Angelatic Cancer Case Summary

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

The patient has no family history of heart disease or diabetes, however both her parents are on medication for high blood pressure. Her paternal grandmother died of breast cancer at age 47. Her maternal grandmother

It is our pleasure to see and provide FTS for Ms. Jennifer Mullins. She is a 19yo, G1 P0, with EDD by an 8-week 1-day ultrasound performed in your office giving an EDD of 12/25/17. Her past medical history is notable for morbid obesity with a prepregnancy BMI of 45. She takes prenatal vitamins, denies any surgical history, is normotensive with a normal urine dip here. This is her 1st pregnancy. Her social history is negative x3. Her family history is notable for breast cancer, HTN, diabetes in her maternal grandmother, and heart disease in her as well. She has having occasional nausea, vomiting, and heartburn and says that the Diclegis is not working at all and would like a different prescription.

Serrita is a 26yo, G3 P1011, who was seen for an ultrasound evaluation and fetal anatomy assessment. As you know, she has chronic HTN and is on methyldopa 500 mg b.i.d. Her BP is normal on today’s assessment at 130/78. Her urine evaluation was negative. She is also hypothyroid status-post a diagnosis of Hashimoto’s thyroiditis. She is on replacement therapy. She did undergo noninvasive prenatal testing (NIPT) that returned low-risk, female and her maternal serum AFP was normal at 0.58 MoM. Based on her height and weight at the start of the pregnancy, her BMI was about 38. Lastly, she is on metformin 500 mg b.i.d. She states that she believes that she was on this due to abnormal insulin levels but she was not completely certain as to why

Objective She is currently on sliding scale insulin, 1200 Kcal diet, and Captopril 50 mg orally twice daily. She has high random blood glucose of 325 mg/dL. Her vital signs are generally normal except for BP (150/97mmhg). Physical exam revealed dry nasal and throat mucus membranes and mild cool leg edema. She is overweight with a BMI of 31kg/m2.

Patient was in the ER room when first seen. PT was with her family members and family states that she speaks little English and that she has had abdominal pain for the past day along with bloody stools. Family states that she is on calcium supplements and no other medications. Last oral intake is 24 hours ago. Family states no known past medical history. Pt is in the hospital bed in the fetal position and towards the right side. Patient's airway is clear and breathing is normal. Skin is warm and dry. Patent is AAOx4. Assessment of head, neck, and chest show no signs of deformities. Abdominal area not assessed due to severe pain. Back is without deformity. The upper extremity shows no sign of deformities or trauma. The lower extremity shows

D.E is a 58-year-old white female who has been living with chronic illness, Chronic obstructive pulmonary disease (COPD), for 6 years. A definitive diagnosis, wasn't made until 2010, four years after the onset of the symptoms. She recalls, having a past medical history of sleep apnea, and chronic bronchitis with frequent admission in the hospital from pneumonia. She reports a past surgical history of an abdominal bilateral tubal ligation at the age of 26 years old. Mrs. D.E. reports using Continuous Positive Airway Pressure Machine (CPAP), Robitussin for cough/chest congestion, Proair-HFA two puffs every 4-6 hrs P.R.N for breathlessness and an occasional Tylenol at the onset of her symptoms occurred. She reports a one pack per

She also had a history of asthma, tobacco abuse (1-1 ½ packs a day) for 15 years in addition to daily marijuana use, polycystic ovarian syndrome (PCOS), and panic

In the case study it discusses a patient, Mrs. Harris, who is a 72 year old and is complaining of fatigue and swelling in her feet. Mrs. Harris also expresses her concern on the swelling, as some days she is unable to put her shoes on despite proper elevation. She also states walking to her mailbox can be challenging because it causes her to feel more tired and to have shortness of breath, also known as dyspnea. Mrs. Harris is currently taking medication for high blood pressure, hypertension; and is also drinking approximately 8-12 glasses of wine a week. While examining Mrs. Harris it’s clear she is a little overweight and has swollen ankles. Upon listening to Mrs. Harris’s breathing, crackles are heard. Therefore, Mrs. Harris seems to have congestive heart failure.

We also rediscussed the AMA issue. She is not interested in the invasive and again CVS and amniocentesis were declined but she was interested in the noninvasive prenatal testing (NIPT) and now that she is beyond 10 weeks gestation that bloodwork was drawn. We will forward the results to your office upon return. In addition, because she did have a 36 week and 22 week loss, she would be a candidate for 17-alpha hydroxyprogesterone starting at around 16 to 187 weeks gestation. She actually was on 17-OHP with her last loss that occurred at around 20 weeks gestation.

Today lung fields are clear. Heart rhythm regular. Abdomen is soft, obese, and nontender. Legs from

A 54 year old black female presents with dyspnea and chest discomfort on exertion, postural lightheadedness, palpitations and a functional limitation of less than one flight of stairs. She denies fever or chills. Further questioning reveals she has been experiencing worsening shortness of breath for one week. Past medical history includes hypertension, Epstein Barr virus and osteoporosis. Surgical history included hysterectomy. She is a 1 ppd smoker and admits to drinking 3-5 alcoholic drinks per week for 10 years. Medications include candesartan, multivitamin, and calcium

The patient is alert and oriented to person, place, and time. Upon initial interaction, the patient is easy to communicate with and states she is doing well. Facial features are uneven and asymmetrical, as she has a slight left facial droop due to her stroke, which she states happened a couple of years ago. DG expresses multiple times that she has a hard time seeing and she wears prescription eyeglasses. PERRLA. Skin is pink, warm, dry; temperature is 97.5 and turgor is brisk. There is a 20 gauge IV in the right hand infusing Lactated Ringers at 20ml/hour per pump, no redness or edema noted at the insertion site. Respirations are even and non-labored at 22 breaths per minute. Lung sounds are bilaterally clear. The client has a nasal cannula infusing 2 liters of oxygen with an oxygen saturation of 96%. DG tells me she is a current smoker and she smokes

SW is a 65 year old white female who is 5’8” tall and who weighs 155 lbs. Her IBW is 140 lbs. and she has an IBW % of 110.71. She went to emergency department on February 1, 2015 complaining of shortness of breath and coughing since November, 2014. Her medical diagnosis includes multi-drug resistant organism, diabetes, COPD, and lung cancer. Her laboratory result shows that she has an elevated WBC of 17.4 on February 2nd and it increased to a critical level of 32.2 the next day. An elevated WBC usually means an infection is happening in the body. Her RBC is elevated at 6.19 which could mean hemoconcentration or it could be due to her COPD. Her decreased MCH of 25.0 & 24.8, her Neutrophils of 13.8 and her elevated RDW of 18.2 & 18.4 could mean that she’s having some iron deficiency anemia. Her laboratory also shows that her albumin is low which can be from prolonged immobilization, decreased nutritional status or worse it could be due to her lung cancer. Her low Sodium of 132 and Chloride at 93 may be due to her diet or medication side effects. Her serum glucose at 118 is elevated which can be from her diabetes or from stress of being in the hospital. Her Platelet count of 405 is normal and her BUN of 5 is also within range. Her arterial blood gas is showing compensated imbalances. Her pH is 7.35 which is normal on the low side. Her PaCo2 is 65.2 which is very elevated, her PaO2 is 66.4 which is very low, her HCO3 is also very elevated at 35.3.