Descriptor: BH is a 56-year-old African American female with a past medical history of chronic obstructive pulmonary disorder (COPD), type 2 diabetes mellitus, hyperlipidemia, and NSAID induced peptic ulcer disease (PUD). She was admitted to the ED due to having difficulty breathing. SUBJECTIVE CC: “I’ve had trouble breathing these last few days and I can’t stop coughing.” HPI: BH is a 56-year-old African American female with a past medical history of chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, hyperlipidemia, NSAID induced peptic ulcer disease (PUD) and tobacco use. She was admitted to the ED after reporting having difficulty breathing. Her symptoms began two days ago, and she reports she experienced increased dyspnea, cough, …show more content…
Hyperlipidemia: Non-drug therapy: Lifestyle changes, such as a low fat diet and weight loss, along with more exercise. Also, quitting smoking would be beneficial as a treatment for the patient. Drug therapy: The patient will discontinue the use of Lipitor and the patient will now be on Rosuvastatin (Crestor) 80 mg oral tablet. The patient will take the prescription daily, at the same time. Efficacy Monitoring: The patient’s LDL and total cholesterol levels should be monitored. Safety Monitoring: The patient should continue to monitor her leg pain and also check on her blood glucose levels, CK levels, and LFT. Patient Education: It will be mentioned how statins may cause muscle pain and to not take any pain relievers for her myalgia, rather contact her provider as it may be due to the statin. Collaboration: Inform the patient’s providers of the change in the patient’s statin medication. 4. PUD: Non-drug therapy: The patient should avoid spicy food and excessive alcohol consumption. Also, the patient should avoid the use of NSAIDS. Drug therapy: Discontinue Nexium because the ulcer will heal by avoiding NSAID use. Efficacy Monitoring: Monitor for any new formations of ulcers and stomach
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.
Mrs. Jones has a history of COPD. She was already taking albuterol for her illness and it was ineffective when she took it that day. Mrs. Jones had been a smoker but had quit several years ago. According to Chojnowski (2003), smoking is a major causative factor in the development of COPD. Mrs. Jones's primary provider stated that she had a mixed type of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to address the growing problem of COPD. The GOLD standards identify three conditions that contribute to the structural changes found in COPD: Chronic bronchiolitis, emphysema, and chronic bronchitis. A mixed diagnosis means that the patient has a combination of these conditions (D., Chojnowski, 2003). Mrs. Jones chronically displayed the characteristic symptoms of COPD. "The characteristic symptoms are cough, sputum production, dyspnea on exertion, and decreased exercise tolerance." (D., Chojnowski, 2003, p. 27).
Based on the initial pain medicine evaluation report dated 06/22/15, the patient complains of constant neck pain which radiates down to the bilateral upper extremity, fingers and hands. Pain is accompanied by intermittent tingling and numbness in the bilateral upper extremities to the level of the fingers and muscle weakness. The neck pain is associated with occipital, temporal and frontal headaches and muscle spasms in the neck area. The patient describes the pain as aching, burning, pins and needles, sharp, and stabbing. The pain is aggravated by activity, flexion/extension, prolonged sitting, pulling, pushing, repetitive head motions and standing. She also reports severe difficulty in sleep.
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 patient is a carpenter by trade with a high school education and lives with his wife who is disabled due to complications from T2DM. He and his wife live in an unsafe neighborhood where they share a one-bedroom apartment. His employment provides their only source of income and he experiences high levels of stress and anxiety as being sick jeopardizes his ability to make a living and care for his wife. He has poor exercise and dietary habits. His meals consist mainly of fast food for lunch and a large meal at the end of the work day, primarily meat and pasta.
*A history of frequent, acute, and severe metabolic complications (hypoglycemia, hyperglycemia, ketoacidosis) requiring medical attention
Bowers, L., Allan, T., Simpson, A., Nijman, H., & Warren, J. (2007). Adverse Incidents, Patient
This chronic disease can be prevented, can be treated professionally at the very beginning of the process however, this disease cannot be cured. There are ...
Lisinopril- Nurse should monitor patient BP and pulse before and during therapy and check for signs of angioedema, if present discontinue therapy. Weight should be monitored and assessed for fluid overload. Patient should take medication at the same time every day and avoid food containing high levels of potassium or sodium due to the risk of hyperkalemia. Nurse should teach about the risk of orthostatic hypotension and dizziness, when changing positions or driving. Blood glucose levels should also be monitored for risk of hypoglycemia.
Basically, there are two forms of treatments for ALD. In one form, treatments are used to prevent ALD from becoming fatal before the symptoms start. In the other form, the treatments are used for children who have already exhibited symptoms of ALD. The first form, know as pro-active treatments, include dietary therapy or administration of the cholesterol-lowering drug, lovastatin. The dietary therapy method encompasses the use of a low fat diet and consumption of Lorenzo’s Oil.
Additionally, the LPN cannot push medications into a peripheral intravenous line if the patient “weighs less than 80 lbs, is prenatal, pediatric, or antepartum”, although given that the situation is on a general med-surg floor it is unlikely these patients would be under Sarah’s care at this time. (Rules and Regulations of Practical Nurses. 2015) Sarah can delegate the postoperative patients who need dressing changes and ambulating them to the LPN, but Sarah should assess the wounds for complications initially and serve as resource to the LPN if she has questions about the wounds. Additionally, she could help the nursing assistant with answering calls and serve as a reference for the nursing assistant to ask questions or help with tasks if Sarah is not available. With regards to supervision, the LPN would need continuous supervision given that the working relationship is new. (Cherry and Jacob, 2014) Sarah should be available and willing to answer any questions or address any concerns the LPN
History of Present Illness: The patient is an 84-year-old Pacific Islander woman who presented to the clinic with complaints of a “bad” cough with phlegm which she notes to have started two weeks ago. She describes the cough as productive and the phlegm as rusty-colored. She states that the cough has been constant. Patient does not know what brought on the cough. She has been taking cough drops with no relief. She came to the clinic today because the cough has gotten worse. She reports that the cough is usually worse at night and sometimes prevents her from falling asleep. She has not tried any over the counter medication. She complains that her symptoms interfere with her daily activities.
Service. To prevent the development of chronic disease there is the treatment of acute or congenital cases is recommended. Antiparasitic drugs are not much effective in the
Patient profile: Heterosexual Muslim Woman who has been in the United Stated for three years. She came from Pakistan. She is 42 forty-two years old, from low socioeconomic standing, English language barrier, and is Muslim rituals and practices. She came to emergency department with her husband due to shortness of breathing, high fever, severe cough. She was dignosed with new onset of pneumonia and currently on antibiotic. she also has history of Vitamin D deficiencies and diabetes mellitus type II. She admitted to medical-surgical floor for observation...
As you consider treatment options that are available it’s important to keep in mind the following: