CASE STUDY Assignment: Thyroid Drugs Ms. Kissinger, 43-yr-old Caucasian female, comes to the urgent care clinic, complaining of weakness, insomnia, awakening during the night with “a rapid heart beat,” and “feeling anxious.” Ms. Kissinger denies chest pain or shortness of breath associated with her rapid heartbeat. She also complains of muscle tremors when doing small motor activities and “can’t wait for the summer to end” because she cannot tolerate the heat. Past medical history includes hypertension diagnosed 8 years ago. Family history includes one sister with “thyroid problems.” Social history includes a twenty-five pack-year history of cigarette smoking, although she quit 5 years ago. She also consumes one to two drinks of brandy per week.
Family history is notable for type 2 diabetes in an older sister; her mother had hypothyroidism and “heart disease.” The patient also has high cholesterol that she has been trying to treat with “weight loss and exercise.” She walks about 20 minutes three times weekly when the weather allows. She has been treated for about five years for hypertension with hydrocholorthiazide. The pertinent findings on physical exam: Height:5’4” Weight:212 lbs. BMI:36 BP:135/86 Heart/Lungs: Normal exam Abdomen: Obese and benign No thyromegaly Vision and optic fundi: normal Feet: normal Remainder unremarkable Risk factors for development of diabetes? Yes.
Why had his respirations not been monitored? The nurse likely in her very busy state forgot to put him on the ECG monitor, or she may have not chosen to place him on a monitor. She may have chosen to not put him on a monitor because in her personal experience he was a low risk patient with a high narcotic tolerance. With the ER getting busier she thought she was saving herself a little bit of time by not placing him on the ECG monitor. Using the “five whys” to
According to Rowena Payne who has worked as a full time Registered Nurse (RN) in the ED at LAC/USC for the past twenty five years, “There is no down time, we operate with six to eight triage nurses at all times and see about 300 patients every day”. She has seen first-hand the increased volume and patient acuity, poor staffing and challenges with inpatient bed availability. She cites the main culprits of extended ED wait time as “sheer volume” being the number one issue of concern followed closely by a lack of inpatient beds and the required “holding” of admitted patients in the ED for long periods. Payne confirms what research shows with regard to lack of primary care for the underserved population of Los Angeles by revealing that the majority of patients who are referred to clinics for follow up return to the ED instead. “I always ask them why they don’t follow up as instructed and the answer is always the same” says Payne, “They simply can’t get an appointment and when they show up at the clinic in person they are turned away”.
It was very noticeable because while she was asleep she snored very loud; even asleep Georgia kept us smiling. Once she was fully off the gas her breathing kept getting worse. As a medical student I knew it wasn’t good, so I asked if the doctor and the nurses had noticed. In which they had so they tried to intubate her giving her more oxygen hoping to allow her to breathe better. As the doctor had intubated Georgia, her body had relaxed making her bladder empty, meaning she had passed.
The author always wanted to be thinner; she had no patience for her body. She began to hate her body and wanted to be seen as an anorectic not a bulimic. She wanted her body to go away and wanted to be admired for her incredible self-control. She was bulimic for seven long years and somewhere in this illness she made the decision to be strictly anorectic. Hornbacher unhealthy weight loss lead into physical symptoms such as starving herself and malnutrition.
Elizabeth on the other hand was rather nervous about the situation and guilt began to eat away at her. The guilt had a strong effect on the younger girl. She became rather distracted, and confused. She babbled nonsense, woke up screaming at night, and became weak, refusing or even forgetting to eat. But her guilt did not give her the courage to report to Reverend Parris what was taking place, and so the meetings continued.
My family began arriving a little at a time. My sisters and mother soon made their way to the hospital. I can only imagine what they had been told. The outlook wasn't great for a 100% recovery, but I never complained. I was in a double room and my roommate, Marie, a heavy girl, had jumped off the roof of her house and shattered her knee.
When she was sick she also refused to rest in bed, but rather sit on a chair for hours. Her health conditioning became worse that her ladies had to spread cushions on the floor and Elizabeth eventually lay on the floor. She became really weak that she wouldn’t
Maybe she was mentally ill and could not take care of herself. Or she had a personality disorder. But in the story she was a writer who was not allowed to write. To me she was heavily sedated with meds that made her hallucinate every hour. She constantly wrote