The nurse is caring for a newly admitted 59-year-old male client in th (1).pdf
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The nurse is caring for a newly admitted 59-year-old male client in the medical surgical unit. History and Physical: The client arrived to the emergency department complaining of a "swelling abdomen," some shortness of breath, and unexplained bruising. Client states that he was diagnosed with Hepatitis C, but stopped taking the medications because of the side effects. He drinks 5-8 beers per week and smokes tobacco, about 2 packs a week. He denies usage of drugs. New diagnosis of cirrhosis has been confirmed and client has been transferred to medical surgical unit. Nurses' Notes: 1245: Client is awake but appears lethargic. He is oriented to person, place, and time. Skin is warm and dry upon touch, yellow in color with bruising noted on upper back and left arm. The client states that his skin is "itchy" at times. He also reports of a "swelling abdomen" and shortness of breath. Diminished breath sounds at lung bases bilaterally. Abdomen is distended and slightly tender upon palpation. Last bowel movement 4 hours ago with clay-colored stools. Peripheral pulses are 2+ with capillar refill time of less than 2 seconds. Call light within reach. Will continue to monitor. Vital signs: 1245: P 90 RR 20 BP 119/70 T: 37.5 C (99.5 F) O2 saturation 98% on room air Laboratory Results: Which of the following is most likely causing ascites for the client? Select one: 1. Fetor Hepaticus 2. Portal Hypertension 3. Impaired coagulation 4. Enlarged liver size.
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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.
1.CC I have been having terrible chest and arm pain for the pa.docx
1.
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
1 of 2 Questions:
Why is HDL considered the “good” cholesterol?
QUESTION 2
1.
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.
QUESTION 3
1.
A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
1 points
QUESTION 4
1.
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sen.
CC I have been having terrible chest and arm pain for the .docx
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
1 of 2 Questions:
Why is HDL considered the “good” cholesterol?
2 points
QUESTION 2
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.
3 points
QUESTION 3
A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
1 points
QUESTION 4
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought.
I need finding assessmentresolutionmon Chief Complaint.pdf
I need
finding, assessment,resolution,mon
= Chief Complaint "My chest hurts, I can't catch my breath, and this cough is getting worse." = HPI
Justin Case is a 60-year-old man with a past medical history significant for MI who was admitted to
the hospital 5 days ago to undergo a scheduled surgical procedure following a recent diagnosis of
colorectal adenocarcinoma with metastatic lesions to the liver. The patient was taken to the OR on
hospital day 2 and underwent an exploratory laparotomy, diverting ileostomy, and Hickman
catheter placement in preparation for chemotherapy. Postoperatively, the patient was transferred
to the progressive ICU for his recovery without complication. The patient had no new complaints
until hospital day 5 when he complained of retrosternal crushing chest pain radiating to the left
shoulder and left jaw, shortness of breath, and a worsening cough with sputum production. The
patient was noted to be in respiratory distress with a RR of 43 breaths/min, HR 153bpm, BP
162/103mmHg, and O2 saturation of 87%. He was then transferred to the medical ICU and
underwent endotracheal intubation due to worsening respiratory status. Cardiac markers were
obtained, given the patient's symptoms and history of MI. Imaging and blood & sputum cultures
were obtained after patient transfer. =PMH CAD, S/P MI 3 years ago for which he did not undergo
any surgical intervention =SH Lives with his wife Smokes one ppd 40 years Denies alcohol or illicit
drug use Meds Patient states that he did not take any medications at home. Hospital medications
include (ICU medication list): Aspirin 325mgPO1 dose, then 81mg PO daily Enoxaparin 70mg
subcutaneously every 12 hours Esomeprazole 40mg PO daily Fentanyl 25mcg /hour IV
continuous infusion Lorazepam 2mg hour IV continuous infusion Metoprolol 25mg PO every 12
hours Nicotine patch 21mg per day applied daily AIl NKDA =ROS Patient is experiencing
significant chest pain, shortness of breath, and a cough with sputum production. He denies
nausea, vomiting, or difficulty urinating. He complains of mild abdominal pain near his ostomy and
incision sites. - Physical Examination Gen WDWN Caucasian man, initially anxious, ill-appearing,
and in moderate respiratory distress; now, S/P endotracheal intubation and in NAD VS BP
162/103 mm Hg, P 147 bpm, RR 42 breaths/min, T 38.5C; Wt 70kg,Ht56 Skin Warm; no rash; no
skin breakdown HEENT PERRLA; moist mucous membranes Neck/Lymph Nodes Supple; no
lymphadenopathy Lungs/Thorax Scattered rhonchi with expiratory wheezing; diffuse bilateral
crackles; decreased breath sounds in bilateral bases; right U Hickman catheter intact without
erythemaAbd Soft; mildly distended; hypoactive BS; large liver palpated in RUQ; ileostomy in RLQ
is pink and functioning; surgical incision is C/D/I Genit/Rect Deferred MS/Ext 1+ pitting edema; 2+
pulses bilaterally; good peripheral perfusion Neuro Prior to intubation, A&O3; CN II-XII intact;
patient is now intubated and sedated m Labs - Cardiac Mark.
Recommended
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.
1.CC I have been having terrible chest and arm pain for the pa.docx
1.
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
1 of 2 Questions:
Why is HDL considered the “good” cholesterol?
QUESTION 2
1.
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.
QUESTION 3
1.
A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
1 points
QUESTION 4
1.
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sen.
CC I have been having terrible chest and arm pain for the .docx
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
1 of 2 Questions:
Why is HDL considered the “good” cholesterol?
2 points
QUESTION 2
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.
3 points
QUESTION 3
A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
1 points
QUESTION 4
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought.
I need finding assessmentresolutionmon Chief Complaint.pdf
I need
finding, assessment,resolution,mon
= Chief Complaint "My chest hurts, I can't catch my breath, and this cough is getting worse." = HPI
Justin Case is a 60-year-old man with a past medical history significant for MI who was admitted to
the hospital 5 days ago to undergo a scheduled surgical procedure following a recent diagnosis of
colorectal adenocarcinoma with metastatic lesions to the liver. The patient was taken to the OR on
hospital day 2 and underwent an exploratory laparotomy, diverting ileostomy, and Hickman
catheter placement in preparation for chemotherapy. Postoperatively, the patient was transferred
to the progressive ICU for his recovery without complication. The patient had no new complaints
until hospital day 5 when he complained of retrosternal crushing chest pain radiating to the left
shoulder and left jaw, shortness of breath, and a worsening cough with sputum production. The
patient was noted to be in respiratory distress with a RR of 43 breaths/min, HR 153bpm, BP
162/103mmHg, and O2 saturation of 87%. He was then transferred to the medical ICU and
underwent endotracheal intubation due to worsening respiratory status. Cardiac markers were
obtained, given the patient's symptoms and history of MI. Imaging and blood & sputum cultures
were obtained after patient transfer. =PMH CAD, S/P MI 3 years ago for which he did not undergo
any surgical intervention =SH Lives with his wife Smokes one ppd 40 years Denies alcohol or illicit
drug use Meds Patient states that he did not take any medications at home. Hospital medications
include (ICU medication list): Aspirin 325mgPO1 dose, then 81mg PO daily Enoxaparin 70mg
subcutaneously every 12 hours Esomeprazole 40mg PO daily Fentanyl 25mcg /hour IV
continuous infusion Lorazepam 2mg hour IV continuous infusion Metoprolol 25mg PO every 12
hours Nicotine patch 21mg per day applied daily AIl NKDA =ROS Patient is experiencing
significant chest pain, shortness of breath, and a cough with sputum production. He denies
nausea, vomiting, or difficulty urinating. He complains of mild abdominal pain near his ostomy and
incision sites. - Physical Examination Gen WDWN Caucasian man, initially anxious, ill-appearing,
and in moderate respiratory distress; now, S/P endotracheal intubation and in NAD VS BP
162/103 mm Hg, P 147 bpm, RR 42 breaths/min, T 38.5C; Wt 70kg,Ht56 Skin Warm; no rash; no
skin breakdown HEENT PERRLA; moist mucous membranes Neck/Lymph Nodes Supple; no
lymphadenopathy Lungs/Thorax Scattered rhonchi with expiratory wheezing; diffuse bilateral
crackles; decreased breath sounds in bilateral bases; right U Hickman catheter intact without
erythemaAbd Soft; mildly distended; hypoactive BS; large liver palpated in RUQ; ileostomy in RLQ
is pink and functioning; surgical incision is C/D/I Genit/Rect Deferred MS/Ext 1+ pitting edema; 2+
pulses bilaterally; good peripheral perfusion Neuro Prior to intubation, A&O3; CN II-XII intact;
patient is now intubated and sedated m Labs - Cardiac Mark.
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?
.
Toxic cases emergency
ا.د/هند الهلالي "ورشة عمل
Principles of poisoning management
الورشة التي قدمت يوم الثلاثاء 8 ابريل 2014 في دار الحكمة بالقاهرة
من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب
و ضمن موديول الطوارئ و التخدير و العناية المركزة
AKI with Hypernatraemia.pptx
Clinical Meeting on AKI with Hypernatremia with Metabolic acidosis with septicemia
0130 Admission nurses note (RN) Client arrived via EMS from lo.docx
0130: Admission nurses note (RN): Client arrived via EMS from long-term-care for evaluation of “low blood sugar.” Pt. arrived confused (alert and oriented X 1) and is a known diabetic. Finger stick was 45. Orange juice and crackers, given repeat finger stick 104. Pt now alert and oriented X 4. Report from the charge nurse at the long-term-care facility indicates that the client has been having frequent bouts of hypoglycemia.
0530: (RN) Foley catheter inserted for incontinence--pt. “too weak” to get up to the bathroom and is experiencing bouts of incontinence.
600 mL clear yellow urine noted. The nurse indicates that the ER is “very busy” and “short-staffed.” 0545 (Admitting Physician) See history and physical. Pt. admitted to the medical-surgical service for evaluation of recurrent hypoglycemia.
View the ER chart before the pt. is transferred to the floor:
0730: (RN) Report is given to RN on 3 North.
Emergency Department Chart
Client: Mabel Simpson
DOB: 4/23/1941
Admission Date 8/16/2019
Medical Diagnosis: recurrent hypoglycemia
Allergies: None
Vitals/ Data Collection:
Temp.- 97.3 PO
History:
Diabetes (insulin dependent)
Medications:
Insulin R titrated to finger sticks
Allergies:
None
Vitals/ Data Collection:
Pulse- 68
History:
Hypertension
Medications:
Furosemide 20 MG twice per day
Allergies:
None
Vitals/ Data Collection:
Respirations- 18
History:
Atrial Fibrillation
Medications:
Warfarin 5 Mg Mon, Wed, Fri 2 Mg Tues, Thurs
Allergies:
None
Vitals/ Data Collection:
Blood Pressure- 122/86
History:
Rheumatoid Arthritis
Medications:
Enalapril 5 Mg once per day
Allergies:
None
Vitals/ Data Collection:
No C/O pain
History:
Mild Heart Failure (class 1)
Medications:
Proventil inhaler as needed for wheezing
Allergies:
None
Vitals/ Data Collection:
Alert and oriented X 4
History:
Former Smoker- smoked 1 pack per day X 40 years- last smoked 10 years ago
Medications:
Methotrexate 2.5 Mg per day
Allergies:
None
Vitals/ Data Collection:
Lungs: No adventitious sounds
History:
Appendectomy as a child
Medications:
Tylenol 650 Mg as needed for pain or fever
Allergies:
None
Vitals/ Data Collection:
+ Bowel sounds
History:
Mobility (baseline): able to ambulate slowly with minimal assist
Clear yellow urine draining from Foley catheter in adequate amts.
Medications:
Allergies:
None
Vitals/ Data Collection:
Clear yellow urine draining from Foley catheter in adequate amts.
History:
Medications:
Allergies:
None
8/16/2019
10:00: (RN) Pt received on 3 North. Alert and oriented X 4. Fingerstick 81. Eating breakfast. Offering no complaints.
8/17/2019 (Medical Assistant)
0130: Sleeping Soundly
0700: (LPN) alert and oriented Finger stick 124. Offering no complaints. Medications given as ordered. Foley catheter draining cloudy yellow urine- RN notified.
1100: (Case Manager note): Pt. alert and oriented. Blood sugar stable. Will speak to the physician about discharge tomorrow morn.
Toxic cases emergency
مشروع إعداد طبيب حكيم ناجح- المعهد العربي للتنمية المهنية المستدامة دورة الطوارئ و التخدير و الرعاية 8-4-2014
1. CC I have been having terrible chest and arm pain for the p.docx
1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.1 of 2 Questions:Why is HDL considered the “good” cholesterol?
QUESTION 2
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QUESTION 3
. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
QUESTION 4.
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu.
The model (graph) below represents a small country trade of coffee- Be.pdf
The model (graph) below represents a small country trade of coffee. Before trade, what area(s)
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The mode of inheritance you are to test on the observed data is autoso.pdf
The mode of inheritance you are to test on the observed data is autosomat dominant.
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phenotype. F. DATA F2 DATA Phenotype Disease Mitd-Type 45 For your assignment, you are
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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?
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Toxic cases emergency
ا.د/هند الهلالي "ورشة عمل
Principles of poisoning management
الورشة التي قدمت يوم الثلاثاء 8 ابريل 2014 في دار الحكمة بالقاهرة
من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب
و ضمن موديول الطوارئ و التخدير و العناية المركزة
AKI with Hypernatraemia.pptx
Clinical Meeting on AKI with Hypernatremia with Metabolic acidosis with septicemia
0130 Admission nurses note (RN) Client arrived via EMS from lo.docx
0130: Admission nurses note (RN): Client arrived via EMS from long-term-care for evaluation of “low blood sugar.” Pt. arrived confused (alert and oriented X 1) and is a known diabetic. Finger stick was 45. Orange juice and crackers, given repeat finger stick 104. Pt now alert and oriented X 4. Report from the charge nurse at the long-term-care facility indicates that the client has been having frequent bouts of hypoglycemia.
0530: (RN) Foley catheter inserted for incontinence--pt. “too weak” to get up to the bathroom and is experiencing bouts of incontinence.
600 mL clear yellow urine noted. The nurse indicates that the ER is “very busy” and “short-staffed.” 0545 (Admitting Physician) See history and physical. Pt. admitted to the medical-surgical service for evaluation of recurrent hypoglycemia.
View the ER chart before the pt. is transferred to the floor:
0730: (RN) Report is given to RN on 3 North.
Emergency Department Chart
Client: Mabel Simpson
DOB: 4/23/1941
Admission Date 8/16/2019
Medical Diagnosis: recurrent hypoglycemia
Allergies: None
Vitals/ Data Collection:
Temp.- 97.3 PO
History:
Diabetes (insulin dependent)
Medications:
Insulin R titrated to finger sticks
Allergies:
None
Vitals/ Data Collection:
Pulse- 68
History:
Hypertension
Medications:
Furosemide 20 MG twice per day
Allergies:
None
Vitals/ Data Collection:
Respirations- 18
History:
Atrial Fibrillation
Medications:
Warfarin 5 Mg Mon, Wed, Fri 2 Mg Tues, Thurs
Allergies:
None
Vitals/ Data Collection:
Blood Pressure- 122/86
History:
Rheumatoid Arthritis
Medications:
Enalapril 5 Mg once per day
Allergies:
None
Vitals/ Data Collection:
No C/O pain
History:
Mild Heart Failure (class 1)
Medications:
Proventil inhaler as needed for wheezing
Allergies:
None
Vitals/ Data Collection:
Alert and oriented X 4
History:
Former Smoker- smoked 1 pack per day X 40 years- last smoked 10 years ago
Medications:
Methotrexate 2.5 Mg per day
Allergies:
None
Vitals/ Data Collection:
Lungs: No adventitious sounds
History:
Appendectomy as a child
Medications:
Tylenol 650 Mg as needed for pain or fever
Allergies:
None
Vitals/ Data Collection:
+ Bowel sounds
History:
Mobility (baseline): able to ambulate slowly with minimal assist
Clear yellow urine draining from Foley catheter in adequate amts.
Medications:
Allergies:
None
Vitals/ Data Collection:
Clear yellow urine draining from Foley catheter in adequate amts.
History:
Medications:
Allergies:
None
8/16/2019
10:00: (RN) Pt received on 3 North. Alert and oriented X 4. Fingerstick 81. Eating breakfast. Offering no complaints.
8/17/2019 (Medical Assistant)
0130: Sleeping Soundly
0700: (LPN) alert and oriented Finger stick 124. Offering no complaints. Medications given as ordered. Foley catheter draining cloudy yellow urine- RN notified.
1100: (Case Manager note): Pt. alert and oriented. Blood sugar stable. Will speak to the physician about discharge tomorrow morn.
Toxic cases emergency
مشروع إعداد طبيب حكيم ناجح- المعهد العربي للتنمية المهنية المستدامة دورة الطوارئ و التخدير و الرعاية 8-4-2014
1. CC I have been having terrible chest and arm pain for the p.docx
1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.1 of 2 Questions:Why is HDL considered the “good” cholesterol?
QUESTION 2
. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.2 of 2 Questions:Explain the role inflammation has in the development of atherosclerosis.
QUESTION 3
. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
QUESTION 4.
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu.
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