Patient is a 61-year-old white male admitted through the ER with on December 10 with recurrent right pneumothoraxes. Patient is known to have COPD with emphysema and has multiple admissions for problems concerning this. At the time of initial evaluation, a small caliber chest tube was inserted in the anterior axillary line, which improved the patient’s respiratory distress but did not completely resolve the pneumothorax. I was called to the ICU to place a second small caliber chest tube in the posterior axillary line below this. This further improved the patient’s pulmonary status with his saturation improving from 76& to 89%. Since admission he has felt better but complained of pain at the chest tube insertion site. He has continued to leak out through the pleur-evac under water seal, and beginning yesterday he developed subcutaneous emphysema, which has gotten progressively worse. Earlier today he began having increased respiratory difficulty again, with his saturation dropping to approximately 80 % despite oxygen per nasal cannula. Chest x-ray today showed a worsening of the right lower lobe loculated pneumothorax, and on examination today he is not only leaking air through the pleur-evac system but also around the two chest tubes.…
This patient was admitted for shortness of breath, fever and chills. He has a history of cystic fibrosis, with secondary diabetes.…
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.…
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.…
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…
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.…
A patient presented to the Emergency Department with the complaints of hip and leg pain. The patient rated the pain 10/10 on the standard pain scale. His (L) leg appeared shortened with swelling, ecchymosis, and limited range of motion. The leg was stabilized and then he was further evaluated and discharged to a room in the nursing department. The patient was also noted to have a history of impaired glucose tolerance and prostate cancer. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient was placed in a room and prepared for a procedure. The physician evaluated the patient and proceeded to order Valium, when unsuccessful hydromorphone was ordered. The patient had not achieved appropriate sedation for the procedure and additional medication was ordered. The patient was not placed on a cardiac monitor and a baseline oxygen level was not obtained prior to the administration of sedatives. The patient was receiving “Conscious sedation” in order for the physician to perform a manipulative procedure. The patient eventually had a decrease in oxygen saturation and became hypotensive- an arrest occurred. The patient was resuscitated and then transferred to a tertiary center. The patient was found to have brain damage and after…
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.…
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).…
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.…
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…
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.…
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…
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…