The patient is alert and oriented times 4. Swollen with 3+ pitting edema on both lower legs, palpation is very warm, and reddish colored dots appearing on the surface of the skin. The patient winces in pain as palpate the area. Patient as a history of diabetes mellitus 2, HTN, hyperlipidemia, hypertension, right hip replacement 2007 and left inguinal herniorrhaphy done over 30 years ago, and tonsillectomy in his childhood. Patient denies any recent tobacco and ETOH use.
Case 2 - A 45 year old engineer presents to the ER complaining of a severe, intense, precordial, crushing sensation with pain radiating to the left shoulder and down the side of the left arm, triggered by exercise. the chest discomfort brought on by the exertion is relieved by rest. ER examination results in the following: 98 beats/min heart rate, BP of 160/110mmHg, and a respiratory rate of 24 breaths/min. EKG is performed and reveals ventricular extrasystole arrhythmia (premature ventricular contraction [PVC]) as well as ST segment depression and decreased R-wave height. Coronary angiography shows luminal obstruction >75% (91%) in three major coronary vessels, including the left anterior in ventricular (descending) coronary artery.
In addition, he complained of intermittent pain in the right posterior lumbar area, radiating to the right flank. He also has post-void dribbling and the sensation of not having completely emptied the bladder. Earlier today, he had hematuria at the end of urination and several bouts of N&D. MEDICATION ALLERGIES: None CURRENT MEDICATIONS: Benadryl 25 mg. dailys, at bedtime. PHYSICAL EXAM: Temperature 98.6® F. Blood pressure 140/90.
The management consisted neurological for severe head injury, maxillofacial for facial injuries, orthopedics for fractured lower limbs. Mr. M was mechanically ventilated and given sedations and analgesics to facilitate the care. Hinds and Watts (2008) define VAP as a nosocomial infection which arises between 48 hours and 72 hours in patients requiring mechanical ventilation for more than 48 hours. They suggest that this is because of the aspiration of secretions during Intubation and VAP occurring after 72 hours is mostly as the consequence of aspiration of infected secretion from the airway. VAP prolongs intensive care stay and increased risk of other complications associated with it.
Identify sites where a pulse may be taken in the hospitalized patient 5. Discuss common errors in blood pressure assessment Timothy Smith is a 46 year old male patient. He has returned to the unit from the recovery room for post-op hernia repair under general anesthesia. You take his vital signs 99F, P/80, RR/18, BP-120/84, O2Sat 94% RA, 3/10 pain abdomen. Focused Questions: 1.
A forty-seven year old patient arrived to the unit with shortness of breath, worsening on exertion. I connected the telemetry wires to the patient, took a set of vitals and oriented the patient to the room. I felt his radial pulse, and knew immediately it was irregular! I asked the RN what rhythm he was in and she confirmed it was atrial fibrillation. I knew it was paroxysmal atrial fibrillation because he reported he had gone into atrial fibrillation because of his thyroid problem once before.
Now when Joseph takes the time to relax after weeks of stress at work, which causes him to start smoking again, his has a heart attack. His hearts stops pumping and he is not breathing in the oxygen needed for his cells to produce ATP that is needed to balance water, ionic equilibrium, and his Ph levels. There is a build-up of carbon dioxide,
Over time the episodes lengthened to 1-2 hours, became severe, and localized in the RUQ. As of yesterday, he has vomited three times, and is now anorexic. The patient denies any previous history of abdominal pain, hemorrhoids, recent weight gain or loss, illicit drug use and excessive alcohol consumption. There are no suggestions of prior postprandial symptoms, or jaundice.
He had Sarcoidosis three years ago and it was treated with Prednisone prescription at onset to control severe rash symptoms and then with Dexamethasone afterwards, to clear the redness, swelling and irritation. His symptoms cleared and subsided. Mr. McDonnell said two days ago he thought he had influenza or the common cold because of his cold or flu-like symptoms,d loss of taste and appetitie and pain in his ears. When he began to experience facial problems he got concerned. He thought he’d had a mini-stroke.