Brittany Merrick's Palpitation Case Study

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

and vomiting (N/V). She has also had coronary artery disease (CAD) for several years, and 2 years ago

Hi Roseann. Good Job. Your Unit 7 Initial Post is very informative. Her verbal report of fatigue, bilateral lower lobe crackles, skin is cool to touch, +2 edema in bilateral ankles, and heart rate of 112 are signs and symptoms of congestive heart failure. Her medical history of high blood pressure and coronary artery disease could also lead to heart failure. My focus would be is to teach her with CHF symptom management and to prevent exacerbation. To avoid hospitalization I would educate and give her a list of preventable measures such as avoiding salts, measuring her weight every morning, and fluid restrictions. I would advise S.P to notify her doctor with weight gain over 2 pounds. Medication compliance is also important in managing her

Her hematocrit levels could be low, along with her red blood cells being pale and immature because she isn’t getting the proper nutrition, and her over

The patient is an 80-year-old female who presents to the ED because of increasing shortness of breath and some chest pain. She was brought in by the Clifton EMS. She stated the symptoms occurred suddenly. It started 2 days ago and became worse the morning of presentation. They are continuous and getting worse. The patient is also complaining of chest pain with coughing in the ED. She has a past medical history of intracerebral hemorrhagem hypertension, had spinal surgery and nephrectomy. On presentation initial blood pressure is 151/150 with a pulse of 93, respirations of 20, temp of 97.1 and her pulse oxymetry is 100% on a nonrebreather. She is placed on 4 L of nasal cannula and she is oxygenating between 95-98%. Her blood pressure fluctuates a but is brought under better

On physical exam, weight is 49 pounds. She is alert and in no acute distress. Her abdomen is soft. She does complain of some tenderness, but there is no guarding and there is no organomegaly or masses. Genitalia feels normal, (___) female.

Maintained: During the past 12 months Lina does not have any documented cardiac complaints or symptoms. Her Lipids throughout the year have been within normal. She consulted Dr. Mild a cardiology for abnormal EKG with pre-sedation indicated patient being stable; however she was uncooperative for BP and limited exam that revealed a 1/6 systolic murmur, cardiology recommended to follow up in one year. Her last EKG in records

M. H. states that she is generally in good overall health. No cardiac, respiratory, endocrine, vascular, musculoskeletal, urinary, hematologic, neurologic, genitourinary, or gastrointestinal problems.

Weslie is a 25yo, G3 P2002, who was seen for an ultrasound evaluation and for palpitations and possible thyroid dysfunction. She overall denies any major medical disorders to her knowledge. Regarding her obstetrical history, she has a term delivery in 2012 of a 7 lb 9 oz male infant without complications. However, her 2nd pregnancy was complicated by episodes of palpitations in 2015. She again delivered at term a 7 ½ lb female infant who is also alive and well. She states that following that delivery in the nonpregnant she has periodically had some episodes of palpitations. She states that she did wear a Holter monitor for approximately one day and no abnormalities were seen. To her knowledge the exact cause for these palpitations is unknown.

-She likes to complain about relatively minor physical problems and distress. She tends to have a lot of physical problems such as having frequent headaches and feeling nauseated.

The patient tells me that she has had this same chest pain in the past. She has been a cardiology at Wentworth Douglass Hospital in her teen years from about 16 to 20. She was followed by cardiology there. She had multiple on the stress evaluations, echocardiograms, Holter monitors, EKGs, and was told that she had "a sensitive heart". The patient tells me when she would get the episodes in the past, she was finding that they were lasting a few hours. They would typically resolve on their own and they did not seem to be associated with anything in particular. The patient has noticed some palpitations at times, though she does not think that this changes the pain at all. She has also felt more short of breath than typical at rest and with activity. The patient now tells me she is under a tremendous amount of stress. Both her mother-in-law and sister-in-law have been arrested. Their niece, who is eight years old, they are trying to work on getting custody of. Apparently, whatever the issue that caused them to be incarcerated was unknown to the rest of the family. She has unfortunately lost her job. She is now working towards starting a

With respect to her history of HTN, we did access her with impedance cardiography today. Her initial BP on arrival today was 149/87 and after resting her BP increased to 151/94. I have included the MIST report with this dictation. She does have a hyperdynamic pattern with an elevated cardiac output. Based on this hyperdynamic pattern I have recommended beginning with a low-dose beta blocker such as

The patient is a 15-year-old girl here today with her mother. They tell me that she started having periods at age 12. She has been having regular periods up until about four to five months ago. Since that time, she has had no periods whatsoever. The patient tells me she did get a period every month prior to this, was not having any irregular menses. She denies any headaches, no excessive hair growth, no skin changes, no visual changes. She states she has changed her diet, but is just eating much more healthy than she had been previously, although she was pretty healthy in general. She denies any issues with restricting her diet. She has no history of eating disorder. She does not exercise on a regular basis.

The excess insulin could be caused by insulin resistance due to Polly’s obesity or by type two diabetes

sexually active and uses a diaphragm for contraception. She takes no medications. She appears uncomfortable. Her