Name: S.A. Occupation: Business owner
Source of History: Patient Reliability of Historian: Reliable
Age: 47 Date of Birth: 7/2/1967
Sex: Female Birth Place: Iraq, Mosul
Race: Middle Eastern Religion: Muslim
Chief Complaint: Patient states, “ I have been having chest pains for the past two weeks”.
History of present illness: 51 y/o middle eastern Female c/o chest pain for the past two weeks. She was in her usual state of good health until she noticed an abrupt onset of chest pain which lasted from a few seconds to a minute. She described her chest pain as dull and aching. The pain began in her left para-sternal area and radiated up to her left arm. The first episode of pain two weeks ago when she was walking her dog for 30 minutes and began to feel tired before the onset of her pain. Her pain lasted about 5 minutes. The pain was accompanied by shortness of breath, but no vomiting, sweating or nausea. Her pain subsided when she went home and rested. Since her initial episode she has had one more episode similar to quality and location of her first episode. She has not attempted any specific measures to relieve her pain other than resting. She describes no other associated symptoms, including palpitations or dizziness. She becomes shortness of breath, but describes no other exertional dyspnea, orthopnea or proxamal nocturnal dyspnea. No association with food, No GERD, No change in pain with movement, No palpable pain. She has never been told she has heart problems. Denies Tobacco and drug abuse. Occasionally takes OTC Ibuprofen (Advil) for headache (QOD). She was diagnosed with HTN February 2012. She had TAH with BSO 4 years ago. She Patient is owner of a pet grooming and is alway...
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...ar pattern. Heard resonance upon percussion of the patients chest. S2 sounded louder than S1 when auscultating over the aortic valve and the pulmonic valve. S1 and S2 heard equally at Erbs point. S1 heard louder than S2 over the tricuspid valve and mitral valve. No heart murmurs present. Apical and Carotid pulse are synchronous.
Abdomen: Skin of the abdomen is consistent with the skin of the rest of the body. The abdomen is flat and umbilicus is mid line. Abdomen is symmetric and free of bulges. Pulsations and wavelike movements present below the xiphoid process. Bowel sounds are present in all four quadrants. Bowel sounds are irregular , gurgling and high pitched. Liver border percussed at right costal margin, and noted to be 7cm in size. When palpated abdomen was soft, smooth, non-tender and free of pain. No masses palpated or visible.
Genitourinary (female):
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.
HPI: MR is a 70 y.o. male patient who presents to ER with constant, dull and RUQ abdominal pain onset yesterday that irradiate to the back of right shoulder. Client also c/o nauseas, vomiting and black stool x2 this morning. He reports that currently resides in an ALF; they called the ambulance after his second episodes of black stool. Pt reports he drank Pepto-Bismol yesterday evening without relief. Pt states that he never experienced similar symptoms in the past. Denies any CP, emesis, hematochezia or any other associated symptoms at this time. Client was found with past history gallbladder problems years ago.
622 Y. When the AV node receives the signal, it fires and causes the ventricles to depolarize, this is known as the QRS Complex. The atria also repolarizes during this phase. Specifically in the QRS Complex, during the Q wave, the interventricular septum depolarizes, during the R wave, the main mass of the ventricles depolarizes, and during the S wave, the base of the heart, apex, depolarizes. After the QRS Complex, the S-T segment can be identified as a plateau in myocardial action potentials and is when the ventricles actually contract and pump out blood to the pulmonary and systemic circuits. The final phase of the heartbeat is the T wave and this is when the ventricles repolarize before the relax, ventricular diastole, EKG Video Notes and pg. 671 D. These phases represent the cardiac cycle, which is the time and events that occur from the beginning of one heartbeat to the beginning of the next heartbeat. In this lab, the first EKG that I took was my regular heartbeat during rest. In this recording, I was able to see the P wave, followed by the QRS Complex and the T wave as well. Everything looks pretty normal, but the T wave does go a little lower than normal and I believe this is due to the fact that I was diagnosed with sinus bradycardia
Liver percusses to 8 cm at midclavicular line, one fingerbreadth below right costal margin: This indicates that the patient does not have signs or symptoms of liver disease or ascites.
Two heart sounds are normally heard through a stethoscope on the chest wall, "lab" "dap". The first sound can be described as soft, but resonant, and longer then the second one. This sound is associated with the closure of AV valves (atrioventricular valves) at the beginning of systole. The second sound is louder and sharp. It is associated with closure of the pulmonary and aortic valves (semilunar valves) at the beginning of diastole. There is a pause between the each set of sounds. It is a period of total heat relaxation called quiescent period.
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
than 9 square centimeters, was placed on the patient's chest at various angles. The transducer delivered ultrasound waves into the body and these
Stomach: The stomach was empty of all contents. There was streaky erythema within the antrum consistent with nonerosive gastritis. No specimens are obtained. The proximal stomach was normal. No hiatal hernia seen.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
HPI: 45-year-old male with past medical history of hypercholesterolemia and hypertension who presented with chest pain. Patient had been moving furniture with his wife all morning. After some time he developed chest
He also has history of chronic obstructive pulmonary disease, muscle weakness, type 2 diabetes mellitus, coronary artery disease, hyperlipidemia, and dementia. He has been a widow for 5yrs now and has one daughter. He currently takes 10 different scheduled medications. These include: Augmentin, Lasix, Aricept, Aspirin, Potassium, Aldactone, Zoloft, Prednisone, Flonase and Seroquel. My patient was diagnosed with congestive heart failure by labs and diagnostic procedures. Lab results: White count 3.7, hemoglobin 11.3, platelet cunt 164, Sodium 140, potassium 3.9, chloride 95, bicarb 28, BUN 19, creatine 0.9, glucose 108. Chest x-ray showed accumulation of fluid around heart and lungs. He also had an electrocardiogram and a cardiac catheterization done to rule that coronary artery disease was the cause of his
Identifying Data: R.S. is a 28 year old Indian female of Indian-American of Asian descent. She is a full time nursing student currently residing in Rochester. She is single and does not have children. Patient presents today complaining of pressure headaches and is alone.
A normal heart rhythm begins at the sinoatrial node and follows the hearts conduction pathway without any problems. Typically the sinoatrial node fires between 60-100 times per minute (Ignatavicius & Workman, 2013). When a person has Atrial Fibrillation, the sinoatrial node releases multiple quick impulses at a rate of 350 -600 times per minute. When this happens, the ventricles respond by beating around 120- 200 beats per minute, making it tough to identify an accurate heart rate. This arrhythmia can be the result of various things. During a normal heart beat, the electrical impulse begins at the sinoatrial node and travels down the conduction pathway until the ventricles contract. Once that happe...
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
The patient has experienced fever, chills on body, headaches and anorexia as well as sweating especially during the night. The patient has also been feeling fatigued, muscle aches and nausea as well as vomiting especially after eating (WHO, 2010, p. 117). These symptoms started forty eight hours ago, and the patient has not taken any medication except for some aspirin.