Critical Thinking Clinical Questions

HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around

He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very small bowel movement earlier this morning that was not normal for him. He has not passes has the morning. 'he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ without radiation at this point. He has never had a colonoscopy.

On later reflection I realized I could have though about interstitial cystitis, appendicitis and renal calculi. My multiple hypotheses for this patient are presented in Table 1.

2. If you were the doctors on the scene, what diagnosis would you give this patient? (You may use the internet to help diagnose the patient.)

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

Blackman’s complaints, signs, and symptoms were downplayed and eventually he was transferred out of the PACU with no further plan of care, assessment of the issues, or action to alleviate his complaints. 3 days postoperative, with continued scheduled Ketorolac administration, Lewis’ pain was unfathomable. Despite repeated attempts to gain the attention of the healthcare team to Blackman’s impending crisis, his pain was once again downplayed. The nurses again failed to recognize the significance of his increasing abdominal pain and deterioration, chalking it up to gas pain, suggesting only movement and a bath as the acceptable plan of care. Lewis’ symptoms continued to progress and he deteriorated to a state of clinical shock evidenced by abnormally low temperature and increased heart rate and respiratory rate accompanied by extreme paleness, enlarged abdomen, with absent bowel sounds. Inexperience, lack of recognition, and failure to rescue eventually led to the unexpected death of Lewis Blackman (Acquaviva, et al., 2013).

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

It is estimated that over 3.3 million U.S. women, or 2.7 percent, who are 18 years of age or older have pelvic pain and other symptoms, such as urinary urgency or frequency, that are associated with IC/PBS.

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

DS is a 57-year-old white female whit a history of diverticulitis who presents to the clinic for an evaluation of abdominal pain. She stated that she began experiencing left lower quadrant pain last night that worsened through the night and into this morning. The pain is described as dull, occasionally cramping, rated 7/10 in severity. The patient also stated that this pain is similar to previous episodes of diverticulitis. The patient stated that she took Gas-X this morning with little relief. She was able to move her bowels yesterday and this morning, both reportedly normal. The patient denied any fever, chills, chest pain, shortness of breath, nausea, vomiting, diarrhea, melena, hematochezia, or any other symptoms. At this time, there were

Anna is a fifty five year old homeless, unemployed woman who was admitted to the Emergency Room (ER) at Victoria Hospital in London, Ontario for pelvic pain and postmenopausal bleeding. During the nurse’s head-to-toe assessment it was found that the patient also had presenting abdominal distention, prompting her physician to order an X-Ray to determine if a gastrointestinal issue caused this distention. Once this was ruled out, Anna’s physicians continued to search for the underlying cause of her abdominal distention, in addition to her other admitting symptoms. As a result, Anna was admitted to the hospital as an inpatient on the Acute Medicine Unit. The day following admission, Anna went for further testing to hopefully discover the cause of her symptoms. The first test completed was an

Patient N.L. was brought into the emergency room (ER) and was admitted to the medical-surgical unit on Tuesday at 1700 complaining of sudden onset of diffuse contraction-like peri-umbilical pain radiating all over her abdomen on and off for an hour after having lunch at home. Patient was a 9/10 on a pain scale with nausea and vomiting x 2. Her admitting diagnosis was small bowel obstruction and systemic inflammatory response with leukocytosis.