The patient is a 16-year-old high school student who is referred to "through not any gastrointestinal problems. Vomiting occurs as a result of the nausea. This has been going for about 3 1/2 years." This story is complex and complicated. When the patient turned about 12 she started having nausea and vomiting, which began about 4 days before her period. Her menses were regular until about 6 months ago. Because of the premenstrual vomiting she went on Tigan, Elixir, and Donnatal. This was tried for about 3 months and did not help. Then she was tried on low doses of birth control pills on a regular basis. This also did not help much and she was then switched to Torecan and Pepcid. Apparently over the last 6 months her periods have become more irregular. In addition, she has had vomiting almost everyday. She says that she vomits up "phlegm" and sometimes vomits yellow bile which tastes bitter. She says that she always feels full and does not want to eat. She has not lost any weight. She vomits in addition, if she eats spicy food. This also results in heart burn by which s...
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.
Biologically Jody can be prescribed antidepressants or can go to a refeeding program. Before she goes through all of this she needs to be hospitalized because of her low body weight and her inability to exercise without being dizzy within a minute. This shows signs of serious medical complications. Jody is extremely underweight and now refuses to eat. This can cause serious medical complications such as anemia, dermatological problems, heart irregularities, menstrual irregularities, muscular weakness, GI problems, dizziness, hypotension and even death. Jody has been suffering from menstrual irregularities, dizziness and muscular weakness. Medical complications are deemed to be serious and medical assistance is needed immediately. Since she has these medical complications there is a possibility that she will have many other underlying ones. Jody needs to go to the hospital immediately because her life could be in danger. It is extremely important that this is the first step taken so we know how to further the treatment that she receives. She can also go through a form of therapy known as cognitive behavioral therapy. I believe that Jody should attend therapy. This therapy will allow her to receive the exposure to food that she truly needs. It will also challenge any maladaptive thoughts that she may have. She should also put on antidepressants because she suffers from anxiety because of
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 on urination, and decreased urine output for three days.
Through assessment, I have come to the understanding that these symptoms come from an underlying issue of abandonment. She is experiencing a negative cognitive shift where she has trouble seeing anything positive about herself leading to a lack of appetite. She is showing significant symptomology of an eating disorder, this coinciding with her high levels of irrational thoughts and faulty cognition (Lask, 2000). Her eating disorder has led to the problematic behaviors of panic disorder and it has to be dealt
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
She asked about the risk of HIV. I informed her that with a high viral load and not medication, this could be as high as 255. If she is on meds and her viral load is < 1000, the risk would be around 2-5%. I do think she has time to get her viral load under control, especially if she has previously been undetectable on Complera. I advised her to make sure that if she is nauseous that she take her Diclegis properly and then Phenergan prn for nausea. If she gets to a point where she cannot keep the Complera down, we may need to treat with Phenergan or Zofran. I scheduled her to return in 4 weeks for completion of the anatomy and growth. I also gave her notes for proof of pregnancy confirmation as well as note stating that she is unable to
Osmara is a 22yo, primigravida, who is currently 34 weeks 5 days. She has been followed for an elevated inhibin. On her visit 2 weeks ago she was noted to be LGA that was symmetric and growth > 90%ile. Amniotic fluid was normal but generous at 19 cm. In the last week, she has gained a fairly significant amount of weight and has noted edema. She does tend to wake-up with the edema but it can be relieved with elevation. She has an occasional headache and has not really taken Tylenol but otherwise has no visual changes or nausea/vomiting.
C. L. a 52-year-old male scheduled for a colonoscopy. Indication was for an initial screening. The patient is allergic to the pertussis vaccine. Vital signs included: temperature 97.1, respiration rate 20, heart rate 98, blood pressure 137/98, and oxygen 98% on room air. Lungs clear bilaterally upon auscultation. The IV attempt was successful on the first try made by me. I placed the IV in the patient’s left hand. This concluded my visit with this patient.
She also used Vyvanse but again, stopped these in mid-December. She also has had MRSA in an infection on her left arm treated in April 2017. Overall on today’s assessment she has no obstetrical complaints today.
Rebecca is a 31yo G2 P1001 who was seen for an ultrasound evaluation and FTS. She overall denies any major medical disorders other than she is hypothyroid and on replacement therapy. She also has a history of a LEEP procedure but that occurred in 2012. She did have a full-term delivery over 2 years later that went to 39 ½ weeks with an 8 lb 12 oz infant. Overall on today’s assessment, she has no complaints.
A 67 year old female, B.H., was admitted with intractable nausea and vomiting. She decompensated quickly and was intubated for respiratory distress and sent to the intensive care unit. B.H. was found to be in multi- system organ failure. Her liver had been damaged by years of alcohol consumption and hepatitis. Her failing liver caused an excess accumulation of abdominal fluid leading to the respiratory distress. The toxins within her body also caused her kidneys to fail resulting in dangerously elevated kidney lab values. Despite medical management, her kidneys did not respond with an increase in
Again since she is coming to us as clinicians with a diagnosis; and we know that there recurrence, one can consider safe to start treating this patient with this initial diagnosis. However, there should be several sessions of therapy, lab test, and reviewing her health’s history before, one can prescribe any medication.’
Crohn’s disease is something that I want to know more about so I can help a victim of it. I feel that the next time Stephanie has a bad exp...
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.
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.