Thank you for referring Victor Lai, a 62-year-ld gentleman of Malaysian origin who immigrated to Australia 34 years ago. Victor is an ex-smoker of 10 pack-years and keeps no pets. Victor is a mining engineer and every couple of months will travel interstate, particularly to Western Australia and a couple of times per year will travel overseas including Indonesia and Africa. Victor is not aware of any asbestos exposure. For at least the last five years, Victor has been aware of nocturnal symptoms, specifically a rattling sensation in the throat area that sometimes will improve with throat clearing and coughing. In the last few months, he has become aware of dyspnoea and wheeze during the day. His nocturnal symptoms respond to Seretide and his daytime symptoms respond to Ventolin. He is currently taking Seretide two puffs nocte day and Ventolin two puffs per day typically three days …show more content…
Examination revealed an oxygen saturation of 95% and oropharyngeal inspection was unremarkable. Chest auscultation revealed prolonged expiratory phase of breathing, but no actual wheeze. Two heart sounds were audible with nil else and JVP was not elevated. Assessment: Victor’s symptoms are most in keeping with adult onset asthma and he is not aware of any recent environmental changes to account for these symptoms. The nocturnal vibrating/rattling sensation in his throat sounds like some laryngeal irritation and I have raised the possibility of silent post-nasal drip with mucus build-up given throat clearing does relieve this problem. Against is the fact that it responds well to Seretide. I have advised Victor to use Seretide two puff bd on a regular basis and hopefully this will alleviate his daytime symptoms. He will undergo a chest x-ray, lung function tests and routine pathology including an allergy screen. I will see him again in a couple of months. Thank you again for your
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.
Examination revealed an oxygen saturation of 98% and blood pressure of 145/90. Oropharyngeal inspection revealed significant crowding (Mallampati class 3) with macroglossia. Chest auscultation was clear and two heart sounds were audible with nil else.
As if being the father of two children and a dedicated husband were not enough, Victor Terhune has to balance his family life with his job. Victor currently works as a Technical representative for the sales department at Weastec in Dublin, Ohio. Though work holds him back from doing some of the things that he would like to be doing, like spending more time with his wife and sons, this is a common theme for many workers today in a relationship with their desire to be with their families. Victor strives to get resolution to this by making time by driving home right after work and focusing on that quality time with his family.
Asthma is a chronic inflammatory disease of the airways. It is a reversible airway obstruction, occurring 8 to 10% of the population worldwide. According to a study in 2005, asthma affects over 15 million Americans, with more than 2 million annual emergency room visits. Asthma patients have a hyper-responsiveness in their airways and generally and increase in their airway smooth muscle cell mass. This hyperplasia is due to the normal response to the injury and repair to the airway caused by exacerbations. The main choice of therapy for asthma patients is β2- adrenergic agonists. Racemic albuterol has been the drug of choice for a short acting bronchodilator for a long time, but since the development of levalbuterol, there is the question of which drug is a better choice for therapy. Efficacy and cost of treatment must both be taken into consideration in each study of these therapies to determine which is best for the treatment of asthma.
HEENT: no headache, no tinnitus, no hearing loss, mouth sores, no voice changes, no problems swallowing, sinus congestion, no visual disturbances.
M.C is a 19 year old male that presents to the office complaining of sneezing, nasal congestion, watery, itchy eyes, and rhinorrhea that have progressed over the last eleven days. His symptoms tend to be worse in the mornings when he wakes up and he has had a sore throat upon awakening that improves as the day progresses. He has also been getting mild sinus pressure 2/10 pain located around the eyes, that are relieved with OTC Tylenol. He has recently moved to Tampa from New York and has not had symptoms similar to this before. He does mention, however, that in the past smoke has caused him to get itchy
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
The EB’s case study said the female patient is 50 years old with symptoms of fever, chills, congestion, three weeks of coughing, shortness of breath when walking. The study implies that the patient is now seeking medical advice due to vital signs recording and the noting of decreased breath sounds and wheezing. She denies smoking and not taking any chronic medication.
Vitals signs: BP 90/60, HR(heart rate) 90-100, RR(respiratory rate) 22, Temp: 100.2 F, Oxygen Saturation: 98%
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
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.
This information is in response to your request regarding Chantix as an ideal method for smoking withdrawal for your 54-year old female patient with Patient ID# 122014. Her medical profile shows that she has type II diabetes, hypertension, and major depression. I noticed that you replaced her lisinopril with olmesartan due to her dry cough in order to reduce her dry cough side effect. Additionaly, she has been taking fluoxetine since December 2004 to treat her long-term depression. She is also working on her diet and lifestyle changes where she significantly lost weight. I also realize that she treats herself a glass of wine with dinner and is down to smoking one pack per day. Your patient shows a strong desire to quit smoking, and Chantix is a viable option for her.
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...
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.