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 whether his treatment for tuberculosis was adequate or whether there is another cause for 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 axillary artery treated last year at Hillcrest. He had an embolectomy and has been on Coumadin since. INR is significantly elevated at 16. Nonetheless, 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 given by the patient’s wife, Nupur, with the patient translating for her from the Hindi language.…
The nurse monitor level of consciousness, vital signs especially monitoring temperature because of the neurological deficit with the hypothalamus in the temperature regulation system has caused a dysfunction of the autonomic nervous system. Monitor pain level on a scale from zero means no pain to ten is the worst pain, the severity, if it radiates, sensation, if T.W. able to move leg, feeling or any movement. Continue to monitor for any changes, perform range of motion for all joints to prevent mobility loss and contractures. In addition, psychosocial assessment for T.W. well-being and include family members to provide comfort and support. Furthermore, continue IV fluid as order to prevent and decrease risk of neurologic shock. Cover with warm blanket as needed to prevent hypothermia.…
DISPOSITION: Discharged to home. The patient and her husband were given detailed written instructions as to her activities and limitations. I will follow her in my clinic in 6 weeks’ time and I have advised her to stay off work until that time. No lifting. She was given a prescription for Tylenol with codeine PRN pain. She was advised that if any problems developed i.e. fever, nausea, vomiting, headache or blurred vision she is to come to clinic earlier or report to Hillcrest Emergency Room.…
DO NOT delegate what you can EAT! E - evaluate A - assess T - teach addisons= down, down down up down cushings= up up up down up addisons= hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia cushings= hypernatremia, hypertension, incrased blood vol, hypokalemia, hyperglycemia No Pee, no K (do not give potassium without adequate urine output) EleVate Veins; dAngle Arteries for better perfusion A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent) TRANSMISSION-BASED PRECAUTIONS: AIRBORNE My - Measles Chicken - Chicken Pox/Varicella Hez - Herpez Zoster/Shingles TB or remember... MTV=Airborne Measles TB Varicella-Chicken Pox/Herpes Zoster-Shingles Private Room - negative pressure with 6-12 air exchanges/hr Mask, N95 for TB DROPLET think of SPIDERMAN! S - sepsis S - scarlet fever S - streptococcal pharyngitis P - parvovirus B19 P - pneumonia P - pertussis I - influenza D - diptheria (pharyngeal) E - epiglottitis R - rubella M - mumps M - meningitis M - mycoplasma or meningeal pneumonia An - Adenovirus Private Room or cohort Mask…
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.…
Objective: Patient is sitting upright on examination table with legs uncovered and shoes/socks off. VS 128/82, HR 86, RR 16, T 37.1*C. There is bilateral lower extremity erythematous rash with fluid-filled vesicles spread throughout. Area around sock-line at ankles appears more inflamed. Rash extends to tops of feet. Skin appears more erythematous in areas where hair is more densely distributed—legs and tops of feet. Ankles and soles of feet are clear. Face and arms are dark tan with freckles; there is a distinct line of demarcation at biceps and neck where skin has prior sun exposure.…
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.…
This is a followup dermatology clinic visit. See Dr. Tara Stewart's dermatology consult from 05/13/2016. The patient has posterior hip herpetic neuralgia over his right neck continues to be troublesome for him. He says his other issues that were discussed in May are much improved. These consisted of apparently some scales and scaly macules and patches over his chest, arms, shoulders, neck, and ears that had some crusting. This he says is all improved and doing well. He is currently followed in the Pain Clinic for his post herpetic neuralgia. His cutaneous issues improved about one month after the dermatology clinic visit in 05/2016. He is now concerned about residual pain in his right scalp and neck and one itchy site on his right thigh that comes…
Physical Appearance – Patient is a healthy 33 year old African American Male with dark brown eyes. Ht: 5’10Wt: 196 poundsColor: Even Skin Tone, Pt. lips are pink in color so dehydration is not present.pain level 0/10 on pain scale. No over the counter medications have been taken.Orientation: A&O x3 (time, place, and person), client denies any depression or anxiety; answers all questions appropriately when asked. Dress and Grooming: Patient was well groomed, and had appropriate footwear. Hair is short and neatly groomed. (Pt. stated no dryness and breakage).Mobility: Patient had normal mobility denied any pain or joint weakness in x4 extremities; posture is normal with no deviations or…
Patient should be made as comfortable as possible. Pain levels should be assessed. Pressure points should be assessed.…
To ensure compliance of the Joint Commission’s standard of pain assessment, a pain management policy will be adopted effective immediately to educate staff. The pain management policy will expect staff to consider pain imperative as a fifth vital sign. To begin this process, a patient’s pain must be evaluated prior to treatment. By using a pain scale of 0-10 (zero being consider painless to 10 being the worst pain a patient has ever experienced), an accurate assessment of a patient’s individual pain level can be properly monitored. Next a patient’s pain level should be assessed during treatment. At the very least, a patient’s pain level should be assessed every two hours utilizing the 0-10 pain scale.…
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…
Use: staff giving the medication needs to be trained in relation to administration, infection control and non-touch technique.…
Upon arrival at the emergency room the patient was shivering which can be seen as an early indication of hypothermia. At this time the patient was instructed to remove her parka in an effort to avoid further heat loss, resulting from an accumulation of moisture from the conditions outdoors. To assist in regulation of homeostasis the patient was wrapped in blankets and given hot chocolate. Pulse was taken at the Dorsalis Pedis to check the patient’s circulatory response. (The EMT Spot, 2014, ¶7). Pain reported by the patient was localized to the medial surface of the right knee, noticeable inflammation present due to the leaking of fluids from compromised internal tissues. The patient’s presentation of symptoms are indicative to that of a potential medial collateral ligament and medial meniscus tear. (Healthline, 2014, ¶5). The medial…
The patient is a 85-year-old disabled male who was admitted to the hospital for a two-week antibiotic therapy to treat Escherichia coli bacteria infection. Patient has no skin breakdown or pressure ulcer. The family wanted the patient to place on an air mattress (Hill-Rom Advanced Microclimate) during his stay to prevent pressure ulcer but the hospital recommends repositioning every two hours, as part of the nursing intervention. The family is concern that after the two weeks stay at the hospital patient may develop the pressure ulcer. As a clinician, to ensure patient safety and prevent pressure ulcer, a well-structured question is asked.…