Case Study : ' Driftwood ' Essay

A visit note from Renu Mehta, MD (Family Medicine), dated 08/02/2017, indicated that the claimant presented with complaints of lower extremity pain and stomach pain. She continued to have abdominal discomfort. She had a history of hematuria and continued to have a 1+ blood. Objective findings showed a BMI of 31.89 with a blood pressure of 105/72. She was diagnosed with an abdominal pain and hematuria. A series of laboratory tests were recommended.

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.

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.

I. Attention: There are a number of researches done about breast and ovarian cancer. Breast cancer is the second largest cause of death in women. Ovarian cancer is the fourth largest cause of death in women, but there isn’t a lot of attention brought to the public by the media. There needs to be more awareness about these types of cancers for better

The patient tells me since she last saw me she has been to see Dr. Cynthia Paciulli, MD. She saw her actually yesterday. She continues to struggle with stomach issues, including issues as far as nausea, vomiting, and abdominal pain. She has, in the past, undergone an EGD in October of 2014, that showed a small hiatal hernia and no other abnormalities. Biopsies taken during that scope showed mild chronic gastritis, negative for H. pylori and reflux esophagitis and she is currently on a regimen of Nexium 40 mg daily. She also intermittently uses Phenergan when she has the nausea. Since the EGD, she has also undergone a HIDA scan showing no significant abnormalities. This

Based off these measurements, M.G has hypertension and if not taken care of, her blood pressure could lead to a hypertensive crisis. During M.G’s physical her lab results showed her fasting blood sugar to be 200 mg/dl, total cholesterol 280 mg/dl, HDL cholesterol 30 mg/dl, LDL cholesterol 180 mg/dl, and triglycerides 200 mg/dl. Normal levels for fasting blood sugar are100 mg/dl or less, good total cholesterol is below 200 mg/dl, LDL cholesterol levels best for people at risk of heart disease are below 100 mg/dl, HDL cholesterol levels of 60 mg/dl and above are good, and lastly triglyceride levels below 150 mg/dl are considered good. When comparing M.G’s level’s to normal levels you notice that her fasting blood sugar is double the normal amount, and her total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides levels are all considered high/poor. With looking specifically at M.G’s fasting blood sugar, you can see her levels are well pass being considered pre diabetes, and are we'll over the diabetes standard level of 126 mg/dl. Overall, M.G’s poor lab results verify her diagnosis of type 2 diabetes and show how serious her condition is, especially if it is not

During hospitalization to relieve her pain, heating pad and oxycodone 5 mg every four hours was provided. It was advised that she undergo dialysis while admitted, in connection to this Nephrologist was consulted to follow up her dialysis and anemia. Laboratory finding revealed; a critical level of troponin T which was 0.14 ng/ml, a red blood cell count of 3.11, a hemoglobin level of 9.1 g/dl and hematocrit level of 27.7% which all noted as low. Addition blood work was done which revealed a glucose level of 537 mg/dl (noted as critical), a Blood urea nitrogen level of 71 mg/dl (noted as high) and a creatinine level of 5.82 mg/dl (noted as

Mitch's serum glucose from the ER was 1524 mg/dl. His Hba was 15.2% over the 3.9-5.2. His osmolality was 360, then the next day 304 which is still over 285-295 the normal limit. His urinalysis showed protein, glucose, and ketones.

On Wednesday, September 15, 2010 I had the pleasure to assist in taking care of a patient I will refer to as M.B. y patient, M.B. is a widowed, white, female of 72 years old, 5’ 7” tall, and weighs 165.66 lbs. M.B. was admitted via ER on September 10, 2010 for abdominal pain and a poor nutritional intake. M.B.’s admitting diagnosis was abdominal pain, acute pancreatitis, hypokalemia, and diabetes.

The patient, CB, presents with signs and symptoms of diabetes mellitus type II. Previously, the patient was to follow up with a work up to determine the cause of her high blood sugar and cholesterol. Not only does CB present with a fasting glucose of 141 and cholesterol of 225, but CB discusses her "weight problem". She is considered to be obese with a BMI of 35.7 (NCI). McCance and Huether describe the "well known risk factors" to include age, obesity, and physical inactivity (2014), all of which the patient has. In addition, CB also has reported an increase in urine production and frequency; vaginal discharge; and blurred vision at times. These manifestations are consistent with diabetes type II.

During the early stages, symptoms are hard to determine because they can be categorized as symptoms that are common among women for other reasons besides ovarian cancer. The early stages have the following symptoms: bloating, feeling the need to urinate urgently, trouble eating, feeling full quickly, fatigue, abdominal pain, upset stomach, back pain, pain during sex, constipation, heartburn, or menstrual changes (Society of Gynecologic Oncology, 2013). Up to 95% of women diagnosed with ovarian cancer before it has spread beyond the ovaries will survive longer than 5 years (Simon, 2012). Transvaginal ultrasound have been found to be not helpful when trying to identify early stage ovarian cancer in women with a high risk of being diagnosed with ovarian cancer (Simon, 2012).

This cancer is found in women and in their ovaries. During the early stages of ovarian cancer there are typically no symptoms. However, symptoms do tend to appear. Symptoms in the early stages include: abdominal bloating, abdominal swelling, feeling full quickly, weight loss, discomfort in the pelvis area, changes in bowel habits such as constipation, and a frequent need to urinate (Norquist, 2007). However, other symptoms may be present: fatigue, indigestion, heartburn, constipation, back pain, menstrual irregulates, painful intercourse, and dermatomyositis. This cancer is very hard to identify with these symptoms. The reason for this is because these symptoms are very vague and can point physicians to other diagnosis. Therefore, ovarian cancer is best diagnosed in the early stages, so this will not occur. Ovaries are located deep in the abdominal cavity, so it is very hard to feel a tumor. Unfortunate, there is no diagnostic screening for ovarian cancer, so reporting any symptoms to a doctor is very necessary. A doctor may require a pelvic exam if any symptoms are present. A pelvic exam will allow the doctor to observe an abnormality. Small ovarian tumors are very hard to find because they are small and press against the bladder and rectum. A doctor may also request a rectovaginal pelvic examination. There are four other test that may be recommended: Transvaginal

First, a creatinine blood draw was obtained for one patient because of his history of renal failure. The patient was present at the hospital before and his current health care provider believes he needs a CAT scan but the hospitalist on duty did not want to do anything until the patient’s creatinine levels came back. These values “diagnose renal function” because creatinine is eliminated from the body by the kidneys (Pagana & Pagana, 2014, p. 191). Therefore, a high amount of creatinine in the body will indicate the kidneys’ inability to excrete this product. Second, glucose levels were measured in all diabetic patients who came into the ER. Since glucose is a form of sugar, increased levels will leave the patient with a high sugar content in their blood. Some patients cannot withstand glucose levels above a certain number. Therefore, the test results of this blood draw will indicate if the patient needs insulin to decrease their glucose

The tests came back and nothing seemed to stick out. Her glucose level was slightly elevated but not enough to cause the lethargia and inappetence she was exhibiting. Dr. Brian Stockinger told the keepers to keep an eye on her and watch for developing signs or signs of improvement. A few days later, the keepers had noted in the reports that she has

Ovarian cancer is the most deadly type of gynecologic malignancy in the United States (Morgan et al.,2013). While there are multiple histological subtypes of ovarian cancer, epithelial cell types are the most common variant and therefore contribute greatly to the morbidity and mortality attributed to ovarian malignancy (Quirk and Natarajan,2005 ). Serous epithelial tumors have the highest incidence noted to constitute about 70% of tumors of epithelial origin, while other subtypes comprise the remaining cases, most commonly mucinous, endometrioid, and clear cell (Irving et al., 2006,McCluggage, 2011). Demo-graphically, white women have the highest incidence of