Ap Case Study Psychology

They are solitary creatures who remain submerged for most of their time at sea making difficult to study their behavioural tendencies.

What clinical findings are likely in R.S. as a consequence of his COPD? The clinical findings that are likely in R.S. as a consequence due to his Chronic Obstructive pulmonary Disease (COPD) is Right Heart Failure. Evidence has shown linking tobacco smoke harms the right structure and function of the right ventricle. Cor pulmonale transpires due to the right side of the heart to fail and increase of the ventricular end-diastolic process. Due to COPD, R.S.’s airways and air sacs loses its elasticity and the walls between the air sacs are devastated. The walls of the airways are inflamed, thick-mucus build up, and obstructions in airway.

A review of the medical records indicates that he suffers from multiple medical illness, which includes chronic COPD/heart failure for which he is oxygen dependent due to debilitating shortness of breath, chronic stable HTN-manage with medication, chronic stable hyperlipidemia-manage with medication, chronic poorly controlled anemia, chronic GERD, chronic phantom limb syndrome with pain- LAKA. He also has a history of DVT. He has had multiple hospitalization. His last hospitalization was in April for pneumonia. He is current on antibiotic therapy fro pneumonia.

This is a self-report case study of C.C., a 22-year-old Asian female, who is single, who was brought to the emergency room by her significant other, with a complaint of “sick with the flu”. In addition, she has been vomiting numerous times every day for the past eight days, wherein she has been taking antacids to stop nausea which afforded no relief. Moreover, unable to keep food or liquid down, related to nausea she continues to take antacids to the point that she over medicating herself. As a result of mentioned signs and symptoms, she became severely dehydrated causes her to collapsed at home and subsequently, was taken to emergency room. While in the emergency room, series of assessment and laboratory workup was ordered. One of the blood tests that was done was arterial blood gas, which resulted to metabolic acidosis (Marino, 2007).

Because COPD affects gas exchange and the oxygenation of all tissues, please describe potential complications of COPD.

Potassium levels were also increasing (6.8) and his urea and creatinine were markedly deranged. He also began to appear grossly oedematous.

Bronchitis COPD is a productive cough for at least 3 months along with airway obstruction. This condition would likely result in the clinical finding of crackles, wheezing, sputum production, and hypoxia and abnormally elevated carbon dioxide retention at rest. Bronchitis COPD involves inflamed airways obstructed by mucus whereas emphysematous COPD involves destruction of terminal airways leading to decreased space for gas exchange. In emphysematous COPD, one would have shortness of breath, dyspnea and may appear barrel chested. Also, hypoxia and hypercarbia aren’t as prominent in emphysematous COPD as in bronchitis COPD.

If the pH is high and the HCO3 is high the patient has metabolic alkalosis

The patient's acid-base disturbance is very clearly a sign of acute renal failure. The levels all correlate to a case of compensated acute metabolic alkalemia. The case is acute because the blood pH is only off by .1 from the average normal range. Furthermore, the levels of PaCO2 40 mm, PaO2 95 mm, SaO2 97%, and HCO3- 32 meq/lite are all well within the normal ranges, which further shows that the failure is acute at the point of testing. It is alkalemia because the blood is slightly more alkaline than normal. This can be seen as blood is normally at a pH of between 7.35 and 7.45. If the pH were to drop below this amount, it would be too acidic. Here, the pH increased, resulting in an alkaline state. This patient's current condition is compensated because it falls within the result range of renal compensation (WHO, 2010).

I agree and also put that Mr. Smith could have primary aldosteronism as his diagnosis. His potassium levels should be checked right away since this electrolyte has a profound effect on the heart when it is not within normal limits. Some patients may or may not have low potassium with this disease. According to Galati, Hopkins, Cheesman, Zhuk, & Levine (2013) “indications for screening have been expanded with recognition that many patients with primary aldosteronism do not have hypokalemia and that the disease may be familial” (421). Mr. Smith does complain of muscle weakness however and because of this would lead me to believe that in his case he probably does have low potassium. Depending on what Mr. Smith’s blood results show I would then

Additional blood work for infectious and autoimmune etiology were also normal including hepatitis panel, HIV, ANA, G6PD and Coombs tests. Patient denied hematochezia, hemoptysis, hematuria, exertional dyspnea, difficulty with ambulation, or cold intolerance. During this current admission, patient was transfused with 2 units of packed red blood cells (RBC) due to low hemoglobin and clinical symptoms of fatigue. DIC was ruled out based on clinical presentations and normal PPT even though prolonged PT/INR and elevated D-dimer were elevated. Due to a concern of thrombotic thrombocytopenic purpura (TTP) with elevated LDH, schistocytes on peripheral smear, anemia, low platelet counts and sluggish mental status, and past treatment of TTP in a different hospital based on a past history of low ADAMST13 level of 30, immediate steroids and plasma exchange were initiated. She received a total of 7 units of plasma during this admission. Plasma exchange was stopped based on ADAMTS13 value of 78% (normal ≥ 70%). Further studies revealed vitamin B12 level 142 pg/mL (normal 211-911), methylmalonic acid level (MMA) 1.19 μmol/L (normal 0–0.40), homocysteine level 17 μmol/L (normal 0-10.7); anti-parietal antibody: 56.2U (normal < 20);

The only medications he takes are metformin and hydrochlorothiazide. The patient appears dyspneic and diaphoretic. An ECG and chest Xx-ray are performed and shown herebelow:

The patient is a 58-year-old African American gentleman who presented to the ED with complaints of nausea, vomiting, diarrhea and generalized malaise associated with no fever, chills. The patient missed his dialysis treatment on Friday because he was not feeling well and he could not get himself to the dialysis center. The dialysis center rescheduled his treatment to Sunday but again he was unable to get himself to the center secondary to feeling generally weak. He denies any fever, chills or chest pain. His medical history is significant for diabetes mellitus, dyslipidemia, hypertension, renal failure, end-stage on dialysis. He also is partially deaf and blind. Initial laboratory work reveals him to have a CO2 of 20, BUN of 90, creatinine

Also recommend rechecking his labs with CH 50, ANA extractable nuclear antibodies, and ANCA (antineutrophil cytoplasmic antibodies screen), sed rate, and CRP

His blood pressure is 119/69, pulse of 94, temp of 99.4. On the abdomen, it