Thank you for referring Annette Harris, a 58 year-od lady who is an administrative worker with the cardiology department at the Austin Hospital. Annette is a non-smoker and currently keeps no pets. As you are aware, Annette is generally in good health. Around three months ago, Annette developed the onset of a tickling sensation in the throat associated with a dry cough. Over the last few weeks, this symptom has improved but in the last couple of weeks, she has been aware of a sensation of throat tightness with some mucus build-up. This came to a head around a week ago when she presented to the Austin Hospital ED. ???endoscopy revealed erythematous arytenoids but an otherwise unremarkable oropharynx and larynx. Annette was commenced on Nexium …show more content…
Examination revealed on oxygen saturation of 97% and oropharyngeal inspection was unremarkable. Chest auscultation was clear and two heart sounds were audible with nil else. Assessment: Radiological changes are non-specific and as stated are more in keeping with either an infective or inflammatory process. The fact that Annette is quite well is obviously reassuring and it may well be that she has had a low-grade atypical infection. The radiological changes will not account for her recent upper airway symptoms. For the imaging abnormalities, as Annette is well, I have not suggested any specific treatment at this stage but rather she will have some baseline pathology including a check of inflammatory markers and provided she remains well, a repeat scan will be performed in a few weeks to assess for and interval?? Change. If there is persistence or progression of these abnormalities, a bronchoscopy will be considered. If Annette does develop any new symptoms during that time, she has been advised to make contact with
Anne Morell is a seventy-four year old female with a past medical history of hyperlidemia, hypertension, osteoarthritis, osteoporosis, diabetes mellitus type 2, renal insufficiency, Charcot foot, and osteomosteomyeltits. Anne has a history of osteosarcoma treated in 1996 with surgery, chemotherapy and radiation. Anne also has a history of breast cancer, diagnosis in 2003 treated with radiation therapy. Anne past surgical history includes tonsillectomy in 1962, removal if osteosarcoma of left thigh in 1996 and lumpectomy of left breast in 2003.
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
Ransley reports frequent nasal congestion that has been more problematic in the last couple of weeks and I note you have commenced him on some oral antibiotics and prednisolone which seems to be helping.
DISCUSSION/ANALYSIS Introduction: Throughout this discussion, I will debate and analyse the ideas I have collected from my research. My discussion is separated under sub headings which will allow me to form a better understanding of how capital punishment is viewed, which will help me in reaching a possible answer to my question. Firstly, I am going to be discussing two very well known case studies. Case studies: The two case studies I have picked to focus my research on are: Derek Bentley who was the last man executed in Britain along with Ruth Ellis who was the last woman executed in Britain.
Thank you for referring Lauris Dniprowskij, a 67 year-old retired private investigator. Lauris is and ex-smoker of approximately 50 pack years and he ceased this habit eight years ago. She currently has four chickens at home and is looking at acquiring other animals having recently moved to another farm.
Vital signs are stable. Noted weight loss of about eight pounds in the past three weeks. She appears to be in no distress. Heart rate at rest was 100. On exam, her lungs were clear bilaterally. Heart: Regular
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
It would be appreciated if you could review Pauline Montalto, a lady who you operated on last year. Pauline has a history of non-atopic asthma, although the one doubt concerning this is that she is currently living in a house with mould exposure and a previous RAST assay has demonstrated slight sensitisation to mould.
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
While performing Claudia’s primary assessment, I would start with ABCs. Airways should be assessed for patency. Rationale: The patient was admitted with a three-day history of vomiting. Vomiting increases the patient’s risk for aspirations. Suctioning or airway adjuncts should be used if necessary in order to maintain airway patency (Gulanick & Myers, 2011). I would auscultate Claudia’s breath sounds for crackles and wheezes. Rationale: The patient could aspirate particles of gastrointestinal content. It could lead to pulmonary obstruction, aspiration pneumonia, damaged lung tissue due to acidic aspirate, and chemical pneumonitis (Gulanick & Myers, 2011).
The Andrews family consists of an African American father and mother that are in their early 50s and two teenage children. This paper will focus on primary heart health for Mrs. Andrews. Mrs. Andrews has a significant risk for developing heart disease, MI, and stroke. Mrs. Andrews non-modifiable risk factors include being an African American female in her 50s. Her modifiable risk factors include stress, hypertension, being overweight, and not seeing a primary care practitioner for two years. She quit smoking three years ago which is a modifiable risk factor that she has changed prior to this visit, the goal is not to sustain the change long term. According to the American Cancer Society the risk of developing coronary heart disease (CAD) is significantly reduced after quitting for year ("when smokers quit," 2014).
In clinical, one of my patients was diagnosed with pneumonia, history of asthma and COPD. She informed me that
Rosa Lee Cunningham is a 52-year old African American female. She is 5-foot-1-inch, 145 pounds. Rosa Lee is married however, is living separately from her husband. She has eight adult children, Bobby, Richard, Ronnie, Donna (Patty), Alvin, Eric, Donald (Ducky) and one child who name she did not disclose. She bore her eldest child at age fourteen and six different men fathered her children. At Rosa Lee’s recent hospital admission to Howard University Hospital emergency room blood test revealed she is still using heroin. Though Rosa Lee recently enrolled in a drug-treatment program it does not appear that she has any intention on ending her drug usage. When asked why she no longer uses heroin she stated she doesn’t always have the resources to support her addiction. Rosa Lee is unemployed and receiving very little in government assistance. She appears to
The primary diagnosis for Amanda Anderson is separation anxiety disorder (SAD) with a co-morbidity of school phobia. Separation anxiety disorder is commonly the precursor to school phobia, which is “one of the two most common anxiety disorders to occur during childhood, and is found in about 4% to 10% of all children” (Mash & Wolfe, 2010, p. 198). Amanda is a seven-year-old girl and her anxiety significantly affects her social life. Based on the case study, Amanda’s father informs the therapist that Amanda is extremely dependent on her mother and she is unenthusiastic when separated from her mother. Amanda was sitting on her mother’s lap when the therapist walked in the room to take Amanda in her office for an interview (Morgan, 1999, p. 1).
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.