes, they are corrected with intravenous fluids.
These fluids have the proper chemicals in them to correct the problem. If the reason for the blockage
does not get better with conservative (nonsurgical) treatment, surgery may be necessary. Sometimes,
surgery is done immediately if your surgeon knows that the problem is not going to get better with
conservative treatment. PROGNOSIS Depending on what the problem is, most of these problems
can be treated by your caregivers with good results. Your caregiver will discuss with you the best
course of action to

Ogilvie's Syndrome Case Report
Introduction
This case report seeks to highlight a rather uncommon yet important complication of caesarean
section; Ogilvie's Syndrome (OS). This syndrome describes the phenomenon of an acute colonic
pseudo–obstruction (ACPO), often without an obvious mechanical cause. The obstruction can then
lead on to bowel perforation or ischemia.
Case Report
We present a case of a young, healthy primigravida who developed OS on Day 6 post caesarean
section (CS), complicated by a perforated caecum and fecal peritonitis. We will summarize the
sequence of events, management and outcome of the patient in this report.
Conclusion
We hope that this report will pique the interest of obstetricians as well as the midwifery staff in
terms of prompt ... Show more content on Helpwriting.net ...
Clinically, it would be rather challenging to differentiate between OS and paralytic ileus in the initial
stage.
CASE REPORT
A 19 years old G1P0 presented for Induction of Labour (IOL) as she was term at 41 weeks.
Antenatal care had been uneventful, and she was categorized as a low–risk pregnancy.She was
induced with 1mg of ProstinD Gel followed by artificial rupture of membrane (ARM) the
subsequent day which showed the presence of light meconium stained liquor. Her labour was
augmented with SyntocinonD and routine labour monitoring was commenced with no abnormal
recordings throughout labour. Following 12 hours of active labour with good progress initially, it
then slowed down and arrested at 8cm. On examination cervix was found to be 8cm dilated and
baby was in direct occiput–posterior position. Subsequently, A Category 2 emergency Caesarean
Section for failure to progress was called.
Caesarean section went smoothly, and abdomen entered via Joel Cohen technique, peritoneal cavity
and pelvic organs appeared normal. No electrocoagulation instruments were used

Symptoms And Treatment Of The Emergency Room
Code Status___No Code__ Allergies__Penicillin____________
Temp (C/F Site) Pulse (Site) Respiration Pulse Ox (O2 Sat) Blood Pressure Pain Scale 1–10
98.3 F Orally 92 Radial 26 94% RA 168/98 9
History of Present Illness Including Admission Diagnosis
Relevant Physical Assessment Findings (normal & abnormal) Relevant Diagnostic
Procedures/Results & Surgeries
(include dates. If not found, state so.)
Admission Diagnosis:
Patient N.L. was brought into the emergency room (ER) and was admitted to the medical–surgical
unit on Tuesday at 1700 complaining of sudden onset of diffuse contraction–like peri–umbilical pain
radiating all over her abdomen on and off for an hour after having lunch at home. Patient was a 9/10
on a pain scale with nausea and vomiting x 2. Her admitting diagnosis were small bowel obstruction
and systemic inflammatory response with leukocytosis.
History of Present Illness:
N.L. has history of constipation and fecal impaction several years ago. Patient also has history of
Diabetes Mellitus type 2 for 9 years, Hypertension for 15 years, and Chronic Obstructive Pulmonary
Disease (COPD) for 5 years. Patient has also had laparoscopic appendectomy 5 years ago for
erupted appendicitis and total hysterectomy 3 years ago due to uterine fibroids. N.L. smoked half a
pack of cigarettes for 20 years and recently cut down to 2 cigarettes per day. N.Ll also drinks
alcohol occasionally, approximately 2 drinks per month.
Family History:
Patient's younger

Short Modest Proposal
1.3.1 Aim:
The purpose of this prospective study is to compare short term outcomes following early and
conventional enteral feeding following anastomosis in colorectal surgeries.
1.3.2 Objectives:
The objectives of the study are:
To study the short term outcomes following early enteral feeding and conventional feeding
management in patients undergoing colonic and rectal anastomosis, with the end points being return
of bowel activity, acceptance / compliance to early enteral feeding, length of hospital stay and
complications between the two study groups.
Popularize early enteral feeding in patients undergoing colonic and rectal anastomosis and support
the concept of fastrack intestinal surgeries.
1.4 MATERIALS AND METHODS
1.4.1 Ethical ... Show more content on Helpwriting.net ...
I understand that I may withdraw at any time without this affecting my future care.
I understand that the information collected about me from my participation in this research and
sections of any of my medical notes may be looked at by responsible persons (ethics committee
members / regulatory authorities).
I give complete access to my records for present and future scientific research

Advantages And Disadvantages Of Endometriomas
The primary outcome of interest was the suturing time. The secondary outcomes were total
operative time, suturing difficulty, intraoperative blood loss, perioperative complications and the
impact of surgery on ovarian reserve.
Statistical analysis
Statistical calculations were performed using Microsoft Excel 2010 (Microsoft Corporation, NY,
USA) and SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version
15 for Microsoft Windows. Student's t and χ2 tests were used to compare continuous and categorical
variables respectively. A probability value (p value) of less than 0.05 was considered significant.
Results
Between December 2014 and March 2016, 86 consecutive patients with endometriomas were
assessed for eligibility. Forty one patients did not meet inclusion criteria and five patients declined
to participate in the study. Figure 1 illustrates the flow of the patients through the study.
Both groups were comparable as regard to age, body mass index, parity, indications for surgery,
basal FSH and mean endometrioma diameter (Table 1).
In both groups, suturing was effective in controlling bleeding from endometrioma bed. Operative
time and suturing time were significantly shorter in the barbed ... Show more content on
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However, barbed sutures shorten operative time and therefore reduce hospital expenses. Intestinal
obstruction may occur if the cut end of the barbed suture is left long. The free end of the barbed
suture can attach to the bowel or the mesentery causing kinking and narrowing of the bowel or
volvulus. Several authors recommended cutting the ends of the barbed sutures flush with the tissues,
burying the ends of the barbed sutures or covering the ends of the barbed sutures with surgicel or
LAPRA–TY device to reduce the risk of bowel obstruction

Social Determinants of Health and Phenomenology to Practice
The purpose of this paper is to thoroughly analyze a patient from a pathophysiological, social, and
philosophical perspective. The World Heath Organization (WHO) social determinants of health will
be applied to the patient data, emphasizing a phenomenological approach to analyze the determinant
of physical environment. By understanding these various influences on a patient's health status, we
can provide a more holistic approach to health care for future patients.
Discussion of Assessment Findings and Application to Social Determinants A 59–year–old male,
whose initials have been changed to "J.S." due to confidentiality purposes, will be the patient for
this paper. J.S. was admitted on January 12, 2014 to the Emergency Room (ER) complaining of
vomiting every 15 minutes and abdominal pain rated at eight out of ten, on a scale where ten is the
highest pain level. J.S. described his abdominal pain as "expanding from the inside of my stomach"
(personal communication, January 15, 2014). J.S. was assessed and had an X–ray and Computed
Tomography (CT) scan preformed while he was in the ER. The X–ray showed that his small bowel
was distended as much as five to six centimeters, and filled with air and gaseous. A CT scan of his
abdomen and pelvic region showed a narrowing of the GI tract lumen (J.S., Medical Chart, January
15, 2014). J.S.'s admitting diagnosis was a Small Bowel Obstruction (SBO), which is a form of
intestinal obstruction where the lumen of the small intestine

The Importance Of Hardship In My Life
Every person that walks the face of the earth has had at least one hardship. Whether it's a cracked
phone or losing a loved one. There will always be moments when times are tough. The hardship in
my life is not as heart ripping as losing a loved one, though slightly more problematic than cracking
your phone. You see my whole life, my stomach never felt right, there would be times that I felt
okay, more often than not though, my stomach would hurt. I never thought much of it as I had just
gotten used to it. I remember in 2nd grade when I would sit in class and I could feel my stomach
ache, I would just tell myself that I had just drank too much water and it wasn't a big deal. I did this
to myself until 7th grade, I told myself that having stomach aches everyday wasn't a big deal and
maybe it was just a part of growing or maybe it was just a family trait. About half way through my
7th grade year my stomach aches became much worse, my stomach would sometimes hurt literally
all day. I couldn't get it to stop no matter how many Tums I took. It progressively worsened until one
day it became terribly bad making me have to go to Children's Mercy. There they listed a long list of
a bunch of things it could be, after telling me all of these names of different diseases I didn't know,
they listed one I did know, Crohn's Disease, which is basically where your immune system is overly
powerful and tries to fight some of my nutrients along with all the stuff it's fighting on a normal

What Is A Bowel Obstruction?
An obstruction could stem from within the cecum, colon, either the ascending, transverse,
descending, sigmoid part of the colon, or rectum within the large intestine. Like a small intestinal
obstruction, the blockage may be partial or complete and should be treated as a medical emergency.
Obstruction of the mechanical nature, are the most common causes in the large intestine.
PATHOPHYSIOLOGY – Interruption of a normal flow of intraluminal contents occurs a bowel
obstruction ensues. The prevention of the passage of the gastrointestinal contents, due to a luminal
defect which causes the obstruction which may be within the wall of the bowel (intrinsic) or external
to the bowel (extrinsic). The small intestine can have a partial or complete obstruction. ... Show
more content on Helpwriting.net ...
Bowel distention can be caused from air and gas being swallowed from bacterial fermentation. The
bowel wall becomes edematous, the normal function absorptive is lost, and fluid is sequestered into
the bowel lumen as the process continues. A loss of transudative fluid into the peritoneal cavity from
the intestinal lumen can occur. Additional ongoing emesis leads to extra loss of Na, K, H, and Cl,
and metabolic alkalosis in the fluid when there is a proximal bowl obstruction. Hypovolemia can be
a result of the lost of these fluids. Emesis, can become feculent, which is normally nearly sterile, can
have an overgrowth of bacteria which occurs in the proximal bowl. Perfusion to the wall of the
intestine is reduced when intramural vessels of the small intestine become compromised and if the
bowl dilation is excessive. If the metabolic needs of the tissue are insufficiently met due to a
possible perfusion to a segment of intestine and unless the process is interrupted, occurrence of
ischemia will appear, which will in the end, lead to necrosis and

Essay On MRI Vs CT Of The Abdomen
MRI vs CT of the abdomen
Imagine growing up as a healthy active child or adult and being able to eat pretty much anything
you desire. Suddenly one afternoon you experience sporadic stomach pain followed with diarrhea
and weakness. Instantly your first thought is what may have upset your stomach? You remain
hopeful that the symptoms will secede on their own. The diarrhea and stomach aches turn into rectal
bleeding and it is at that point you realize these symptoms may be more serious than you think.
Pains become more persistent and worsen day after day so you decide to visit the doctor's office.
How can you tell if these symptoms are indeed a serious life threatening issue? In order for a doctor
to diagnose a patient with severe ... Show more content on Helpwriting.net ...
It affects between 400,000 and 600,000 individuals in North America alone
(www.radiologyinfo.org). This disease may be caused by a combination of factors such as bacterial,
environmental, immunological, and genetic. In Crohn's disease, the affected person's immune
system attacks the intestines. This chronic inflammatory bowel disease exhibits a bimodal age
distribution, with a peak onset between 15 to 30 years. (Corman, 2015). Being diagnosed with such
a disease at a young age it is important to be aware of the medical treatment he/she is receiving.
Although it is said both men and women are prone to this disease it seems to be more prevalent in
women, those of Jewish descent, and whites. An MRI or CT would be ordered by the doctor in the
hospital or outpatient facility. A MRI is a test that uses powerful magnets, radio waves, and a
computer to make detailed pictures inside your body. On the other hand, a CT scan is a computed
tomography scan that generates three–dimensional images of the bones, internal organs and soft
tissue using x–rays. It is said that MRI imaging is preferred over CT scans because it lacks radiation
exposure which is a more sensitive procedure specifically, in both adults and children
(www.hopkinsmedicine.org). On the other hand, CT scans are not recommended for pregnant
women or children unless absolutely necessary due to the amount of increase radiation dose given to
the body. The

Crohn 's Disease And Disease
CROHN'S DISEASE
Crohn's Disease is a chronic inflammation of the gastrointestinal ("GI") tract that can occur
anywhere along the alimentary canal from the mouth to the anus. It is the second most common
form of Inflammatory Bowel Disease ("IBD") after Ulcerative Colitis and can be hard to distinguish
from it due to the overlapping signs and symptoms. They are not, however, the same. With Crohn's
Disease the inflammation most often occurs in the small intestine at the end of the ileum and
continues into the beginning of the colon, but inflammation may be found in multiple places along
the digestive tract at the same time with normal, unaffected areas in between the distended areas.
Furthermore, the disease will spread through every ... Show more content on Helpwriting.net ...
However, it is possible for patients to present with all three symptoms making it more difficult to be
precise. The two most common types of fistula are the Perianal which goes from the rectum to the
skin around the anus; and the Enterocutaneous which goes from the small bowel to the abdominal
wall. Other common forms of fistula are the Retrovaginal which goes from the rectum to the vagina,
Colovesical which goes from the large bowel to the bladder, and the Enteroenteric which is bowel to
bowel.
The symptoms of Crohn's Disease can range from mild to very severe depending on the area of the
gastrointestinal tract involved. When a patient's disease is active, as opposed to being in remission,
the most common signs and symptoms of GI inflammation related to Crohn's Disease are: persistent
diarrhea; rectal bleeding; abdominal cramps and pain, which can vary in intensity and may lead to
vomiting; an urgent need to move the bowels; the sensation of incomplete evacuation; constipation,
which can lead to bowel obstruction; blood in the stool; and mouth sores. Other general symptoms
of IBD that can also be associated with Ulcerative Colitis as well as many other diseases, are: fever;
loss of appetite; weight loss; night sweats; signs of malnutrition from the digestive tract not being
able to properly absorb needed nutrients; anemia; and feeling tired. In addition, while not very
common in children under the age of 10, the lack of

Small Bowel Obstruction Case Study Essay
Sally Checketts
Small bowel obstruction
Student Case Study
Please review the information available in DocuCare patient chart, including demographics, notes,
diagnostics, assessments and flow sheet. Included in the "notes" section is a history and physical (H
& P) which includes a review of systems (ROS), past history and family history as well as the
physical exam (PE).
Please utilize the DocuCare information, your text and other resources to assist in answering the
following questions and to prepare for simulation. Complete your answers with a maximum of 5
sentences. Cut and pasted responses are not acceptable and will result in a low grade. If references
are cited, please use APA format. Submit to canvas prior to the Friday simulation and bring a copy
the day of simulation for in–class review. We will review the case in class and develop a priority
based care plan for this patient.
1. State in your own words what you would say to this patient to explain why she is unable to eat or
drink (relate to diagnosis).
You are unable to eat and drink before surgery because we don't want to make the bowel obstruction
worse because ... Show more content on Helpwriting.net ...
Checketts for adequate hydration by checking many things, but six assessments that are important
are: (1) amount of urinary output or yellow urine, (2) normal blood pressure, (3) elastic skin turgor
with no tenting (Kalia, 2008), (4) basic metabolic panel (BMP) to assess BUN, creatine, and
electrolytes including sodium, potassium, chloride, and bicarbonate (Dehydration, 2016), (5) her
level of consciousness (LOC) including confusion and lethargy, and lastly (6) seizures. Other
assessments include checking if capillary refill is less than three seconds and if pulse and
respirations are normal. I'm also checking to make sure mucus membranes are moist (Kalia, 2008)
and if her eyes normal and not sunken in. I'd perform a urinalysis, a CBC to check hematocrit, and
finally a blood/urine osmolality (Dehydration,

Hall vs. Hilbun Essays
Module 06 Written Assignment
Hall Vs. Hilbun
Eliza B. Gray
Rasmussen College
Authors Note: This paper is being submitted on the 18th of March 2013 for the winter semester of
Medical Law and Ethics section 05.
Hall Vs. Hilbun
The case of Hall versus Hilbun is a case in which an exploratory surgery was conducted to try to
locate a possible blockage in the small bowel to alleviate abdominal pain. Mrs. Hall went into the
hospital complaining of abdominal pain, upon being seen by doctors she was treated by a general
surgeon by the name of Dr. Hilbun who stated he thought the pain was due to a blockage in the
small bowel and thought an exploratory surgery was deemed appropriate for treatment. Mrs Hall
consented to the surgery and at ... Show more content on Helpwriting.net ...
Hilbun alleging that he failed to give attending nursing staff proper care instructions for Mrs. Hall
nor had he provided her case with proper post–surgery follow up. Mr. Hall and her lawyers were
able to find an expert witness by the name of Dr. Hoerr to provide testimony proving the alleged
malpractice. During the trial Dr. Hoerr's testimony was thrown out and deemed inaccurate due to the
fact that he was not familiar with the local standard of care a patient would receive from a different
doctor in the general area.
This case is extremely relevant to what is known as the four D's of negligence; duty, dereliction,
direct cause and damages. Duty is when a doctor and a patient have formed a relationship and said
doctor has taken on the responsibility of taking care of the patient. Dereliction or failure to perform
a duty, there must be some kind of proof that the doctor somehow neglected the doctor neglected the
patient. Direct cause, there must be some kind of proof that what happened to the patient was a
direct cause of how the doctor conducted himself or his failure to act which resulted in injury.
Damages a patient must prove that harm was incurred by the direct result of the physicians actions.
Upon reviewing the four D's I think that it is clear that Mrs. Halls death was not a direct result of Dr.
Hilbuns actions or lack of action. While the surgery did result in a sponge being left in Mrs. Hall's
abdomen that sponge did not directly result in

Sakeenah Case Study
Progress Note CC: "abdominal pain and blood in stool" HPI: Sakeenah is 14 years old African
american girl, she comes to the University of Michigan Pediatric Gastroenterology clinic on
5/22/2018 complaining of abdominal pain. She is accompanied mom and dad today and she
provides the interval medical history, She states that the pain started month ago, epigastric, and
occasionally radiate to right side, described as squeezing or burning pain. She states that the pain is
on/off, in scale of 7–8/10, occur more in the morning. The pain lasts few hours several time a day.
She feels that "food sits in my stomach and doesn't digest." Sakeenah states that pain is worse when
she eating a grassy food, she stop eating it for a while and the pain seems ... Show more content on
Helpwriting.net ...
External ears, nose, and mouth appear normal in appearance, with moist mucous membranes. Neck
is supple with trachea in midline. There is no cervical adenopathy noted. Chest: is clear to
auscultation bilaterally. Heart: has regular rhythm and rate, with no clubbing, cyanosis, or edema of
the extremities. Skin: is without lesions or rashes. Abdomen: soft, nondistended, with no
hepatosplenomegaly or masses noted. The rectal exam showed no sacral dimples or tufts of hair,
normal external rectal exam. Recommendation: 1–Start Miralax 17g mixed in 8oz water/juice. Take
2 times daily. Adjust the dose as needed, to achieve a pudding consistency stool. 2.Blood work today
for celiac and iron studies due to the iron deficiency 3.refer to adolescent gynecology here for her
heavy periods and to see if the low hemoglobin 4.Start iron supplement, 325mg, 3 times

Bowel Obstruction Case
Richard, it is true that most hand outs are intended to be short and concise, but if relevant
information is left out then it does not serve any good purpose for the patient. I just took care of a
young patient the other day who had to have surgery for bowel obstruction. She had been on pain
pills for a while and so the doctors were thinking that was what led to the obstruction. I mentioned
your story sounded so familiar because she was told pain medication can lead to constipation, but
she had on idea constipation can lead to bowel obstruction that required surgery. In talking to her
she told she had been doing everything that she was instructed to do, but then upon further
questioning her I realized she had not been drinking enough water.

The Nurse On Fifth Surgical West
Fifth Surgical West The nurse on fifth surgical west stayed very busy throughout the day. When she
comes on shift her day consists of beside report. Where they are at the patient's bedside giving
report. It is to ensure everything that is said is accurate and nothing is left out. How she prioritizes
her day depends on the patient's needs. It is difficult to know what will happen that day because
patient's can be discharged and admitted. The nurse prioritizes her patients by looking at the reason
they are being treated. If everyone is doing ok then she goes by what medications are due. This is to
reduce the risk of late medications. She also is aware of the patient's pain level. She mentioned if the
patient is in pain or uncomfortable then ... Show more content on Helpwriting.net ...
Without the nurses the doctors would be unaware of their patient's status. It is highly important for
the nurses to collaborate with the doctor in patient care. The nurse I followed was always aware of
how her patients were doing. She sat by her patient's room that way she knew what was going on at
all times. With help of the CNA the nurse was able to provide proper care to each of her patient's. A
medical diagnosis was a small distal bowel obstruction. The patient was NPO, on an NG tube, and
IV fluids. The patient was also bipolar, which was a learning experience. The patient had an incision
lower abdomen from umbilical region down to the pelvic region. It was approximately 10 cm. The
nurse measured her NG to ensure it was in proper placement. She encourage the patient to eat ice
chips to decrease cotton mouth. The nurse educated the patient on how ambulating will help the
bowels to move and relieve abdominal pain. The nurse auscultated the patient's bowel sounds to
ensure the bowels were active. The nurse also had the patient use an incentive spirometer. This is to
ensure the patient does not get pneumonia which would compromise the healing process. The nurse
strongly encourage the patient to suck in air slowly through the mouth piece. The patient was able to
such in 1000 for inspiratory volume. This was doubled from yesterday which was only 500. (Bunker
Rosdahl, 2012) The patient with the bowel obstruction had wound cleaning that is done three

Opioid Case Studies
The client was on a regular diet and was tolerating it well. Upon auscultation, bowel sounds were
positive in all four quadrants. The bowel sounds were slightly hyperactive. Inspection and palpation
of the abdomen by the student nurse revealed no rigidity, tenderness, masses or distention. The
client's last bowel movement was the night prior and reported her stools had been loose. Frequent
loose stools are an expected finding due to the antibiotic treatment for the pneumonia (Deglin &
Vallerand, 2014).
Musculoskeletal Assessment Independent and out of bed as tolerated, the client was ambulating
well. J.S. was considered a fall risk because of her decreased level of consciousness upon arrival to
the unit and possibility of decreased blood ... Show more content on Helpwriting.net ...
The manifestations of an opioid overdose include respiratory depression, pinpoint pupils and a
comatose state. These three symptoms are considered the classic triad, specifically for an opioid
overdose (Lewis et al., 2014). The Narcan, used to stabilize the client, works as an antidote to the
high levels of Percocet and Tylenol in the body from the ingestion of the opioids. Specifically, it
blocks the opioid receptors, ultimately reversing the overdose and saving the client's life (Deglin &
Vallerand, 2014).
The client's secondary diagnosis is community–acquired pneumonia. Typically, immune defense
mechanisms, such as the secretion of alveolar macrophages and immunoglobulins A and G, protect
the lower airway from infection. Streptococcus pneumoniae, the most common causative agent of
community–acquired pneumonia, invades the lungs. The organism triggers an inflammatory
response, resulting in increased blood flow and vascular permeability. Neutrophil activation occurs,
to surround the kill the invading organism. A combination of the offending organism, neutrophils
and fluid from the surrounding blood vessels flood the alveoli, inhibiting normal oxygen
transportation. This filling of the alveoli may lead to tachypnea, tachycardia and dyspnea. Further
obstruction of airflow and an increased impairment of gas exchange occur as mucous production
increases. When

Present Illness Case Study
History of Present Illness: Patient presents with complaints of nausea and abdominal pain that is
occurring two or three times a week. She reports that she has been having this pain for four months.
Patient states pain is around the umbilicus area and then around her entire stomach. She reports the
pain usually lasts one to two hours then goes away. She reports sometimes the pain is accompanied
by nausea but not always. Reports occasional belching. She reports the pain occurs at different
times. It occurs when she eats and when her stomach is empty. Patient reports that an empty
stomach seems to be when she notices the pain the most. She has tried to take TUMS but has not
been successful swallowing the TUMS due to the chalky taste when ... Show more content on
Helpwriting.net ...
Reports nausea and abdominal pain around umbilicus 2–3 times a week and reports its worse when
stomach is empty. Reports stools are soft and usually has BM daily. Occasional belching. Denies
rectal bleeding. Denies bloody stools.
Genitourinary: Denies hematuria, dysuria, urgency, frequency, and incontinence.
Musculoskeletal: Denies muscle weakness
Neurological: Denies headaches or visual changes.
Psychosocial: Reports she interacts well with her friends and enjoys playing sports. Denies ideas of
self harm.
Objective:
Physical Exam: (systems that apply)
Vitals: Temp–97.4 HR–86 BP–98/54 RR–16 SpO2–99% Ht– 48in Wt– 56 lbs
BMI– 17.1 (77% for growth for age)
General: Thin female child that is well groomed and in no distress.
Integumentary: Skin warm and pink with no rashes or lesions.
HEENT:
Head: Normocephalic Eyes: PERRLA Ears: TM normal with no erythema or fluid noted Nose: No
erythema noted or drainage Neck: Full ROM and no tenderness to palpation Mouth/Throat: No
erythema noted, no post nasal drainage noted
Respiratory: RRR. Lungs clear to auscultation in all fields and chest expansion is equal bilaterally.
Cardiovascular: RRR. Normal SI and S2 with no cyanosis or edema
Gastrointestinal: BS are normoactive in all quadrants. No tenderness noted with palpation to
abdomen. Spleen and liver not palpable. No masses palpated. Negative rebound tenderness.

A Research Project On Colon Cancer
Research Project Outcome
Colon cancer claims the lives of 12 Australians each day and is the second largest cancer killer (1).
Colon cancer is one of the leading causes of cancer in the Australian population after the age of 50.
It is essential that Australian men and women are aware of the aggressiveness and severity of the
disease (2) and the primary preventative methods. The Indigenous Australian population, in
comparison to the non–indigenous population, have a higher prevalence of the disease and
experience higher mortality rates (3). Due to the lack of medical resources and awareness, men and
women living in rural areas have an increased risk of developing colon cancer (4). For these reasons,
I have decided to conduct an investigation on the significance, the primary preventative methods
and the impact they can have on the health and awareness of the Australian population.
I conducted my initial research by investigating the internet and books, both of which encompassed
the anatomy of the stomach and allowed me to gather a greater understanding of Colon Cancer.
Bowel cancer is a malignant growth that develops most commonly in the lining of the large bowel.
The vast majority of bowel cancers develop from growths called 'polyps '. Not all polyps become
cancerous. The larger that a polyp grows, the more likely it is to become malignant (cancerous).
Polyps can be easily re moved without surgery by a procedure called a colonoscopy (inspection of
the bowel with a

Small Bowel Ingestion: A Case Study
A 61 year old female was at Christus Spohn South Hospital to have a small bowel series done on
September 15, 2016. She had prior radiographs from September 14, 2016, September 13, 2016 and
September 12, 2016. She also had a CT scan of the abdomen and pelvis from September 8, 2016 and
had a recent surgery on her abdomen. Radiographs of her abdomen showed staples and surgical
clips along her midline in the epigastric region of her stomach. She was being evaluated for a
possible bowel obstruction in the ileus. The radiographic exam of the small bowel was being
performed without the use of fluoroscopy. The patient's radiographic room was prepped before she
came down for the study. A 14x17 digital image receptor was placed lengthwise in ... Show more
Following the ingestion of the barium sulfate a high KUB radiograph was taken using 100 kV and
80 mAs with 50 inch SID. The central ray was 3 inches above the level of her iliac crest and the
exposure was taken at the end of expiration. The time was annotated on each and every radiograph
taken throughout the study. The patient was then rolled onto their right side to allow the stomach to
drain. The patient remained lying on her right side for 15 minutes and then turned back to the supine
position for another high KUB radiograph of the stomach. The same technical factors were used of
100 kV and 80 mAs and a SID of 50 inches with the central ray 3 inches above her iliac crest. On
the 15 minute radiograph the barium had moved to the second part of the small intestine the
jejunum. The patient requested that she stay lying in the supine position instead of lying on her right
side because it was more comfortable for her. The technologist said that was fine because the barium
did move. However, if the barium had not moved, she would have been returned into the right
lateral position. If the patient is able to get up and walk around at this time it is ideal to allow the
barium to start moving through the small

Pancreatic Adenocarcinoma Case Paper
ABSTRACT: A case of pancreatic adenocarcinoma diagnosed following work up for eosinophilia is
reported. A 68 year old female was referred to our Hematology clinic for an absolute eosinophil
count of 1869 per microliter. No allergic signs or symptoms were reported. Laboratory studies for
parasitic infestations autoimmune disease and collagen vascular disease were negative. Computed
Tomography of the abdomen revealed a mass in the neck of the pancreas with biopsy consistent with
adenocarcinoma. The patient received one cycle of modified FOLFIRINOX with complete
resolution of eosinophilia. There are rare case reports of tumor associated blood eosinophilia in sold
malignancies. The finding may be indicative of rapid disease progression and poor ... Show more
Tumor–associated blood eosinophilia (TABE) is rare occurring in about 0.5% of malignanicies [3]
with the onset usually being late when the disease is often widespread [4]. Lowe et al described
eosinophilia in cases of squamous cell carcinoma of the skin, head and neck cancer, lymphoma of
the gastrointestinal tract and cancer of the bladder [5,6,7]. Three cases of eosinophilia in patients
with chromophobe renal cell carcinoma (CRCC) were described by Yong–Bao Wei et al [8]. TABE
may portend a poor prognosis and more aggressive disease

Weight Loss And Decreased Appetite
Weight loss and Decreased Appetite in an 11 year old Girl
History: A.B. is an 11 year old girl who presents with a 7lb weight loss over 4 months. Additionally,
she complains of a 3 week history of decreased appetite. Her primary medical doctor (PMD)
referred her to the emergency department after physical exam revealed a palpable abdominal mass
encompassing nearly her entire right upper quadrant. A.B. reports non–specific abdominal pain that
lasted 2 days, and spontaneously resolved earlier in the week. She denies pain with urination. One
week prior she had URI symptoms and a fever that also resolved. She has a recent history of travel,
to Nicaragua 4 months ago. She has not had any recent sick contacts. Her last bowel movement was
normal today. Her mother recalls her eating strings of fabric as a child. She denies recently eating
hair or fabric but does admit to this in the past. Father states he has noticed areas of her hair being
shorter but when confronted she simply is quiet and cries. A.B. has no past medical or surgical
history prior to this emergency room visit.
Review of Systems:
Constitutional: Recent fatigue and decreased activity. 1 week ago history of fever. 7lb weight loss
over 4 months.
HENT: Denies sore throat.
Eyes: Negative for blurred vision, dizziness
Respiratory: Negative for cough, shortness of breath, or wheezing.
Cardiovascular: Negative for chest pain or syncope.
Gastrointestinal: History of 2 days of abdominal pain, denies vomiting, nausea, or

Bowel Cancer Prevention
Prevention of Bowel Cancer
Introduction
The bowel is a hollow tube within the digestive system composed of the small bowel (small
intestine) and large bowel (colon and rectum). Bowel cancer generally affects the large bowel,
which absorbs water from digested food and then produces waste (Cancer research UK, 2014).
Bowel cancer, also known as colorectal cancer, develops from uncontrollable cell division of polyps,
pre–cancerous growth cells, which cause potential harm within the bowel (Bowel cancer UK, 2016).
Bowel cancer is treatable and curable if diagnosed early; nevertheless, by simply adopting healthier
changes to your lifestyle, two–thirds of cases could be prevented (Cancer research UK, 2010).
Screening and family history
Bowel screening ... Show more content on Helpwriting.net ...
The recommended weekly amount of cooked red meat (beef, lamb and pork) is 500 grams, though it
is advised that red meat and processed meat (bacon, ham and salami) is replaced with healthier
alternatives such as fish, poultry, soya and quorn. (Beating bowel cancer, 2016).
Conclusion
Based on hereditary, lifestyle and dietary factors discussed, bowel cancer can be prevented by taking
these preventative measures into strict consideration. Ultimately, living a healthy lifestyle will lead
towards a lower risk of this unwanted disease, likewise, bad lifestyle choices will significantly
increase the risk. Hence, taking precautions and adjusting lifestyle choices in a positive manner will
not only decrease the possibility of developing bowel cancer but consequently will improve the
quality of life, which is beneficial in the long

Cyst Case Study
Results
Over a period of 4 years, 10 patients (6 men and 4 women) with abdominal complications of VP
shunt catheter were managed. Their ages at operation were ranged from 10 months to 17 years (table
1). All patients were investigated, diagnosed and managed laporoscopically. The median operative
time of the laparoscopic procedure varied according to the diagnosis. It was 120 minutes in
abdominal pseudocysts, 45 minutes in recurrent congenital inguinal hernias, 100 minutes in
adhesive intestinal obstruction and 35 minutes in subcutaneous cyst. All patients were completed
laparascopically except one patient with large amalgamated abdominal pseudocyst; it was converted
to laparotomy with complete excision of the cyst and removal of the catheter ... Show more content
on Helpwriting.net ...
Our series reinforces the feasibility and safety of laparoscopic management for distal catheter
complications. The advantages of the laparoscopic approach include a shorter hospital stay because
of less postoperative pain. The catheter is positioned under direct vision with less bowel
manipulation, thus reducing the risk of bowel injury and the development of adhesions(3).
Laparoscopy allows us to replace the shunts in the abdominal cavity under direct visual guidance
and cut them to appropriate size if necessary.
In addition, laparoscopy is a diagnostic tool that can be used to exclude any other intra–abdominal
process possibly causing abdominal pain. Laparoscopy can be repeated several times in case of
further complications because it is less invasive. This is not the case with laparotomy, which is more
traumatic (3).
The potential problem that has been raised is retrograde leakage of carbon dioxide into the ventricle.
This was not recognized in our series and has not been reported previously. A recent in vitro study
found that none of the valves tested showed any signs of leak associated with increased gaseous
back pressure below a pressure of 80 mm

Small Bowel Obstruction Case Study
Small Bowel Obstruction
The 78–year–old female client came into the emergency room (ER) with intractable nausea and
vomiting over the previous 24 hours. She also presented with leukocytosis of approximately 14,000
cells/uL, mild hyponatremia and hypokalemia, and mild distention. The client was otherwise
asymptomatic. An abdominal X–ray was able to identify and locate an adhesive related obstruction
in her small intestine, resulting in a diagnosis of a Small Bowel Obstruction (SBO) (Lewis, Bucher,
Heitkemper, & Harding, 2017). A SBO is a disruption in the progression of chyme in the
gastrointestinal (GI) system (McCance, Huether, Brashers, & Rote, 2014). When it is an adhesive
related SBO, fibrin is what is responsible for attaching a segment

Hillcrest Medical Case 2
RADIOLOGY REPORT
Patient Name: Benjamin Engelhart
Patient ID: 112592 DOB: 10/05/ Age: 46 Sex: M
CT Scan No: 10–790031
Ordering Physician: Alex McClure, MD
Procedure: CT scan of abdomen and pelvis without contrast.
Date of Procedure: 11/14/2012
HISTORY: RLQ pain, no previous studies.
ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals,
kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study
appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of
the abdomen appeared unremarkable. No free air was seen.
PELVIS: Good quality, non contrasted actual CT examination of the pelvis with coronal
reconstructions. ... Show more content on Helpwriting.net ...
He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very
small bowel movement earlier this morning that was not normal for him. He has not passes has the
morning. 'he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ
without radiation at this point. He has never had a colonoscopy.
PAST MEDICAL HISTORY: Significant for arthritis of bilateral hips seen by Dr. Hersch.
PAST SURGICAL HISTORY: Negative
MEDICATIONS: Piroxicam for degenerative joint disease of bilateral hips
ALLERGIES: No known drug allergies
SOCIAL HISTORY: Patient admits alcohol ingestion nightly and on weekends. Denies tobacco use
and illicit drug us. He is married.
FAMILY HISTORY: No history of cancer or inflammatory bowel disease in his family.
REVIEW OF SYSTEMS;;12 point ROS was preformed and is negative except noted in above HIP,
PMH and PSH. Careful attention was paid to endocrine, integumentary, pulmonary, renal and
neurological exam
PHYSICAL EXAMINATION: Vital Signs. TEMPERATURE: 101.0, Blood Pressure– 127/179,
Heart Rate–129, Respirations– 185, Weight–215. Situations 96% on room air. Pain Scale– 8/10.
HEENT–Normal cephalic, atrumatic pupils equally round and reactive to light. Extra ocular motions
intact. ORAL: Shows oral pharynx clear but slightly dry mucosal membranes. TMS: Clear. NECK:
Supple, No thrangegally or JVD. No cervical, subclavicular, axilarry or lingual lymphinalpathy.

Preceptor Experience Essay
The second half of my preceptorship went well and I learned a lot. I felt comfortable giving
medications, performing assessments, and caring for the patients. I was able to complete all of my
objectives. We were in the ER for one day, and the rest of the time my preceptor was the Charge
Nurse on the med–surg floor. I gave medications every day that I was precepting. When giving
medications I am very cautious. I verify the patient, and we scan the patient and medications. But
sometimes medications are split in half and I needed to make sure to set them aside during scanning.
One day I scanned an aspirin and the computer said it was for the wrong patient. I verified the
medication on the MAR, and it was the correct medication. My preceptor said that happens
sometimes, and we manually entered the medication. I feel comfortable giving medications, but will
continue to be cautious. I performed assessments every day of preceptorship. Lung sounds can be
difficult for me to identify, so I liked being able to listen and ask my preceptor if she heard the same
thing. I heard a whooshing sound over the heart of one of my patients and spent extra time listening
to it. I guess he noticed that I was confused because he told me that he has a Pig Valve. Some of the
other sounds I could verify were crackles and wheezes. ... Show more content on Helpwriting.net ...
This was awkward for me since I have never been around it. I did not help with post–mortem care
because they were not our patients and we were busy doing other things. My preceptor had to call
Lifeshare for organ and tissue donation, even though the patient was not an organ donor. This is
standard for all patients that pass away. The spouse of the patients insisted that the patient wasn't an
organ donor, but Lifeshare insists on talking to a family member. After telling Lifeshare that the
patient's religion was a Seventh Day Adventist, they didn't need to talk to the family because that
religion does not donate

Nursing Care Pl Nursing
Nursing Care Plan
STUDENT–Cassandra Varnum____COURSE–NURS 101L DATE March 14, 2015 FACULTY
Anna Tevosyan Patient Initial N.L Age –48 Ht/Wt–162.56cm/72.3kg Unit –Medical/Surgical Unit
Room–# 234 Code Status–No Code Allergies– Penicillin
Temp (C/F Site) Pulse (Site) Respiration Pulse Ox (O2 Sat) Blood Pressure Pain Scale 1–10
98.3 F/Orally 92 Beats per Minute 26 Breaths per minute 94% 168/98 9/10
History of Present Illness Including Admission Diagnosis
Relevant Physical Assessment Findings (normal & abnormal) Relevant Diagnostic
Procedures/Results & Surgeries
(include dates. If not found, state so.)
Admission Diagnosis– Patient ... Show more content on Helpwriting.net ...
Her mother had a history of diabetes and hypertension and died of Cerebrovascular accident (CVA)
at age 63. Her younger brother currently has Diabetes Mellitus and hypertension.
Abnormal Physical Assessment Findings– Patient N.L had respiratory rate of 26 beats per minute
(RR), Blood pressure of 168/98 (BPM), and Oxygen Saturation of 94%, complaining of moderate to
severe distressed abdominal pain. Palpating abdomen shows distentions and bowel sounds are
absent in the lower quadrants with tenderness in the peri–umbilical area.
Normal Physical Assessment Findings– Patient N.L was afebrile with temperature of 98.3 orally and
92 pulse beats per minute. General appearance reveals a pleasant AA female. She is awake and
oriented. There was no trauma to the head and her skin was warm, dry and intact. Lung and heart
sounds were normal. Chest X–Ray (CXR)
This is a non–invasive procedure that is performed in order to view the through the chest cavity
including the heart, lungs, blood vessels, and chest bones. (National Heart, Lung, and Blood
Institute, 2010)
Patient's Chest x–ray came back normal two days ago.
Abdominal and Pelvic CT
This procedure is a diagnostic test that is used to view and diagnose abdominal and pelvic pain and
diseases that are located in those internal organs. (Radiology Info, 2014)

Patient's CT shows dilated small bowel with focalization identified in the distal small bowel with a

Hall V. Hilbun
Hall v. Hilbun– The four D's of negligence
The four D's of negligence are duty, dereliction of duty, direct or proximate cause, and
damages. In order to obtain a judgment of negligence against a doctor the patient has to be able
to show all four D's in the case. In the case Hall v. Hilbun, Mrs. Hall was the patient and Dr.
Hilbun was her surgeon.
Duty is the responsibility that a doctor has to a patient. A patient has to prove that a
relationship with the doctor has been established. In the case Hall v. Hilbun there was a
relationship established when Mrs. Hall was admitted to the Singing River Hospital complaining
of discomfort in her abdomen, and Dr. Hilbun was asked to examine her. On examination, Mrs. ...
Show more content on Helpwriting.net ...
Mr. Hall
filed a malpractice/wrongful death action against Hilbun. He alleged that Hilbun failed to inquire
about Mrs Hall's recovery and failed to give proper instructions to the hospital nurses.
Fremgen, B, F.(2012). Medical Law and Ethics. New Jersey:Pearson Prentice Hall
Retrieved from:

Giant Inguinoscrotal Herni A Case Report
Giant InguinoScrotal Hernia: A case report
Abstract: Giant Inguino scrotal hernia, though an uncommon entity presents with operative dilemma
as there are no standard surgical procedure. Here we present a case of giant inguinoscrotal hernia
which was partly reducible. Patient underwent mesh repair after reduction of content through
inguinal and lower midline laprotomy with scotal reconstruction.
Key words: Giant inguino–scrotal hernia, mesh repair.
Introduction:
Giant inginoscrotal hernia are defined as, extending beyond the midpoint of thigh in standing
position. Such cases are due to neglect of symptoms by the patient till it affects the quality of life or
present with complications. Operative intervention in such cases is assosciated with high motality
and post operative complications. We present a case of giant inguinoscrotal hernia, partially
reducible with no co morbidities. Case Report:
A 49yrs Auto rickshaw driver presented to us with the complains of swelling in right groin since
20yrs which was initially reducible and since last 5yrs its not reducible. Patient had difficulty in
walking and performing his daily activities. Patient is a smoker since 30yrs.
On examination: Right sided Ingunioscrotal swelling extending upto lower 1/3 of thigh in standing
position, non reducible, cough impulse present, right side testis was atropic with elongated
spermatic cord.
Preoperatively patient was advised to quit smoking and incentive spirometry exercises for 2weeks.

Chronic Acalculous Cholecystitis
When a patient comes with abdominal pain, it can be due to different causes. The pain may be
visceral, somatoparietal or referred pain as an indicator of a wide variety of systemic and local
causes. Visceral pain is from abdominal distention or stretching of the muscle fibers, carried by
sympathetic nerve fibers, presents as dull, poorly localized pain in the mid areas of the abdomen.
Somatic pain occurs once the parietal peritoneum is inflamed or irritated, and passed by sensory
fibers. Somatic pain is better defined and more localized, high intensity, and also associated with
tenderness and spasm of the localized muscle groups.
Differential diagnosis
Chronic Acalculous Cholecystitis: Here Ms. G presented with right upper abdominal pain, ... Show
more content on Helpwriting.net ...
G: Ms. G appears ill–looking, uncomfortable and clutching her abdomen, as she is experiencing
pain, she rated her pain as eight on the scale of 0 to 10 as 10 being the worse pain. The pain of Ms.
G is in her upper abdomen and radiating to her upper right back and right scapular tip consistent
with Collins sign. The pain initially stated as achy but changed to colicky in nature and became
more constant. The pain started after she ate and vomited few times before arrival. Percussion of
Ms. G's abdomen is significant for tenderness to palpation towards her upper right quadrant a
positive murphy's sign, without rebound tenderness. Bowel sounds are normal. Ms. G's clinical
presentation is consistent with Cholecystitis. The pain for Cholecystitis usually starts within an hour
post food; it can last from one to five hours and increases steadily over ten to twenty minutes along
with Collins sign, and the pain doesn't relieve after vomiting.
Diagnostic tests
CBC with differential
Leukocytosis with a left sided shift is the common abnormality in Cholecystitis. A high white blood
cell count suggests inflammation, an abscess, gangrene, or a perforated gallbladder.
Gall bladder ultrasound
Gall bladder ultrasound typically helps in establishing the diagnosis of Cholecystitis. A sonographic
Murphy's sign, (when the ultrasound probes the ultrasound patient will have pain) is a useful
diagnostic

Bubble Boy Disease Case Study
The case presented regards a young Arabian foal that exhibited lethargy and diarrhea for two weeks.
Upon examination, it was noted that the animal had a fever, conjunctivitis, an elevated heart rate and
trouble breathing. Hematological tests revealed that the horse suffered from leucopenia, severe
lymphopenia and possessed no M immunoglobulins. From these findings, it was deduced that the
foal suffered from severe combined immunodeficiency (SCID). The diagnosis was confirmed by a
molecular test that identified the mutation responsible for dysfunctional T and B cells, which causes
SCID in Arabian horses. The patient died due to viral and bacterial pneumonia. Upon necropsy
examination, its lung infection was evident, as was the hypoplasia of its spleen. ... Show more
An attempt to cure an animal was made through bone marrow transplant, the horse died after a year.
Similar to the "bubble boy" disease in humans, a foal that is born with the mutation causing SCID
lacks both T and B appropriate cell function, their antigen receptors are dysfunctional, its natural
killer cells, despite being a part of the innate immune response, may be affected, as they are also
descendants of the common lymphoid progenitor. Without these receptors, the lymphocytes do not
differentiate, with all components of the adaptive immunity affected, the sick individuals are in a
state of immunodeficiency: their immune systems are incapable of fighting infectious diseases. This
explains why affected animals die because of multisystemic infections, a consequence of SCID:
without any functional B cells, no antibodies are produced, they can't perform their usual roles of
neutralization, opsonization and complement activation. They also can't be activated by T cells. T
cells, on the other hand, are unable to kill infected cells, activate macrophages and B

Pancreatitis Essay
Pancritits is an inflammation of the pancreas characterized by a process in which the digestive
enzymes are spilled out to autodiagest the pancreatic paranchema(1). Pancreatits is known to be
found in two major forms, one of which is marked by the presence of inflammatory cells resulting in
reversible structural and functional changes; known as acute pancreatitis (AP). On the other hand,
chronic pancreatits is known to have irreversible changes that ultimately results in fibrosis and loss
of exocrine and/or endocrine function(2). We focus here on acute pancreatitis in children. Children
with AP usually presents with abdominal pain as a cardinal sign accounting for 87% of all
presentations. However, other nonspecific symptoms might present, ... Show more content on
Helpwriting.net ...
An American study published in 1999 states that 25% of AP in children is of unknown etiology, and
13% to 33% of the cases are attributed to blunt trauma making it to be the most common cause of
pancreatitis in both adult and pediatrics (5). However, more recent study claims that pediatric AP
due to trauma is less common than previously believed, and a more broad list of causes is seen,
including biliary tract disease, systemic diseases, autoimmune disorders, anatomical anomalies,
drugs, and genetic and hereditary diseases (6). Racial and geographical variations are recognizable
in the course and etiology of pediatric AP(7). A study conducted in Japan and published in 1994
states that congenital dilatation of the common bile duct is more common in Japanese and Chinese
children, wheres trauma is more common among Western children(PDF 8). Another retrospective
chart review study conducted in the United States collected data between 1998 and 2008 states that
17% of African–American children were admitted to a pediatric intensive care unit, while only 7%
of white children were admitted. The same study found that boys and malnourished children have
longer stay than girls, obese and children of healthy weight

Living With Crohn 's Disease
Living with Crohn's Disease
Sharon is a 17 year old young women, her mother noticed that Sharon had lost a significant amount
of weight, and she looked pale and had dark circles under her eyes. Sharon was complaining of
severe diarrhea, stomach cramps, and after battling this for weeks she was extremely tired. Her
doctor conducted a standard physical exam, and interviewed Sharon about her general health, diet,
family history, and environment.
Her doctor performed laboratory tests of blood and stool matter, as well as X–rays of the upper and
lower gastroesophageal tract (GI).Sharon had to have a colonoscopy to obtain a biopsy of the colon.
Sharon was diagnosed with Crohn's disease.
Crohn's disease, also called Regional Enteritis, belongs ... Show more content on Helpwriting.net ...
Cells move from the blood into the intestines and produce inflammation which is a normal immune
system response. The inflammation does not subside, leading to chronic inflammation, ulceration,
thickening of the intestinal wall, and eventually causing patient symptoms.
The tell–tale symptoms of Crohn's disease are abdominal cramps and pain, urgent need to move
bowels, sensation of incomplete evacuation, severe or persistent diarrhea, constipation which may
lead to bowel obstruction, rectal bleeding, fatigue, weight loss, loss of appetite and malnutrition
because the disease causes inflammation of the lining of your digestive tract .Some other general
symptoms may also include, fever, night sweats, loss of normal menstrual cycle. Crohn 's disease
can be both painful and incapacitating, and sometimes may lead to life–threatening complications. If
you think you are showing signs of Crohn's Disease, loss of appetite, weight loss, and feeling of low
energy, and fatigue, schedule an appointment with your doctor. Crohn 's disease in children may
delay growth and development. Remember, only your doctor can render a diagnosis, so seek
medical attention if experiencing any of these symptoms because in more severe cases, Crohn's can
lead to tears in the lining of the anus, which may cause pain and bleeding. Inflammation may also
cause a fistula to develop, which is a tunnel that

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