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
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
ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen.
A basic or complete metabolic panel which shows the serum concentration of electrolytes is sufficient to diagnose hyponatremia, however testing plasma osmolality and a urinalysis for sodium level may be useful in determining the cause the hyponatremia if it is not apparent (Goh, 2004). Treatments for hyponatremia are discussed in the section
On my second day of clinical experience this week I focused a lot on time management and documentation for a full patient load, and also on the admission and discharge process. After taking report on all three of our patients, I began my initial morning assessments. It was clear that our 8-year-old post-operative appendectomy was ready to be discharged. My priorities were assessing her incision sites and ensuring the presence of bowel sounds, as well as making sure she did not have a fever and was tolerating a general diet. After completing my assessment and documenting in the computer, we
Melissa Johnson is a 45-year-old woman who today was seen on an emergency basis when she called the office complaining of left upper quadrant pain. The patient stated that the pain has been increasing for about three months. The patient’s most notable symptom is increased belching. The patient also experiences heart burn, increased satiety, and intermittent left upper quadrant pain. The patient denies any vomiting, change in bowel habits, melena, or dysphagia. She also denies having chills, fever or rigors. The patient states that she has not been examining her sugars, and she has not felt any chest pain with exertion or dyspnea. In addition, the patient denies any orthopnea, pedal edema, or paroxysmal nocturnal
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
Patient History: my patient is a 79 y/o female. She weighs 71.7 kg and is 165.1 cm tall. She has a history of colon carcinoma and hypertension. She has had a previous cholecystectomy, appendectomy, and removal of a uterine polyp. She has no history of bleeding disorders. She was a smoker, but quit 30 years ago. She smoked a half pack per day for 10 years; rare alcohol use. She is status post right-hemicolectomy. She is allergic to penicillin.
A 59-year-old male, whose initials have been changed to “J.S.” due to confidentiality purposes, will be the patient for this paper. J.S. was admitted on January 12, 2014 to the Emergency Room (ER) complaining of vomiting every 15 minutes and abdominal pain rated at eight out of ten, on a scale where ten is the highest pain level. J.S. described his abdominal pain as “expanding from the inside of my stomach” (personal communication, January 15, 2014). J.S. was assessed and had an X-ray and Computed Tomography (CT) scan preformed while he was in the ER. The X-ray showed that his small bowel was distended as much as five to six centimeters, and filled with air and gaseous. A CT scan of his abdomen and pelvic region showed a narrowing of the GI tract lumen (J.S., Medical Chart, January 15, 2014). J.S.’s admitting diagnosis was a Small Bowel Obstruction (SBO), which is a form of intestinal obstruction where the lumen of the small intestine
A 57-year old male came to my clinic with the following symptoms, gradual onset of dyspnea, frequent dyspepsia with nausea, epigastric pain and breathing difficulty, especially while lying on his back. His vital signs are B/P 180/110, pulse 88, temp. 98.0 and his respiration 20.
Client J.D. is a 45 year old white male who presents to the emergency department with a chief complaint of severe epigastric and LUQ pain that radiates to his back and shoulder. He has been nauseated and has vomited several times. Client J.D. has been previously healthy. The pain awoke the client from sleep about 24 hours ago and it has become progressively worse since then. His vital signs: 90/50-150-32-100.5-96% on RA. The client also has elevated serum amylase and lipase levels. The client has abdominal tenderness, muscular guarding, and his bowel sounds are diminished. Lung auscultation revealed crackles in the base of the left lung. He rates his pain 8/10. The client describes the pain as constant and sharp and it becomes worse when he is lying on his back. The client is currently NPO and is on the stretcher in the fetal position in an attempt to gain some relieve from the discomfort. The client may be experiencing an episode of acute pancreatitis. It is recommended that this client be seen immediately. IV fluids of LR should be started along with an abdominal CT scan, pain medication, an anti-emetic for the nausea and vomiting and the client should be admitted for observation.