stomach has been hurting for the past.docx
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A 65-year-old African American male presented to the emergency department with intermittent epigastric abdominal pain that radiated to his back for the past two days. The pain had been increasing in severity over the past few hours and led him to vomit after lunch. He was previously given PPIs by urgent care with no relief. His medical history includes hypertension, GERD, and hyperlipidemia.
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Urinary FunctionMr. J.R. is a 73-year-old man, who was .docx
Urinary Function:
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions
The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
Create a list of risk factors the patient might have and explain why.
Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study Questions
...
1 A 45-year-old male comes to the clinic with a chief complaint.docx
1 A 45-year-old male comes to the clinic with a chief complaint
QUESTION 1 A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. Also, he denies nausea, vomiting, weight loss or obvious bleeding. Finally, he admits to bloating and frequent belching.
PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.
Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
1 of 2 Questions:
What factors may have contributed to the development of PUD?
2 of 2 Questions:How do these factors contribute to the formation of peptic ulcers?
QUESTION 3 A 36-year-old morbidly obese female comes to the office with a chief complaint of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. Says she has started coughing at night which has been interfering with her sleep. Also, denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
Family history-non contributary
Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn
Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping
The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).
Question:
The client asks the APRN what causes GERD. What is the APRN’s best response?
QUESTION 4 A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.
Question:
What factors can contribute to an upper GI bleed?
Question 5 A 64-year-old steel worker presents to h.
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docx
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
Ht 6 10.docx
A 65-year-old male presented to the emergency department with abdominal pain. His vital signs and physical exam revealed abdominal tenderness. Potential diagnoses considered included abdominal aortic aneurysm, perforated ulcer, and pancreatitis. Additional history should be taken and diagnostic tests performed to further evaluate the patient's condition and symptoms to make an accurate diagnosis.
Chief complaint I have recurrent H. Pylori infection”.HP.docx
Chief complaint:
“I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries:
None
Allergies
:
NKDA
Vaccination History:
Up-to-date
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea.
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
Assessment:
Primary Diagnosis:
Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:
two months ago and
failed.
Clarithromycin 500 mg po BID for 2 weeks
Omeprazole 40 mg po BID for 2 weeks and then po daily.
Cipro 500 mg po BID for 2 weeks
Plan: Tests
Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results.
Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test.
Labs:
No new labs are needed.
Referrals
: may refer based on effect of medication therapy given for 2 weeks.
Follow up:
return to office in 8 weeks to reevaluate symptoms.
As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection.
Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.
Below is the website for the
American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.
Follow APA guidelines
ht.
Abdominal Ultrasound Reveals Enlarged.docx
A 36-year-old male presented with abdominal pain, back pain, nausea, weight loss, and oily stools. An abdominal ultrasound revealed an enlarged pancreas with calcification, and the patient was diagnosed with pancreatitis. Further history and testing were needed to confirm the diagnosis and assess risk factors, stage, and treatment options.
Chief complaint I have recurrent H. Pylori infection”. HPI .docx
Chief complaint:
“I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries:
None
Allergies
:
NKDA
Vaccination History:
Up-to-date
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea.
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
Assessment:
Primary Diagnosis:
Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:
two months ago and
failed.
Clarithromycin 500 mg po BID for 2 weeks
Omeprazole 40 mg po BID for 2 weeks and then po daily.
Cipro 500 mg po BID for 2 weeks
Plan: Tests
Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results.
Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test.
Labs:
No new labs are needed.
Referrals
: may refer based on effect of medication therapy given for 2 weeks.
Follow up:
return to office in 8 weeks to reevaluate symptoms.
-As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection.
1)Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.
Below is the website for the
American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.
Total of .
Hernia Presentation
A 55-year-old male construction worker presented to the emergency department with pain in his groin, nausea, vomiting and fever. He reported a six-month history of a lump in his groin that was painful with exertion. On examination, he had an obvious, irreducible, firm lump above his inguinal ligament that was tender to touch and dusky in color, consistent with a strangulated inguinal hernia. His symptoms and examination findings indicated an urgent need for surgical referral and hernia repair.
Recommended
Urinary FunctionMr. J.R. is a 73-year-old man, who was .docx
Urinary Function:
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions
The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
Create a list of risk factors the patient might have and explain why.
Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study Questions
...
1 A 45-year-old male comes to the clinic with a chief complaint.docx
1 A 45-year-old male comes to the clinic with a chief complaint
QUESTION 1 A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. Also, he denies nausea, vomiting, weight loss or obvious bleeding. Finally, he admits to bloating and frequent belching.
PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.
Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
1 of 2 Questions:
What factors may have contributed to the development of PUD?
2 of 2 Questions:How do these factors contribute to the formation of peptic ulcers?
QUESTION 3 A 36-year-old morbidly obese female comes to the office with a chief complaint of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. Says she has started coughing at night which has been interfering with her sleep. Also, denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
Family history-non contributary
Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn
Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping
The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).
Question:
The client asks the APRN what causes GERD. What is the APRN’s best response?
QUESTION 4 A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.
Question:
What factors can contribute to an upper GI bleed?
Question 5 A 64-year-old steel worker presents to h.
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docx
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
Ht 6 10.docx
A 65-year-old male presented to the emergency department with abdominal pain. His vital signs and physical exam revealed abdominal tenderness. Potential diagnoses considered included abdominal aortic aneurysm, perforated ulcer, and pancreatitis. Additional history should be taken and diagnostic tests performed to further evaluate the patient's condition and symptoms to make an accurate diagnosis.
Chief complaint I have recurrent H. Pylori infection”.HP.docx
Chief complaint:
“I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries:
None
Allergies
:
NKDA
Vaccination History:
Up-to-date
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea.
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
Assessment:
Primary Diagnosis:
Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:
two months ago and
failed.
Clarithromycin 500 mg po BID for 2 weeks
Omeprazole 40 mg po BID for 2 weeks and then po daily.
Cipro 500 mg po BID for 2 weeks
Plan: Tests
Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results.
Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test.
Labs:
No new labs are needed.
Referrals
: may refer based on effect of medication therapy given for 2 weeks.
Follow up:
return to office in 8 weeks to reevaluate symptoms.
As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection.
Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.
Below is the website for the
American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.
Follow APA guidelines
ht.
Abdominal Ultrasound Reveals Enlarged.docx
A 36-year-old male presented with abdominal pain, back pain, nausea, weight loss, and oily stools. An abdominal ultrasound revealed an enlarged pancreas with calcification, and the patient was diagnosed with pancreatitis. Further history and testing were needed to confirm the diagnosis and assess risk factors, stage, and treatment options.
Chief complaint I have recurrent H. Pylori infection”. HPI .docx
Chief complaint:
“I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries:
None
Allergies
:
NKDA
Vaccination History:
Up-to-date
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea.
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
Assessment:
Primary Diagnosis:
Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:
two months ago and
failed.
Clarithromycin 500 mg po BID for 2 weeks
Omeprazole 40 mg po BID for 2 weeks and then po daily.
Cipro 500 mg po BID for 2 weeks
Plan: Tests
Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results.
Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test.
Labs:
No new labs are needed.
Referrals
: may refer based on effect of medication therapy given for 2 weeks.
Follow up:
return to office in 8 weeks to reevaluate symptoms.
-As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection.
1)Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.
Below is the website for the
American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.
Total of .
Hernia Presentation
A 55-year-old male construction worker presented to the emergency department with pain in his groin, nausea, vomiting and fever. He reported a six-month history of a lump in his groin that was painful with exertion. On examination, he had an obvious, irreducible, firm lump above his inguinal ligament that was tender to touch and dusky in color, consistent with a strangulated inguinal hernia. His symptoms and examination findings indicated an urgent need for surgical referral and hernia repair.
Exercise ContentChief Complaint I fell down in my .docx
Exercise Content
Chief Complaint: “I fell down in my house a week ago and my knee is still hurting”.
History of Present Illness: Mr. Brown is 45-year-old male teacher who presents to the clinic with symptoms of right knee pain related to a fall sustained at home one week ago while he was coming down the stairs. Patient states that he tripped and during the fall, the right knee twisted and was caught between two bars of the stair wells. Immediately after the fall, the pain was sharp and stabbing, and he was unable to walk straight and apply weight on the knee. He applied ice and took 800mg of Motrin and went to bed. Patient states he did not want to go to the emergency department because of the long wait. After 24 hours he applied warm compresses intermittently and took extra strength Tylenol as needed. Mitigating factors include ES Tylenol, heat application, and resting the knee. However, sometimes the pain is so severe that even Tylenol does not help. Aggravating factors are standing too long, bending the knee, and climbing stairs. He describes the pain as sharp, and annoying at the same time. At present time he feels like "something is not right inside the knee”. Level of pain is 8/10. He denies previous musculoskeletal injuries.
Patient also reports shortness of breath but denies chest pain.
PMH: Asthma, bipolar disorder. Left knee anterior crucial ligament (ACL) 10 years ago from basketball injury.
Past surgical history: Right hip replacement 15 years ago from kick boxing.
Medications/OTC: Theophylline, Prednisone, Singular, Geodon, Prozac, Benadryl.
Allergies: NKA.
Past family history: One brother with asthma, and another brother with bipolar. Maternal aunt with DM type II.
Health Maintenance: Immunization up to date.
Social history: Patient does not smoke, drink or use recreational drugs. He maintains a regular diet and exercises 3 times a week. He has been married for 10 years and lives with his wife and one adult son, and one teenage daughter. He is a mathematics teacher in the same high school where he attends clinic. He sleeps well.
With the information provided above, please continue the patient’s soap note to include:
Subjective: A thorough review of systems
Objective: A thorough physical examination
Primary diagnosis
3 differential diagnosis with one citation for each ddx (APA formatted).
Laboratory tests
Diagnostic testing
Management plan
Medications
Non-pharmacological approach
Follow up
Patient education and Health promotion
References: A minimum of 3 different references are required for this assignment. All references must be properly APA formatted.
This assignment will be graded according to the rubric. Please have the Rubric handy when you are writing the soap note.
.
Chief complaint I’m here for a medication refill because I r.docx
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral .
Chief have recurrent H Pylori.docx
A 46-year-old Hispanic female presents with recurrent H. pylori infection after failing previous triple therapy treatment 2.5 months ago. She reports worsening dyspepsia and nausea. Her medical history includes diabetes, GERD, and previous H. pylori gastritis. Physical exam is normal. Recent EGD showed H. pylori positive gastritis. The patient will receive new treatment and undergo a urea breath test in 8 weeks to confirm eradication of H. pylori.
patient_record.pdf
A 35-year-old female presented with abdominal pain, vomiting, diarrhea and high fever. She was diagnosed with septic shock due to E. coli bacteremia. Tests did not reveal the source of the infection. She was treated with antibiotics and improved. She was discharged on cefpodoxime with instructions to follow up with her primary care physician after completing the antibiotic course.
DOC_PATIENT.pdf
A 35-year-old female presented with abdominal pain, vomiting, diarrhea and high fever. She was found to have septic shock from E. coli bacteremia. Tests did not reveal the source of infection. She was treated with antibiotics and improved. She was discharged on cefpodoxime with instructions to follow up with her primary care physician in one week after completing the antibiotic course.
Ileocecal TB.pptx
A 35-year-old male presented with a 5-month history of fever, a 2-month history of a lump in the right lower abdomen, and abdominal pain. Examination found a firm lump in the right iliac fossa. Investigations including blood tests, ultrasound, CT scan, and FNAC suggested intestinal tuberculosis. The patient underwent diagnostic laparotomy and right hemicolectomy. Histopathology unexpectedly found mucinous adenocarcinoma of the cecum with lymph node metastasis. The patient will be referred to oncology for further assessment and chemotherapy.
Case presentation: rif lump.pptx
A 23-year-old female presented with 4 days of right lower abdominal pain shifting from peri-umbilical to the right lower abdomen, accompanied by 3 days of nausea, vomiting and fever. On examination, a tender, firm lump was found in the right iliac fossa. The provisional diagnosis was a right iliac fossa lump due to acute appendicitis. Differential diagnoses included ileo-caecal TB, carcinoma of the caecum, right ovarian cyst, mesenteric lymphadenopathy, and intussusception.
Case presentation: Chronic pancreatitis
This document summarizes a clinical meeting discussing a 60-year-old female patient presenting with recurrent upper abdominal pain over the past 2 years. Examination findings included tenderness and guarding in the epigastrium. Investigations revealed elevated serum lipase, anemia, and ultrasound findings suggestive of chronic pancreatitis. The provisional diagnosis was chronic pancreatitis, with differential diagnoses of chronic cholecystitis or peptic ulcer disease. CT scan and laboratory results confirmed the diagnosis of chronic pancreatitis due to pancreatic calculi, complicated by iron deficiency anemia.
Case APA 3 Similarities Less.docx
This case study involves a 46-year-old Hispanic female who presents with recurrent H. Pylori infection. She was previously treated around 2.5 months ago with triple therapy but failed treatment. Her symptoms of dyspepsia have worsened over the past 2 months. Her physical exam and labs are normal. The assessment is recurrent H. Pylori gastritis. The plan is to treat with antibiotics for 2 weeks and do a urea breath test 8 weeks later to check for infection clearance. The patient will be followed up in 8 weeks to reevaluate symptoms.
Pharma Case Study week 8 Chief complaint I’m here for a medi.docx
Pharma Case Study week 8
Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.
HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH: Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Penicillin
Vaccination History: Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bil ...
Case StudyChief complaint I’m here for a medication refi.docx
Case Study
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light-headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduates married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has a history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has a history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crep.
CC I have itchy white discharge”HPI Patient is a 32 African.docx
A 32-year-old African American female presented with increased vaginal itching and thick white discharge for 2 days. She reported using Monistat 3 days ago without relief and increased pain after sex. On examination, the patient had a fever and curdy white vaginal discharge with inflamed mucosa. A diagnosis of vulvovaginal candidiasis was made and a KOH smear was ordered to confirm. The patient was prescribed a single dose of oral fluconazole or topical antifungal and educated on maintaining a dry environment and use of probiotics to prevent recurrence.
CASE PRESENTATION.pdf
Peptic ulcer disease presents with abdominal pain, often described as a burning or gnawing sensation. Other common symptoms include nausea, vomiting, indigestion, and heartburn
Case StudyChief complaint I’m here for a medication refill .docx
Case Study:
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepi.
Diabetes mellitus - a case presentation for SPM
Case of A Diabetic person with complicated ulcer of foot. It's not perfect in a correct format , but near to it.
Hyphae Flagellated Microbes.docx
Mr. J.R., a 73-year-old man, was admitted to the hospital with gastroenteritis and possible renal injury. His symptoms included fever, nausea, vomiting, diarrhea, weakness, dizziness, and a metallic taste. He developed acute kidney injury likely from pre-renal causes due to dehydration from vomiting and diarrhea. As his kidney damage became irreversible, he was diagnosed with chronic kidney disease and is now at risk for anemia and coagulopathies from reduced kidney function.
CASE PRESENTATION ON PEPTIC ULCER DISEASE(PUD)
Galib Hossain, a 25-year-old male, presented with 5 days of upper abdominal pain and 2 days of nausea and vomiting. He reported a history of NSAID use for 2 months and smoking. Examination found epigastric tenderness. Laboratory tests confirmed peptic ulcer disease caused by H. pylori infection, with a duodenal ulcer seen on endoscopy.
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?
.
Support with 1 journals no older than 5 years. H. Pylori infect.docx
Support with 1 journals no older than 5 years.
H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection. According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format. ACC/AHA Guidelines Chief complaint: “ I have recurrent H. Pylori infection”. HPI: M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. PMH: H. Pylori infection gastritis Diabetes Mellitus, type 2 Surgeries: None Allergies: NKDA Vaccination History: She receives an annual flu shot. Last flu shot was this year Social history: High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Family history: Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. ROS: Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: No edema. No palpitations. Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain. Skin: No lesions. No rash. No itching. Psychiatric: No anxiety. No depression. Physical examination: Vital Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: Slow gait but steady. No Kyphosis. SKIN: Dry. Intact. PSYCH: Normal affect. Cooperative. Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal A: Primary Diagnosis: Recurrent H. Pylori infection gastritis Secondary Diagnoses: Dyspepsia Differential Diagnosis: Peptic Ulcer Disease Previous medication plan: two month ...
Urinary Function Mr. J.R. is a 73-year-old man, who was admitte.docx
Urinary Function:
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions
1. The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
2. Create a list of risk factors the patient might have and explain why.
3. Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Ca.
The candidates will develop a substantive understanding of six components.docx
The candidates will develop a substantive understanding of the six components of reading by creating a 7-10 page paper. The paper must define and explain each of the six components of reading: comprehension, oral language, phonological awareness, phonics, fluency, and vocabulary. It must also include evidence-based practices that promote development in each reading area and have at least five references from journals or textbooks.
Women in The Testament of the Bible shows.docx
The document discusses several powerful and influential women in the Old Testament of the Bible, including Miriyam who helped lead the Israelites out of Egypt, Devorah who led the Israelites in battle as a judge, Yael who killed an enemy general, Yudit who saved her people by killing an invading general, Huldah who was a prophetess that King Josiah consulted, and Hadassah (Esther) who saved the Jewish people from annihilation.
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Exercise Content
Chief Complaint: “I fell down in my house a week ago and my knee is still hurting”.
History of Present Illness: Mr. Brown is 45-year-old male teacher who presents to the clinic with symptoms of right knee pain related to a fall sustained at home one week ago while he was coming down the stairs. Patient states that he tripped and during the fall, the right knee twisted and was caught between two bars of the stair wells. Immediately after the fall, the pain was sharp and stabbing, and he was unable to walk straight and apply weight on the knee. He applied ice and took 800mg of Motrin and went to bed. Patient states he did not want to go to the emergency department because of the long wait. After 24 hours he applied warm compresses intermittently and took extra strength Tylenol as needed. Mitigating factors include ES Tylenol, heat application, and resting the knee. However, sometimes the pain is so severe that even Tylenol does not help. Aggravating factors are standing too long, bending the knee, and climbing stairs. He describes the pain as sharp, and annoying at the same time. At present time he feels like "something is not right inside the knee”. Level of pain is 8/10. He denies previous musculoskeletal injuries.
Patient also reports shortness of breath but denies chest pain.
PMH: Asthma, bipolar disorder. Left knee anterior crucial ligament (ACL) 10 years ago from basketball injury.
Past surgical history: Right hip replacement 15 years ago from kick boxing.
Medications/OTC: Theophylline, Prednisone, Singular, Geodon, Prozac, Benadryl.
Allergies: NKA.
Past family history: One brother with asthma, and another brother with bipolar. Maternal aunt with DM type II.
Health Maintenance: Immunization up to date.
Social history: Patient does not smoke, drink or use recreational drugs. He maintains a regular diet and exercises 3 times a week. He has been married for 10 years and lives with his wife and one adult son, and one teenage daughter. He is a mathematics teacher in the same high school where he attends clinic. He sleeps well.
With the information provided above, please continue the patient’s soap note to include:
Subjective: A thorough review of systems
Objective: A thorough physical examination
Primary diagnosis
3 differential diagnosis with one citation for each ddx (APA formatted).
Laboratory tests
Diagnostic testing
Management plan
Medications
Non-pharmacological approach
Follow up
Patient education and Health promotion
References: A minimum of 3 different references are required for this assignment. All references must be properly APA formatted.
This assignment will be graded according to the rubric. Please have the Rubric handy when you are writing the soap note.
.
Chief complaint I’m here for a medication refill because I r.docx
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral .
Chief have recurrent H Pylori.docx
A 46-year-old Hispanic female presents with recurrent H. pylori infection after failing previous triple therapy treatment 2.5 months ago. She reports worsening dyspepsia and nausea. Her medical history includes diabetes, GERD, and previous H. pylori gastritis. Physical exam is normal. Recent EGD showed H. pylori positive gastritis. The patient will receive new treatment and undergo a urea breath test in 8 weeks to confirm eradication of H. pylori.
patient_record.pdf
A 35-year-old female presented with abdominal pain, vomiting, diarrhea and high fever. She was diagnosed with septic shock due to E. coli bacteremia. Tests did not reveal the source of the infection. She was treated with antibiotics and improved. She was discharged on cefpodoxime with instructions to follow up with her primary care physician after completing the antibiotic course.
DOC_PATIENT.pdf
A 35-year-old female presented with abdominal pain, vomiting, diarrhea and high fever. She was found to have septic shock from E. coli bacteremia. Tests did not reveal the source of infection. She was treated with antibiotics and improved. She was discharged on cefpodoxime with instructions to follow up with her primary care physician in one week after completing the antibiotic course.
Ileocecal TB.pptx
A 35-year-old male presented with a 5-month history of fever, a 2-month history of a lump in the right lower abdomen, and abdominal pain. Examination found a firm lump in the right iliac fossa. Investigations including blood tests, ultrasound, CT scan, and FNAC suggested intestinal tuberculosis. The patient underwent diagnostic laparotomy and right hemicolectomy. Histopathology unexpectedly found mucinous adenocarcinoma of the cecum with lymph node metastasis. The patient will be referred to oncology for further assessment and chemotherapy.
Case presentation: rif lump.pptx
A 23-year-old female presented with 4 days of right lower abdominal pain shifting from peri-umbilical to the right lower abdomen, accompanied by 3 days of nausea, vomiting and fever. On examination, a tender, firm lump was found in the right iliac fossa. The provisional diagnosis was a right iliac fossa lump due to acute appendicitis. Differential diagnoses included ileo-caecal TB, carcinoma of the caecum, right ovarian cyst, mesenteric lymphadenopathy, and intussusception.
Case presentation: Chronic pancreatitis
This document summarizes a clinical meeting discussing a 60-year-old female patient presenting with recurrent upper abdominal pain over the past 2 years. Examination findings included tenderness and guarding in the epigastrium. Investigations revealed elevated serum lipase, anemia, and ultrasound findings suggestive of chronic pancreatitis. The provisional diagnosis was chronic pancreatitis, with differential diagnoses of chronic cholecystitis or peptic ulcer disease. CT scan and laboratory results confirmed the diagnosis of chronic pancreatitis due to pancreatic calculi, complicated by iron deficiency anemia.
Case APA 3 Similarities Less.docx
This case study involves a 46-year-old Hispanic female who presents with recurrent H. Pylori infection. She was previously treated around 2.5 months ago with triple therapy but failed treatment. Her symptoms of dyspepsia have worsened over the past 2 months. Her physical exam and labs are normal. The assessment is recurrent H. Pylori gastritis. The plan is to treat with antibiotics for 2 weeks and do a urea breath test 8 weeks later to check for infection clearance. The patient will be followed up in 8 weeks to reevaluate symptoms.
Pharma Case Study week 8 Chief complaint I’m here for a medi.docx
Pharma Case Study week 8
Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.
HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH: Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Penicillin
Vaccination History: Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bil ...
Case StudyChief complaint I’m here for a medication refi.docx
Case Study
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light-headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduates married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has a history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has a history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crep.
CC I have itchy white discharge”HPI Patient is a 32 African.docx
A 32-year-old African American female presented with increased vaginal itching and thick white discharge for 2 days. She reported using Monistat 3 days ago without relief and increased pain after sex. On examination, the patient had a fever and curdy white vaginal discharge with inflamed mucosa. A diagnosis of vulvovaginal candidiasis was made and a KOH smear was ordered to confirm. The patient was prescribed a single dose of oral fluconazole or topical antifungal and educated on maintaining a dry environment and use of probiotics to prevent recurrence.
CASE PRESENTATION.pdf
Peptic ulcer disease presents with abdominal pain, often described as a burning or gnawing sensation. Other common symptoms include nausea, vomiting, indigestion, and heartburn
Case StudyChief complaint I’m here for a medication refill .docx
Case Study:
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepi.
Diabetes mellitus - a case presentation for SPM
Case of A Diabetic person with complicated ulcer of foot. It's not perfect in a correct format , but near to it.
Hyphae Flagellated Microbes.docx
Mr. J.R., a 73-year-old man, was admitted to the hospital with gastroenteritis and possible renal injury. His symptoms included fever, nausea, vomiting, diarrhea, weakness, dizziness, and a metallic taste. He developed acute kidney injury likely from pre-renal causes due to dehydration from vomiting and diarrhea. As his kidney damage became irreversible, he was diagnosed with chronic kidney disease and is now at risk for anemia and coagulopathies from reduced kidney function.
CASE PRESENTATION ON PEPTIC ULCER DISEASE(PUD)
Galib Hossain, a 25-year-old male, presented with 5 days of upper abdominal pain and 2 days of nausea and vomiting. He reported a history of NSAID use for 2 months and smoking. Examination found epigastric tenderness. Laboratory tests confirmed peptic ulcer disease caused by H. pylori infection, with a duodenal ulcer seen on endoscopy.
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?
.
Support with 1 journals no older than 5 years. H. Pylori infect.docx
Support with 1 journals no older than 5 years.
H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection. According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format. ACC/AHA Guidelines Chief complaint: “ I have recurrent H. Pylori infection”. HPI: M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. PMH: H. Pylori infection gastritis Diabetes Mellitus, type 2 Surgeries: None Allergies: NKDA Vaccination History: She receives an annual flu shot. Last flu shot was this year Social history: High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Family history: Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. ROS: Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: No edema. No palpitations. Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain. Skin: No lesions. No rash. No itching. Psychiatric: No anxiety. No depression. Physical examination: Vital Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: Slow gait but steady. No Kyphosis. SKIN: Dry. Intact. PSYCH: Normal affect. Cooperative. Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal A: Primary Diagnosis: Recurrent H. Pylori infection gastritis Secondary Diagnoses: Dyspepsia Differential Diagnosis: Peptic Ulcer Disease Previous medication plan: two month ...
Urinary Function Mr. J.R. is a 73-year-old man, who was admitte.docx
Urinary Function:
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions
1. The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
2. Create a list of risk factors the patient might have and explain why.
3. Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Ca.
Similar to stomach has been hurting for the past.docx (20)
Exercise ContentChief Complaint I fell down in my .docx
Exercise ContentChief Complaint I fell down in my .docx
Chief complaint I’m here for a medication refill because I r.docx
Chief complaint I’m here for a medication refill because I r.docx
Pharma Case Study week 8 Chief complaint I’m here for a medi.docx
Pharma Case Study week 8 Chief complaint I’m here for a medi.docx
Case StudyChief complaint I’m here for a medication refi.docx
Case StudyChief complaint I’m here for a medication refi.docx
CC I have itchy white discharge”HPI Patient is a 32 African.docx
CC I have itchy white discharge”HPI Patient is a 32 African.docx
Case StudyChief complaint I’m here for a medication refill .docx
Case StudyChief complaint I’m here for a medication refill .docx
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 yesterda.docx
Support with 1 journals no older than 5 years. H. Pylori infect.docx
Support with 1 journals no older than 5 years. H. Pylori infect.docx
Urinary Function Mr. J.R. is a 73-year-old man, who was admitte.docx
Urinary Function Mr. J.R. is a 73-year-old man, who was admitte.docx
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The document discusses the importance of developing a global mindset for HR leaders. It recommends watching two videos on the evolving role of HR and profiles of global HR leaders. Developing a global mindset requires understanding how to work across cultures, which is an intellectual and emotional learning process. Readers are asked to respond to questions from a case study that describes management training challenges in Malawi, explaining how a global mindset could help address the HR issues and applying effective training methods in their analysis.
There is a relationship between an emotionality and their.docx
Individual decisions are influenced by both emotion and reason. When calm, rational thinking guides decisions, but strong emotions constrain clear thinking and increase impulsivity. Emotions can influence decisions and judgments in several ways. They can create tunnel vision or a narrow mindset, lead to jumping to conclusions, cause attention and memory biases that filter information processing, and distort time perception. Emotions are also catchy and can be transferred from others or triggered by unrelated background events.
What is required to petition is a formal letter the.docx
To petition for readmission after dismissal from Maryville University, a formal letter is required that describes the circumstances that impacted the student's success, what the student would do differently to be successful if readmitted, and the student's current academic goals at Maryville and why consideration should be granted based on those goals and circumstances.
what is mental illness as an officially recognized.docx
Mental illness is officially recognized as a category of deviance in society. It downplays the social foundations of conditions seen as deviant. The most commonly identified mental illness today in the US is depression. The perspective of "Pharmacracy" views mental illness as primarily a biological condition to be treated with medication. Goffman's book Asylums was important for policy as it shed light on the social environment of institutions and how that impacted patients. Stress from social inequality and lack of social support is most likely to lead to mental illness. The mentally ill employ "stigma management strategies" like passing or covering to avoid discrimination.
With you have learned about the cell DNA.docx
Cancer is caused by mutations in DNA that cause cells to multiply uncontrollably. While scientists have made progress in understanding cancer and developing treatments, curing cancer is challenging because of the complexity of the human body and diversity of cancer types. With continued research into genetics, cell biology, and new therapies, scientists hope to find cures for more cancer types in the future.
TO EACH POST 100 WORDS MIN This.docx
The document discusses several models of radicalization and analyzes the USS Cole terrorist attack. It addresses the following key points:
1) The USS Cole attack in 2000 was clearly an act of terrorism carried out by al-Qaeda operatives in Yemen with the goal of forcing US withdrawal from the Middle East.
2) The attack served as al-Qaeda in Yemen's major initiation and revealed capabilities prior to the 9/11 attacks. Both US and Yemeni responses to the attack were inadequate and allowed al-Qaeda to strengthen.
3) Radicalization is generally a complex process involving multiple behavioral, psychological, social, and political factors that can lead one to extremist views over time rather than suddenly. The
TO EACH POST MIN 100 WORDS In.docx
This document discusses two pathways to terrorism - top-down and bottom-up - as explained by Professor Mohammed Hafez. The top-down process involves centralized organizations that promote radical ideology through social services, while the bottom-up process occurs when individuals have personal grievances and seek out radical groups. The document also examines case studies of Ted Kaczynski and Timothy McVeigh, analyzing which radicalization models best describe their paths to committing acts of terrorism.
Take a look back at your DPP and the Belmont.docx
The document advises to review the Detailed Project Plan (DPP) and Belmont Report to ensure clarity on the purpose of the research and adherence to ethical principles of protecting participants, as outlined in the Belmont Report, rather than having a good or bad hypothesis.
Stakeholder support is necessary for successful project Consider your.docx
Stakeholder support is crucial for successful project implementation. Both internal stakeholders within the healthcare setting considering a change proposal, as well as external stakeholders outside the setting, require support. Their backing is necessary for success, so determining why it is needed and how to obtain it is important.
The OSI data link layer is responsible for physical.docx
The OSI data link layer is responsible for physical addressing, network topology, error notification, sequencing of frames and flow control. IEEE has defined numerous protocols used with TCP/IP at the OSI data link layer, including various IEEE 802 standards. These standards require certain network devices, media, and topologies to implement them in a network.
This assignment is intended to help you use leadership skills.docx
This assignment aims to help students practice leadership skills by gathering a cross-functional mock project team and guiding them using project management tools. Students must create a 10-12 slide PowerPoint presentation with speaker notes that outlines the project description, management charts, improved process flowchart, meeting schedule, metrics, financial considerations, and reporting structure while citing references and using APA format.
What are the different portals of entry for a pathogen.docx
The document discusses different topics related to disease and immunity including portals of entry for pathogens, categories of disease outbreaks, types of immunity, classes of vaccines, and differences between hypersensitivity reactions and autoimmune diseases. Specifically, it asks about the different ways pathogens can enter the body, defines endemic, sporadic, epidemic and pandemic, describes innate versus adaptive immunity and which type is longer lasting and more specific, differentiates between active and passive immunity and which is longer or shorter lasting, lists the five classes of vaccines used for active immunity, and asks to define and differentiate hypersensitivity reactions from autoimmune diseases with an example of each.
You are the Social Media Manager for Savannah Technical.docx
The Social Media Manager for Savannah Technical College should measure internal and external engagement with the college by tracking data on reach, frequency, sentiment and engagement that can be realistically obtained from social media platforms. This data would allow further analysis of how effectively the college is engaging its various audiences and what messaging is most successful online.
When you are engaging it is important to understand.docx
To engage a specific community, one must understand both geographical and non-geographical factors. The document instructs the reader to describe the strengths, challenges, and reasons for community membership of their identified community to an potential employer. They are to advocate for their community's offerings while being honest about its challenges. The description should analyze the impact of community membership on members and identify elected and unelected leaders to support community engagement efforts.
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