Bs Case Studies

The history, briefly, this is a 66-year-old gentleman who presented to the hospital for an elective admission because he was failing outpatient diuresis. The patient complained of increased shortness of breath, weight gain and lower extremity edema for 3 weeks. He had no (UI) symptoms, no chest pain. He did have (dyspnea exertion) at 8 blocks, now worse, and had recently gone from 2 pillow orthopnea to (three) pillow orthopnea. He denies post-op PND. He also complained of skin lesions over his chest, back, arms and upper thighs, which were new onset and pruritic.

When I arrive to the Trauma ICU 4800 unit, all of the nurses were already being followed by other students. The nurse in charge had me follow several different nurses, so I was able to observed several different patient cases. The first patient had received a triple bypass open-heart surgery. The patient had received a creatinine blood test. The patient had a dialysis machine next to them, which was used to function as the kidneys since the patient’s kidneys were not functioning correctly. Also, the patient’s body temperature was lowered from having a taken cool liquids so the nurses were keeping him warm with a bair hugger, which was a machine that helped regulate the patient's’ body temperatures.

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

A week after initial admission, the patient is on the medical surgical floor recovering from his transverse colostomy five days ago. At 1200 vital signs are as follows, temperature 99.1; pulse 96; respirations 18; blood pressure 141/69; pulse ox is 94% on 1L NC in AM. The patient appears acutely ill and lays in bed with his eyes closed even when family comes into the room to check on him. He is alert and oriented to person, but not place or situation. He appears lethargic and is slow to respond to questioning, this appears to be due to recent administration of pain medication. Pupils are equal round and reactive to light and grips are week bilaterally in hands. Abdomen is firm, distended, and non-tender. Colostomy site appears to be

The patient is an 87-year-old female who was recently hospitalized here at St. Joseph's Medical Center and discharge to rehabilitation spent approximately 3 weeks in the rehabs setting and was home for a day before she represented to the emergency room complaining of inability to move, profound weakness, right hip pain and right thigh swelling, as well as bilateral leg edema. The patient's medical history is significant for afib, coronary disease, congestive heart for diabetes mellitus, GERD, thyroid disease, sick sinus syndrome with permanent pacemaker. She has undergone CABG, nausea, profound vascular disease, anemia, severe gastroparesis, as well as having had polio, she presents with profound weakness and she is essentially bedbound.

She is 74 years old, has a height of five foot six inches, and I was unable to acquire her weight. She was experiencing pain with her hammer toes at five on the pain scale. Her appetite was well. L.F. does not experience difficulty with urination or defecation, but sometimes needs assistance with going to the bathroom. She was having shortness of breath while laying down, however does not require oxygen interventions. I did have to repeat myself while performing her head to toe assessment. L.F. does not have any hearing devices. She wears corrective glasses. Her vital signs were as follows, blood pressure was 120/90 on her left arm while sitting, radial pulse rate was 84, pulse ox was 92, respirations were 20, and her temporal temperature was 97.6 ˚ F. L.F.’s radial pulses were equal in both arms. She was able to grasp my fingers equally and strongly with both hands. Her capillary refill lasted one to two seconds. Her breath sounds were normal and clear without productive or nonproductive coughing. L.F.’s apical pulse was 75 with a normal rate and rhythm, and her aortic, pulmonic, erb’s point, tricuspid, and mitral pulses had a normal rate and rhythm. Her abdomen had a round shape and bowel sounds were present and active with a low pitch in all four quadrants. L.F.’s abdomen was soft and she denied pain. She explained that she had normal passage of bowel movements without complications. She

McMaster University is located in Hamilton, Ontario, Canada. The school is currently 129 years old and founded on the 23rd of April, 1887 by Senator William McMaster in Toronto. In 1930, the school relocated to Hamilton. There are currently 22,558 full-time undergraduates and 3,519 graduate students attending McMaster. The total student population is 30,117, including part-time students and interns. There is lots of scenic property surrounding the school. Grey and maroon are the official school colours and their mascot is Mac the Marauder, a predatory bird. The port city of Hamilton is located in the centre of the Golden Horseshoe, near Toronto and Niagara Falls. The city has a growing

The patient tells me that though everyone in the hospital and the emergency room kept calling her symptoms chest pain, she wants to be very clear that it was not a pain, it was more of a discomfort, in her words. She said that it started when she awoke on August 20th. She said that it was discomfort. She said it felt like something was stuck in her esophagus. She said she, however was eating, drinking, and swallowing okay. She was not nauseous and there was no vomiting. She had not eaten anything unusual and does not seem to have anything that instigated the symptoms. She said she questioned whether it was like indigestion

The patient is a fifty-seven year old Caucasian male who presented to the University Medical Center triage center on September 6, 2015 with shortness of breath (SOB) and labored breathing. The patient’s SOB was of moderate severity with a three-week duration of gradual onset, recurrent, worsening, constant, worse with exertion, and relived by sitting up. The patient reported an inability to climb one flight of stairs without experiencing SOB. The patient presented with bilateral lower extremity edema, abdominal swelling and distention, anasarca, jugular vein distention (JVD), wheezing, and productive cough with phlegm. The patient reported a fifty-pound weight gain over the past few weeks because prescription diuretics were ineffective when he stated “fluid pills haven’t

O: Mr. P is alert but restless. His vital sign are Temputure-97.3, Pulse-88, resperatin-22, Blood Pressure 155/88, Oxygen Saturation on room air is 96%, Weight-210lbs, and Height 5fl 9in. Normal breathing, lungs clear on auscultation, hyperactive bowel sounds in all four quadrants, and heart sounds are normal on auscultation with regular S1 and S2 rhythm. His abdomen is soft, non-tender, extremities without clubbing, cyanosis or edema. A 12 lead EKG was done and result are pending for lipid panel, CK-MM, CK-BB, chest x-ray, Troponin I and Troponin T, CBC, BMP, and myoglobin levels.

The patient is a 41-year-old gentleman who was recently discharged from the hospital 2 days ago. He presented back to the ED complaining of nausea, vomiting, abdominal pain and he presented here instead of going to his regularly scheduled hemodialysis. He also stated that he thought he had blood in his stools. He was also complaining of abdominal pain and constipation and requesting IV Dilaudid and IV Benadryl. CAT scan of the abdomen showed wall thickening around the rectum and distal sigmoid, procto-colitis was not excluded. Initially the attending physician has hoped to keep the patient in outpatient status, however he was admitted inpatient. The case was discussed with Dr. Lasheen, it was decided in view of his multiplicity of comorbidities

After returning to the unit after a few days off, I cared for the same patient on post-operative day 8. Upon assessing, the patient findings included; patient needed oxygen to ambulate to the bathroom and appeared very short of breath, low urine output, lungs with crackles throughout, low-grade temperature, brown drainage from abdominal incision

step is to notify Monica about the situation and ask for guidance or help to correct the

The role of the Emergency Physician (EP) is to identify life-threatening conditions for timely interventions.

This is 53 year old WF. Patient reports chest congestion, thick green sputum production, chills, fever, and generalized body aches for the past 3 days. Patient states, everyone at the Love lady Center are sick and it's just going back and forth between eachother. Patient denies chest pain, SOB, N/V/D. Patient staes she hsa cut down on her cigatettes to 6 cigattes per day from one pack per day. Patient is currently atking prozac 40 mg QD and currently denies depressive moods. Working on getting Blue Card from Cooper Green for her GI issues as previously discussed.