Upper GI Bleeding Case Presentation/ Patient History A 76 year old Caucasian man presents to the Accident and Emergency department complaining of constellation of symptoms of dizziness, near fainting, shortness of breath, weakness and lethargy. The patient states that he has passed black tarry stools for 1 day. He also complains of intermittent and generalized abdominal pain. His past medical history is significant for duodenal ucer diagnosed on OGD in 2010, osteoarthritis and neck spondylosis, hypertension and hypercholesterolenemia. Review of systems showed no significant weight loss or anorexia nor change of bowel habits.
Vitals: BP 173/80; Temp 98.5F; HR 97bpm; Skin: clear, no evidence of jaundice Lymphatics: unremarkable HEENT: Sclera was icteric, ears, nose, and throat are clear Chest: unremarkable Abdomen: Moderately obese with a very tender globular mass in the RUQ. No splenomegaly or hepatomegaly noted on palpation. Rebound tenderness was negative over the RLQ. No ascites noted, or other evidence or portal hypertension. Bowels sounds are normal and no bruits noted.
The conjunctival surface of the eyes presented no signs of petechial hemorrhaging; capillary hemorrhage into the skin, forming petechiae. Ears appeared normal, no sign of abnormality or foul play. Along the anterior cranial fossa; a depression in the floor of the cranial vault which houses the projecting frontal lobes of the brain, possessed a contusion (discolored and purple).
The causative agent is Varicella-zoster virus. This disease causes pain and often causes a rash on one side of the body, either right or left. The rash turns into clusters of blisters and the blisters then filled with fluid. According to the first observation, the baby has several blisters to the left side of his spine and the blisters have clear fluid inside. These symptoms reflect that the baby has shingles.
The fracture healed without complications. He had an inguinal hernia repaired at age 30. He has had no serious illnesses and has no known chronic diseases. He has no known allergies and does not take any medication on a regular basis. Prior to seeing the nurse practitioner, he fills out a history form which elicits a family history and review of systems.
Previous Hospitalizations: none listed 2. Presence of Chronic Illness: Hashimoto's thyroiditis, gluten allergy, celiac disease, anxiety disorder, GERD, joint and musculoskeletal problems, right ear canal wall down mastoid cavity w/ superficial infection, HTN, depression 3. Previous Surgical Procedures: right ear cholesteatoma E. Regular medications taken prior to surgery: prilosec, pepsid, metoprolol, xanax, celenium, thyroset, percoset F. Cognitive/Perceptive 1. Hearing-bilateral moderate conductive hearing loss 2. Vision-normal 3.
His responses to questioning were appropriate. He complained that he could not feel his arms and legs. His pupils were equal and reactive to light. He showed no other signs of injury except for several scrapes on his arms. His vital signs revealed a blood pressure of 110 / 72, heart rate of 82 beats per minute, respirations of 18 per minute.
Don’t forget to include pertinent negatives as well as pertinent positives for each system. (Use space as needed): General: Pt intubated unable to complete ROS. Past medical history (PHM): Parents report no major illnesses. Has received all childhood immunizations. Past surgical history (PSH): Parents deny Social history: Graduated HS, working in warehouse driving fork lift.
Because there was not a color change and bubbles were not formed this was not a chemical change. However, once you add HCl to the the mix, you will see a chemical change because the blue will change to green. * Kl and Pb(NO3)2 * Both of these chemicals were clear in the pipets. When you mix them together they turn yellow. It is a cloudy yellow.
Long or short hair does not change how a person performs on an audio exam. There are no tests completed by scientist providing this theory, the individual is good at audio memory exams by their brain functionality not by the length of their hair. When referring to causation we look for proven facts to support any theory, “Ice cream melts when heated” is a proven theory. Many scientist and children have been able to put this one to the test. It is able to provide results not only with the melting ice cream but also with other liquid objects such as ice.