CC Victoria is a 20-year-old female here today complaining of pain on her right rib cage. HPI The patient tells me her symptoms started on Saturday night. Prior to that, she was not having any symptoms or concerns. There was no specific injury or trauma. She said the right side of her body along the lower ribs and the skin area became painful even to light touch. She feels the pain not only in the right front, but also towards the right back, where the ribs are as well. She had not done any unusual activity. She has not had any unusual other symptoms that she is aware of. Initially, it was coming and going, but now it is becoming more constant. She realizes when she takes a deep breath it worsens the pain. If she touches it or lies …show more content…
No anterior or posterior cervical lymphadenopathy. Heart Regular rate and rhythm. Normal S1, S2. No murmurs, rubs, or gallops. Lungs Clear bilaterally. Good breath sounds. No wheeze or rhonchi. Abdomen Soft, nontender. No masses or discomfort. There is no pain with pressure over the right upper quadrant. She does have pain with pressure over those lower ribs, even as you move around the ribs towards the back, though that area is still tender as well. No obvious step-off at the rib. There is no bruising. There is no redness. There is no overlying rashes. Extremities No lower extremity swelling is noted. Skin No rashes on the rest of the body. A/P Victoria Bond is a 20-year-old female here today with pain over the right rib cage. We talked about the differential diagnosis. Prior to coming in today, she did call. A CBC was drawn at the hospital. I was able to pull up that report showing a white blood cell count of 4.7. Hemoglobin and hematocrit 13.7 and 40.6 respectively, platelets 216, normal differential with the exception of a slight increase in lymphocytes at 47%. We reviewed further evaluation. I would like her to get an x-ray of the area. Depending on the chest x-ray and rib series result, further evaluation may be necessary. She is going to use anti-inflammatories, should she feel she needs to and will follow up with me for the results of her testing tomorrow. Should her symptoms worsen acutely, particularly having higher fevers, vomiting,
The signs and symptoms are pressure, stiffness, pain in the chest or/ and arms that may advanced to the neck, jaw, or back
In terms of her presenting complaint, she described herself as an active lady, who ran her own pub, but her recent symptoms rendered her unable to carry out her normal activities, such that her husband recommended she should go to hospital.
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
Since one of the prominent concerns she has is related to health, she needs to be reassured by a physician that these symptoms are not dangerous, along with being aware about the fact that she misinterprets these symptoms and these symptoms can be created if she persistently focus on the certain parts of her body.
It’s a “nonlesion” syndrome , exhibit no clinically detectable lesions, although symptoms of pain and burning can be intense. This is particularly frustrating problem for both patient and clinician, because there is usually no clear cut cause and no uniformly successful treatment is present.
The care that the public health nurse provides to her clients is patient-centered. During one of the home visits, the nurse talked and questioned her client about what her needs were and if there was anything she could do for her. The client mentioned that she needed more supplies such as diaper and baby clothes. The nurse agreed to bring these items the next time she visits. When the nurse had to perform an assessment on the client’s son by using the ASQ-3, which is a screening tool that screens for developmental delays, the client mentioned that she was not feeling well and did want to answer questions. The nurse respected her client’s request and did not carry on with the assessment. Patient-centered care was evidenced in the nurse’s practice as she was assessing and responding to her client needs. The client also had control on how the care was delivered to her. By letting the client have a voice in her care, the nurse was establishing a caring relationship with the client, which is one of the cornerstones of public health nursing (Garcia, Schaffer, & Schoon, 2014, p. 9). In addition, by providing support and care as well as addressing the client’s needs, the nurse was working at the individual level of practice.
Throughout the Practical Nursing program, there has been many opportunities to closely observe working nurses in different hospitals and facilities. It also has been a great chance to grasp the general idea about professionalism in the workplace and how it can have a great impact in a successful work environment. Combining what was observed and what was learnt from the class, there were three particular aspects of professionalism that seemed to be key characteristics of professional nurses: knowledge from continuous education, autonomy, and positivity. Out of all other characteristics for professionalisms in nursing, those three were the most remarkable features found from the some of the great nurses observed from the clinical sites.
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.
The modern nurse has much to be thankful for because of some of the early pioneers of nursing, such as Florence Nightingale and Jensey Snow. However, the scope and influence of professional nursing, as well as the individual nurse, has seen more exponential growth and change in North America since the establishment of the first professional organization for nursing, the Nurses Associated Alumnae of the United States and Canada, which in 1911 came to be known as the American Nurses Association.
A hypothesis that can be made from the patient’s report is that she is suffering from cervical radiculopathy, or a nerve root lesion. Symptoms that describe cervical radiculopathy include: arm pain in a dermatome distribution, pain increased by extension, rotation, and/or side flexion, possible relief of pain from arm positioned overhead, affected sensation, altered hand function, no spasticity, and no change to gait or bowel and bladder function (Magee, 2008, p. 142). These symptoms correlate to what the patient reported as a result of her injury. She stated that her pain is in the posterolateral upper and lower arm with aching and paresthesia in the thumb and index finger, which is in the dermatome pattern of cervical root 5 and 6 (C5, C6) (Magee, 2008, p. 25). She also reports lancinating pain with extension or rotation to the right of her head.
Jane had not slept for 72 hours and had poor diet and was observed not to be drinking fluids. Jane has a diagnosis of Bipolar
1. What is the difference between a. and a. Which K, S, and A pertain to the care you provided to the patient you have chosen? Why do you need to be a member? K- Describe the limits and boundaries of therapeutic patient-centered care. S- Assess levels of physical and emotional comfort.
This was his second episode since 10 days ago where he develop the same pain at his right flank. He suddenly experienced severe pain 8 hours before admission when the pain shifts to his right lower quadrant of his abdomen. The onset is at 6.30 am before worsening at 10 p.m to 2 p.m. He described the pain as continuous sharp pain and gradually increased in severity. There is no radiation of the pain. The pain was exaggerated on movement and touch. There were no relieving factor and he scale the severity as 7/10. He experienced fever for 1 day prior to admission. It was a mild grade continuous fever. He does not experienced chills and rigor. The patient does not experience any nausea or vomiting, no dysphagia, no pain during micturition and no alteration in bowel habit. He experienced loss of appetite but not notice any weight loss.
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.