HOSPITAL COURSE: The patient’s hospital course was characterized by a progressively downhill course. He was initially hospitalized and found to be mildly hypoxic, which rapidly corrected with supplemental low flow oxygen therapy. However, he gradually became more oxygen dependent on high flow oxygen, eventually requiring intubation with mechanical ventilation in order to maintain his oxygenation. He underwent an open lung biopsy in an attempt to delineate the etiology of his pulmonary situation, and this was reported as idiopathic pulmonary fibrosis and alveolitis. The specimen was sent to the Forest General Pathology Department for further evaluation, and they were able to give no further help concerning the ideology of his pulmonary status. An echocardiogram showed left ventricular wall motion hypokinesia and an ejection fraction of approximately 35%.…
HISTORY OF PRESENT ILLINESS: Mr. Barua is a 42 year old gentleman from Bangladesh who presents with chest tightness, shortness of breath, and tachycardia. Dr. J.K McClean of cardiology is evaluating his heart condition. The patient has had the recent onset of hemoptysis. He was treated for tuberculosis in Bangladesh 15 years ago. This has prompted the concern of weather his treatment of tuberculosis was adequate or if weather there is another cause of his hemoptysis. The duration of his tuberculosis treatment was apparently adequate, according to his wife. But no records are available. In addition, the patient had thrombosis of the axially artery treated last year at Hillcrest. He had an embolectomy and has been on Coumadin since. INR is significantly elevated at 16. None the less, because of the cavitary lesions that are seen in the right and left upper lobes, the possibility of tuberculosis has been raised. Ancillary history was been given by the wife, Nupaul, with the patient translating for her from the Indie language.…
Mike has complained of being fatigue quite often. After a doctor’s visit, Mike found out that he had emphysema which is a condition that causes the alveoli of the lungs to expand…
Chronic bronchitis B. Bronchial Asthma * Recurrent and reversible shortness of breath * Occurs when the airways of the lungs become narrow as a result of: * Bronchospasms * Inflammation of the bronchial mucosa * Edema of the bronchial mucosa * Production of viscid mucus * Alveolar ducts/alveoli remain open, but airflow to them is obstructed * Symptoms * Wheezing * Difficulty breathing C. Asthma *…
R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH = 7.32, PaCO2 = 60 mm Hg, PaO2 = 50 mm Hg, HCO3- = 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is using an inhaled ß2 agonist and Theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia.…
Hospital course: the patient’s hospital course was characterized by a progressively downhill course. He was initially hospitalized and found to be mildly hypoxic, which rapidly corrected to his supplemental low- flow oxygen therapy however, he gradually became more oxygen dependent on high flow oxygen, eventually requiring intubation with mechanical ventilation in order to maintain his oxygenation. He underwent an open lung biopsy in an attempt to delineate etiology of his pulmonary situation, and this was recorded as idiopathic pulmonary fibrosis and alveolitis. This specimen was sent to the Forest General Pathology Department for further evaluation and they were able to give no further help concerning the ideology of his pulmonary status. An echocardiogram showed left ventricular wall motion hypokinesia and an injection fraction of approx. 35%.…
2. An 56-year-old established patient presents to her doctor's office with chest pain and shortness of breath. The doctor orders an ambulance to take the patient to the ED to be checked out. From the ED the patient is admitted for some tests to determine what the problems are. The history and exam performed were comprehensive and the MDM was of moderate complexity…
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.…
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.…
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.…
History of Present Illness: 64-year-old, well-nourished black male came in the office with chest pain for 2 days. Patient verbalized that he started having chest pain, especially when he is at work. He recently started a new job as a delivery driver where he is required to pick up and carry 50 pound boxes. He verbalized of generalized pain mostly in the chest area. He complains of pain 8 on a scale of 0-10. The pain is provoked with movement. Blood pressure was 154/90.…
Past Medical history includes : Essential Hypertension, Cardiac pacemaker, Coronary Artery Disease, Dyspnea, Sensiosenural hearing loss, Restless legs, headache, acute hypothyroidism due to radiation, Mandible Cancer, Pseudophakia of both eyes, Posterior vitreous detachment, malnutrition, Generalized weakness, Smoker of 2 packs of cigarettes per day for 30 years.…
LC is a 65 y/o caucasian female diagnosed with small cell carcinoma of lung. Introduced self to patient, explained assessment procedure to patient. Patient awake alert, oriented x 3, pleasant and follows commands. PERL, mucus membranes pale, lips dry and cracked. Multiple small bruises on bilateral arms and on legs. No further skin breakdown observed. Port-a-cath left upper chest under skin, no redness around site, port is not accessed at this time. No JVD observed. Patient states she has been coughing up small amounts of blood, lungs with bilateral crackers and diminished sounds in left lower lobe of lung. Respirations unlabored 18 rpm, no use of accessory muscles.Patient states she has to use 2 pillows at night to sleep. Oxygen @ 2L per nasal cannula, patient wears 24/7. Heart rate and rhythm regular, S1/S2 auscultated, apical pulse 68, no gallops noted, no murmurs auscultated. Abdomen soft, nontender to palpation, scar from belly button to pelvis (patient has history of C-section and hysterectomy), Bowel sounds present and active x 4 quadrants, patient states that last BM was normal earlier this AM. Patient states that she has frequent nausea and vomiting. Patient voiding without difficulty, at times has stress incontinence. Urine dark. No edema observed. Patient moves all extremities with weakness bilaterally. Patient's gait unsteady, states she just doesn't have good balance. Patient walks with cane. Patient walks less than 50 feet and becomes short of breath. Education given on signs and symptoms of dehydration and the need to increase fluid intake and notify doctor if unable to void. Patient verbalizes understanding.…
General Health: Patient states he feels generally healthy, only concern is his current, peristent cough that has been bothering him for the past couple of months. Pt relates the cough to his use of smoking tobacco, smokes approximately half a pack (10-12 cigarettes every day) M.C. states that he has been smoking for the past 35 years.…
During the interview with the 65 year old male client, who was recently hospitalized for shortness of breath and worsening peripheral edema, the wife also gave a brief history on how the disease was discovered. The patient currently lives at home with his wife as the caretaker and the mother of two young adults. According to the recent studies, signs and symptoms typically begin between 40 and 70 years of age with a…