A 57-year-old female presents to her physician with changes in her bowel habits for the past few weeks. The patient reveals that she usually has soft bowel movements once a day. However, she has started passing pellet-like stools that alternate with loose stools. Her current symptoms are associated with sense of bloating and abdominal fullness. The patient denies seeing blood in her stool, weight loss, low-grade fever, a family history of colorectal cancer, or previous colon cancer screening. Abdominal examination reveals normal bowel sounds, no tenderness to palpation, and no evidence of a mass. Rectal examination is normal, and stool is negative for occult blood. Which of the following is the most appropriate next step in the management of
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.
The patient's current symptoms include joint pain, ringing in her ears, loss of taste and smell that is been ongoing for two months, loose bowel movements that occur every morning, but not in the afternoon, she has bilateral rib soreness that comes and goes, she has noticed hair loss, she has random tooth pain in different parts of her mouth and has seen her dentist, who told her there is nothing wrong with her teeth or gums. She also has aversion to smells, she gets headaches, which mostly are frontal that she rates as a five out of 10 in severity and occurs about one time per week. Tylenol will take them away. She has also been having weight loss, noticing that her clothes are not fitting well. She has been taking an herbal supplement that includes things like cats claw, red root, St. John's wort, etc. She is overdue for her colonoscopy, given that she has a family history of colon cancer. Her last
The ethical discernment model described by Slosar (2004) and developed for use at Ascension Health will assist us as we analyze this case. It reminds us that discernment engages our spirituality, intellect, imagination, intuition, and beliefs. It is decision-making that reaches into the heart of our beliefs about God, creation, others, and ourselves. It therefore requires structured time for reflection and prayer from the beginning and throughout the process.
Mrs. Jones, 78 years old, arrived in the emergency department (ED) via ambulance. She was alert and oriented, but was having episodes of lost consciousness. She was put on the cardiac monitor and her vital signs were obtained. Her cardiac rhythm was normal. Her vital signs were as follows: Temperature 97.3°F, Pulse 43, respirations 26, blood pressure 100/58 and O2 saturation of 94% on room air. Additionally, Mrs. Jones was vomiting and had 2 loose, incontinent stools. She was pale, cool to touch and diaphoretic. Auscultation of her lungs revealed expiratory wheezes.
IBS is a functional GI disorder, meaning it cannot be explained by any specific structural or biochemical abnormality. The disorder is subdivided into three different types, which are named on the basis of the predominant symptom – IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), IBS-M (mixed diarrhea and constipation). Clinical presentation varies considerably with regard to the quality of the predominant feature and the overall severity of symptoms. Formal diagnosis is based on the most recent Rome III criteria, which require that a patient experience recurrent abdominal discomfort of at least 3 days per month over the previous 3 months, with a total symptom duration of at least 6 months, in...
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.
Being part of the modeling industry can be a dangerous decision. The modeling industry doesn’t use the power they have in order to make sure the models are in a healthy state. If the modeling industry doesn’t put any rules on how thin models should be then they’re putting many of their models at risk of tragic consequences. Many of these tragic consequences are eating disorders such as bulimia that can possibly lead to death. Not only is this affecting the models it’s also affecting the mentality of the women or men that look up to these models. I think that having certain regulations on how thin a model should be is vital for the health of the model and other people that the models inspire.
Patients with ulcerative colitis if usually referred to a gastroenterologist. This is a specialist who manages patients with gastrointestinal diseases. The physicians will need to assess the severity of the condition. The questions he or she is likely to ask include how many times are you passing stool? Is the stool bloody? Do you have nonspecific symptoms such as a high temperature, tachycardia and shortness of breath? The patient should be examined and investigated to rule out differential diseases.
This 89-year-old lady is seen at MCCRC on 03/28/2017. She was admitted here from Johnson City Medical Center on 03/23 after her second hospitalization for acute on chronic heart failure and a respiratory infection. She was sent home but instead of to a Rehabilitation Center when the family felt they could care for her then they could not get her out of bed. She has early dementia and much of her history is difficult to obtain, although she says that I had seen her mother some 30 years ago and prefers to talk about that era. She says she has never smoked. Her present medications at this facility include spironolactone 25 mg daily, a multivitamin, calcium, vitamin D, and vitamin K. She is on glucosamine. She is on citalopram
Jorge did not have any constipation episodes this year. He experienced one episode of diarrhea on 6/8/17 that required the administrator of Immodium 2 mg cap PO once; Miralax was held, then restarted on 09/25/17. NO other GI related symptoms were reported or documented. His bowel elimination at present being treated with Miralax 17 gram orally, High fiber diet, and 2 tbsp. Ground Flaxseeds mixed with food at lunch.
I have undergone many scintigraphy studies with both solid and liquid foods. Some studies looked at empting over just an hour’s time span whereas the longest study visualized empting for six hours. The older I’ve become the slower my stomach has emptied. Over the years various forms of treatment have been utilized in my care. Common treatments involve diet modification, pharmacological treatment and surgical intervention.8 While there is a lot of current and past research and information about gastroparesis much of it does not address other methods of treatment that I have found to be particularly effective in managing my symptoms. I’ve learned about these various treatments from others who suffer from the disease, physicians who have treated me and just from living with the disease.
III. REASON FOR SEEKING CARE (CC): 38 y/o female c/o abdominal pain throughout the entire abdominal cavity, states she has always had abdominal discomfort, but the past 3 days’ pain has become unbearable. Describes pain as a burning churning through out 8/10. Pain intermittent c/o of sour stomach after meals accompanied by nausea, denies vomiting, diarrhea or anorexia, last bowel movement 4 days ago. States she moves bowels 2-3 times a week. She states this happened about 2 years she went to emergency room, CT was done, no blockage, she was sent home without meds, CT contrast helped her move bowels at the time, symptoms eventually resolved on their own. Pt c/o of waking up feeling unrested, had trouble falling asleep ever since she could remember, wakes up frequently with difficulty getting back to sleep. She reports sleep disorder sometimes coincide with inability to get comfortable due to shoulder and neck pain especially in the winter months. Pt states the head and shoulder pain are the result of a MVI in 1995 where she had spinal nerve damage and bulging disc.
Disputes are almost unavoidable between people when there are disagreements or misunderstandings. In the construction industry, contractual relationships could lead to dispute. To resolve disputes, construction disputes are most likely encouraged to use Alternative Dispute Resolutions such as arbitration, mediation, and mini-trials to resolve their disputes faster and keep the dispute confidential and at lower cost (Ray, 2000). The construction case presented in this paper first resorted to negotiation; however, it could not give the parties a resolution which led to a mini-trial.
I remember my mom telling me how excited she was when she found out she was pregnant for me, even though she was not expecting to get pregnant and was not really with my dad anymore. She told me about the nights she would lay in bed and read to me in her belly. Mom never told me about the times she would be worried sick about how she would be able to support us, she never told me but I know it had to have occurred, my mom was not expecting me after all.
This worker met with Ms. Mathali at her home. Privacy practices and Tennessen notices were reviewed and signed. The interview was recorded.