You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.…
This patient was admitted for shortness of breath, fever and chills. He has a history of cystic fibrosis, with secondary diabetes.…
Patient X is a 52-year-old man who lives in Bowen Hills, Brisbane. He is an automotive repair man. However, he has recently lost his job and has stayed idle for one year. Recently, he was playing basketball with his eldest son and suddenly developed a substernal chest pressure. When he thought it was just a typical ‘heartburn’, he continued playing. After another 20 minutes, he had an intolerable sharp, nagging chest pain. His left arm became numb. His son verbalised that he looked pale and was sweating a lot. His son called the paramedics which accordingly arrived after 30 minutes and he was brought to Royal Brisbane and Women’s Hospital.…
The patient was transported from home by her daughter-n-law. According to patient daughter-n-law she has been complaining of pains in her right leg approximately one day. Family administered daily pain medications that did not help the condition of her persisting pain. After pain persisted daughter in law later brought the patient in to the emergency room for examination.…
PHYSICAL EXAMINATION: GENERAL: The patient is a well-developed, well-nourished male who appears to be in moderate distress, with pain and swelling in the upper left arm. Vital sign: Blood pressure 140/90, temperature 98.3, pulse 97, and respiration 18.…
Vioxx (Rofecoxib) medication is a class of drug called nonsteroidal and inflammatory drugs (NSAIDs). Vioxx was introduced on May 20, 1999 by Merck & Co. It has been used by over 20 million Americans since it was put on the market. Vioxx works by reducing substances that cause inflammation, pain and fever in the body. Vioxx is used to reduce pain, inflammation, and stiffness cause by osteoarthritis, rheumatoid arthritis and certain forms of juvenile rheumatoid arthritis. Also vioxx is used to treat acute pain in adults, treat migraines, and menstrual pain. Vioxx was available on prescription in both tablets and as an oral suspension. At the hospitals it was also available in injection. Vioxx was prescribed worldwide to up to 80 million people at some time. Vioxx belongs to a class of…
D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is an acute exacerbation of chronic emphysema.…
PHYSICAL EXAMINATION: The patient is a well-developed, well-nourished male who appears to be in moderate distress with pain and swelling in the upper left arm. VITAL SIGNS: Blood pressure 140/90, temperature 98.3 degrees Fahrenheit, pulse 97, respiration 18.HEENT: Head normal, no lesions. Eyes, arcus senilis, both eyes. Ears, impacted cerumen, left ear. Nose, clear. Mouth, dentures fit well, no lesions. NECK: Normal range of motion in all directs. INTEGUMENTARY: Psoriatic lesion, right thigh, approximately 1 mL in diameter. CHEST: Clear breath sounds bilaterally. No rales or rhonchi noted. HEART: Normal sinus rhythm. There is a holosystolic murmur. No friction rubs noted. ABDOMEN: Normal bowl sounds. Liver, kidneys, and spleen are normal to palpitation. GENITALIA: Tests normally descended bilaterally. RECTAL: Prostate 2+ and benign. EXTREMITIES: Pain and swelling noted above…
83 year-old female with an admitting diagnosis of aspiration pneumonia, and sepsis. BP 120/62, HR 115, RR 22, temp 101.1, 96% sp02 on 2L nasal cannula. Patient is Awake and oriented to self but unable to identify year and location, PERRLA, speech is faint and unclear. Patient unable to ambulate and requires full assistance changing positions, minimal range of motion in arms and legs. Patient has a regular rate and rhythm with a clear distinction between S1 and S2, no extra heart sounds noted. No signs of edema, radial and pedal pulses + 2 equal bilaterally with a cap refill of less than 2 seconds on all extremities. Respirations shallow with diminished lung sounds bilaterally, rhonchi noted on right upper lobe, both posteriorly and anteriorly. Bowel sounds present in all four quadrants, patient has peg tube in place. Patient has a Foley catheter draining cloudy, yellow urine. Patient is NPO with 1L of NS infusing. Skin is warm, dry, with a stage 4 sacral ulcer with tunneling and draining sanguineous fluid, Oral mucosa is dry. Bed set in lowest position with 2 rails up and call bell in right hand.…
References: Cutting,K. White,R. Edmunds,M. (2007) The safety and efficacy of dressings with silver- addressing clinical concerns. International Wound Journal.4 p.177-184…
daughter insisted on taking him to the ED for evaluation. After orienting him to the room, call light, bed controls, and lights, you perform your physical assessment. The findings are as follows: he is awake, alert, and oriented (AAO) \3, and he moves all extremities well (MAEW). He is restless, is constantly shifting his position, and complains of (C/O) fatigue. Breath sounds are clear to auscultation (CTA). Heart sounds are clear and crisp, with no murmur or rub noted and with a regular rate and rhythm (RRR). Abdomen is flat, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. A sharp inspiratory arrest and exclamation of pain occur with deep palpation of the costal margin in the RUQ (positive Murphy’s sign). He reports light-colored stools for 1 week. The patient voids dark amber urine but denies dysuria. Skin and sclera are jaundiced. Admission vital signs (VS) are 164/100, 132, 26, 36° C, SaO2 96% on 2 L of oxygen by nasal cannula (O2/NC).…
GENERAL: The patient is a well-developed, well-nourished male who appears to be in moderate distress with pain and swelling in the upper left arm. Vital signs: Blood pressure 140/90, temperature 98.3 degrees Fahrenheit, pulse 97, respiration 18.…
Within this assignment it is intended to present an example of a prescribing situation that arose in practice, to ensure prescribing issues are illustrated. The rationale for the decisions reached will also be discussed. A brief overview of the nurse prescribing initiative and how it developed will be addressed. The importance of ethical principles, accountability and legal issues that surround nurse prescribing will be demonstrated. As a patient will be addressed in the example, a pseudonym will be used.…
Patient complains of having tightness and pain in his chest that seems to move down the left arm. Patient describes the pain as being sharp and can be sometimes a mild pain or an immobilizing pain.…
Evaluation: After 48 hours on diuretics, patient demonstrates significantly less edema in extremities, clear lung sounds bilaterally and no added weight gain. Patient can now breathe with ease, and his blood pressure is 130/84. Patient was educated on his diet, and states that he “will do a better job maintaining a healthy diet”. There are no signs or symptoms of DVT, no signs of skin breakdown, and SPo2 is at a 99% on room air. Patient seems to be in good spirits with a positive outlook with his prognosis. We scheduled him an appointment with his cardiologist for a follow up in 1 week from…