OSCE_ppt_questions_yr_2.ppt
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This document contains 6 scenarios describing different patient cases. Scenario 1 involves inserting an indwelling catheter for a patient with urinary incontinence. Scenario 2 involves teaching a student how to administer insulin using a sliding scale for a diabetic patient with high blood sugar. Scenario 3 involves assessing a patient diagnosed with depression for key symptoms of depression. Scenario 4 involves providing health education on drugs and diet for a hypertensive patient. Scenario 5 involves commencing an intravenous infusion for a patient with severe dehydration. Scenario 6 involves performing an immediate postoperative assessment for a patient who had surgery for bowel obstruction.
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Report 2: Discharge Summary
Diagnoses include:
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4. Hypertension.
HOSPITAL COURSE:
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2. Nurses are asked to answer questions for each case related to diagnoses, monitoring, patient education and medication management.
3. Lab results, provider orders and treatment plans are still pending or in progress for some of the patients.
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A 37-year-old female presented to the emergency room with abdominal pain, shortness of breath, chest pain, and palpitations. She had a history of gestational diabetes. Laboratory tests confirmed diabetic ketoacidosis with high blood glucose, ketones, low pH, and high anion gap. She was treated according to guidelines with IV fluids, insulin, electrolyte replacement, and antibiotics. Over four days in the ICU and medical ward, her condition improved as her acidosis, electrolytes, blood glucose, and vital signs normalized.
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Diagnoses include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location.
2. Vena Cava syndrome post placement of Hickman catheter.
3. Anemia due to chronic disease.
4. Hypertension.
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3. Lovenox 1 mg/kg subcutaneously every 24 hours.
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Background This case study presents a 68year old righthan.pdf
Background
This case study presents a 68-year old right-handed African-American man named Randall
Swanson. He has a history of hypertension, hyperlipidemia and a history of smoking one pack per
day for the last 20 years. He is prescribed Atenolol for his HTN, and Simvastatin for
Hyperlipidemia (but he has a history of not always taking his meds). His father had a history of
hypertension and passed away from cancer 10 years ago. His mother has a history of diabetes
and is still alive.
Story
Randall was gardening with his wife on a relaxing Sunday afternoon. Out of nowhere, Randall fell
to the ground. When his wife rushed to his side and asked how he was doing, he answered with
garbled and incoherent speech. It was then that his wife noticed his face was drooping on the right
side. His wife immediately called 911 and paramedics arrived within 6 minutes. Upon initial
assessment, the paramedics reported that Randall appeared to be experiencing a stroke as he
presented with right-sided facial droop and weakness and numbness on the right side of his body.
Fortunately, Randall lived nearby a stroke center so he was transported to St. Johns Regional
Medical Center within 17 minutes of paramedics arriving to his home.
Day 1
Initial Managment
Upon arrival to the Emergency Department, the healthcare team was ready to work together to
diagnose Randall. He was placed in bed with the HOB elevated to 30 degrees to decrease
intracranial pressure and reduce any risks for aspiration. Randalls wife remained at his side and
provided the care team with his brief medical history which as previously mentioned, consists of
hypertension, hyperlipidemia and smoking one pack per day for the last 20 years. He had no
recent head trauma, never had a stroke, no prior surgeries, and no use of anticoagulation
medications.
Physical Assessment
Upon first impression, Nurse Laura recognized that Randall was calm but looked apprehensive.
When asked to state his name and date of birth, his speech sounded garbled at times and was
very slow, but he could still be understood. He could not recall the month he was born in but he
was alert and oriented to person, time, and situation. When asked to state where he was, he could
not recall the word hospital. He simply pointed around the room while repeating here.
Further assessment revealed that his pupils were equal and reactive to light and that he presented
with right-sided facial paralysis. Randall was able to follow commands but when asked to move his
extremities, he could not lift his right arm and leg. He also reported that he could not feel the nurse
touch his right arm and leg. Nurse Laura gathered the initial vital signs as follows: BP: 176/82, HR:
93, RR: 20, T:99.4, O2: 92% RA and a headache with pain of 3/10.
Doctors Orders
The doctor orders were quickly noted and included:
-2L O2 (to keep O2 >93%)
500 mL Bolus NS
VS Q2h for the first 8 hrs.
-Draw labs for: CBC, INR, PT/INR, PTT, and Troponin
-Get an EKG
-Chest X ray
-CT
-Gluc.
CKD MBD - Drug Related Issues - Dr. Gawad
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Session 3, GIT diseases
Based on the information provided:
- Inspection revealed jaundice and tattoos, suggesting possible liver disease
- Abdominal examination showed no masses, organomegaly, or tenderness. However, jaundice suggests underlying liver disease
- His history of illicit drug use, smoking, and frequent heartburn are risk factors for peptic ulcer disease or esophageal varices due to liver disease
- The absence of melena, hematemesis as the initial symptom, no change in stools, and no epigastric tenderness make peptic ulcer disease less likely
- Jaundice and history of illicit drug use suggest possible underlying chronic liver disease as the cause of his bleeding
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Untitleddocument (2)
Emily Grace, a 45-year-old woman, was admitted to the medical-surgical unit with a small bowel obstruction. She has a 4-day history of abdominal pain and vomiting up to 12 times per day, with blood-streaked vomitus. Her medical history includes hypertension and type 2 diabetes. The learning objectives are to care for a patient with a small bowel obstruction and manage a nasogastric tube. The simulation will focus on a focused abdominal assessment and nasogastric tube management for Emily Grace.
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ا.د/هند الهلالي "ورشة عمل
Principles of poisoning management
الورشة التي قدمت يوم الثلاثاء 8 ابريل 2014 في دار الحكمة بالقاهرة
من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب
و ضمن موديول الطوارئ و التخدير و العناية المركزة
Anticholinergic Plant Poisoing
Eleven elderly patients were brought to the emergency room after ingesting an unknown bitter green leafy vegetable. They exhibited symptoms of anticholinergic poisoning such as blurred vision, dilated pupils, dry mouth, confusion and urinary retention. The document discusses anticholinergic plant poisoning caused by tropane alkaloids found in plants such as Datura, treatment involving supportive care and potentially physostigmine, and monitoring patients until symptoms resolve.
1.The APRN is giving a pathophysiology lecture to APRN students on .docx
1. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow
Question:
What would be the most important concept of hormonal regulation that the APRN should address?
2. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, related hormones, and glomerular filtration rate.
Question:
What would be the most important concept of glomerular filtration rate that the APRN should address?
A 46-year-old Caucasian female presents to the PCP’s office with a chief complaint of severe, intermittent right upper quadrant pain for the last 3 days. The pain is described as sharp and has occurred after eating french fries and cheeseburgers and radiates to her right shoulder. She has had a few episodes of vomiting “green stuff”. States had fever and chills last night which precipitated her trip to the office. She also had some dark orange urine, but she thought she was dehydrated.
Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl. Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment.
Question 1 of 2:
Describe how gallstones are formed and why they caused the symptoms that the patient presented with.
Question 2 of 2:
Explain how the patient became jaundiced
3. Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days. The pain has significantly increased over the past 6 hours and is now accompanied by nausea and vomiting. The pain is described as “sharp and boring” in mid epigastrum and radiates to the back. Ruth admits to a long history of alcohol use, and often drinks up to a fifth of vodka every day.
Physical Exam: Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air.
General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly.
CV-tachycardic. RRR without gallops, rubs, clicks or murmurs
Resp-decreased breath sounds in both bases with poor inspiratory effort
Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed. Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.
The APRN makes a tentative diagnosis of acute pancreatitis based on history and ph.
Urgent-start PD
The document outlines a protocol for urgent-start peritoneal dialysis (PD). It defines urgent-start PD as initiating dialysis before the traditional 2-week waiting period after PD catheter placement for patients who need dialysis but do not require emergent dialysis. The protocol describes key elements, patient selection criteria, orders for catheter placement and PD initiation, prescriptions, transition to home PD training, and managing emergent situations with hemodialysis.
Toxic cases emergency
مشروع إعداد طبيب حكيم ناجح- المعهد العربي للتنمية المهنية المستدامة دورة الطوارئ و التخدير و الرعاية 8-4-2014
61182471 case-study-final
The document discusses diabetic nephropathy, a progressive kidney disease caused by damage to blood vessels in the kidneys from long-term diabetes. It causes nephrotic syndrome and kidney scarring. The exact cause is unknown but uncontrolled high blood sugar is believed to damage the tiny filtering units in each kidney over time. Symptoms include swelling, foamy or frothy urine, weight gain, fatigue, headaches, nausea and poor appetite. Proper management of blood sugar and blood pressure can help prevent or slow the progression of kidney damage.
Acute complications of haemodialysis
This document discusses various acute complications that can occur during hemodialysis and how to manage them. It describes common complications like hypotension, cramps, dialysis disequilibrium syndrome, steal syndrome, headaches and chest pain. It provides guidance on prevention, recognition and initial treatment of these complications through case examples. Preventing complications requires careful management of fluid removal rates, electrolyte and medication adjustments, and recognizing signs and symptoms to address issues promptly.
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