Extreme Bradycardia Case

The patient was born in Lagos, Nigeria. He migrated into the United States six years ago, October, 2009 through family ties. His highest education is high

2/10/2016, 1600, Vital Signs: BP 140/85 P132 RR32 Temp 102.2 SpO2 85% on 2 liter by nasal cannula. Jacquline Catanzaro is 45 years old female on disability admitted to Medical Unit Hospital. Sister with patient. Reason to admit is can’t breathe. Diagnosis is 30 year of asthma exacerbation, psychiatric schizophrenia, obesity, pneumonia and herniated disc. Smokes 40 packs year. Drinks 2 pots of coffee a day. Drinks 3 beers each day. Frequency ED visits and hospitalization dependence on rescue inhaler. Patient refuses wear nasal cannula because of worry that it contains poison. Patient has a long history of stopping taking psychiatric medication and asthma medications. Patient has isolated herself from others. Sister is only caregiver. Neuro

A is an 87 year old women, with a long history of health troubles including chronic kidney disease, congestive heart failure, coronary artery disease, a pacemaker insertion for her atrial fibrillation, type 2 diabetes, dyslipidemia, colon cancer, breast cancer, mild cognitive impairment and most recently paranoid psychosis.

African American male that is seen today for followup post hospital discharge. He is a 48-year-old gentleman with complicated cardiac history as well as neurological history including congestive heart failure. History of strokes 01/2017, possible sick sinus syndrome. He has an implanted pacemaker that was placed in 06/2017, as well as hypertension. He was taken to the Central Hospital on 09/01 with presentation of chest pain, noted to be around his pacemaker site. He identified being in seizure and suddenly felt chest pain with shortness of breath, and was offered nitro, he developed headaches and dyspnea post nitro treatment, of note is that the EKG that was obtained during that process, did not identify any pacemaker spike despite having a

Patient L.H. is a 69-year-old married Caucasian male that is a retired teacher that lives at home with his

The patient is a 76-year-old Hispanic gentleman brought to the ED by his wife because the patient has been anxious for 2 weeks and now unable to sleep much of the night. He denies any chest pain but has had on-and-off palpitations that seemed not to be related to activity or a particular time of day. He denies any shortness of breath, lightheadedness or loss of consciousness. He had two episodes of syncope three years ago. He was diagnosed with having an MI. He was at that time treated at St. Mary's Hospital in Passaic and underwent cardiac catheterization and he has had some stenting done to his coronary arteries. He saw his PMD approximately a week ago who prescribed some sleeping medicine and neurology consult which the patient has

Patient 1: monitor B/P, pulse, respirations, skin appearance and touch, notable changes in neurologic function, ECG, lab

Situation: the patient is a 78 year old male, with chronic obstructive pulmonary disease, demonstrating restlessness, agitation with a rapid heart rate, tachycardia.

The following case scenario is based on a fictitious patient, and it would be use on this paper as a guidance to develop a patient and family teaching plan. The situation: Mrs. Marquez, a 39-year-old Caucasian female was admitted into the Emergency Department due to complains of shortness of breath and anxiety. Patient cannot take deep breaths, appears overweight and denies Allergies to medication. The background: Patient has medical history for panic attacks, atrial fibrillation, and Grand Mal seizures; however, patient is not constantly taking her seizure medication. Patient previously had a cholecystectomy, and smokes 1 pack of cigarettes per day for 12 years. The Assessment: Patient vital signs 98.8° F oral, 109 heart rate, 26 respiratory rate, 150/86 blood pressure, SaO2 97% on room air. Denies pain. Neurological; Patient is 65 inches tall, weighing 246 lbs. She is able to move all extremities with strong pushes and pulls. States her “last seizure was two months ago.” Respiratory; Respirations are even, deep, and rapid. Lungs are clear on auscultation. Cardiac; EKG reveals atrial fibrillation; patient states, “It feels like my heart is racing at times.” Pulses are palpable +3 all extremities; capillary refill is instant. GI; Abdomen soft, no distended, and no tender with bowel sounds present in all four quadrants; skin is intact and warm. Current medications: Dilantin 400mg PO BID, Lexapro 20mg PO daily, Metoprolol 25

The patient is married and lives with his wife in a suburban area. They have two children who are in good health who lives with their families. Patient is well established with family and friends as powerful support system; he experienced little stress. He has a master degree in engineer, and making decent money. He has no financial issues, and has great health insurance coverage. He does see his primary health care physician regularly. Patient lacks of knowledge on his health issues despite his high education in engineer. Patient does comply with his medication regimen and does not know the current resources available to him.

Epilepsy/seizure – caused by an abnormal electrical condition in the brain producing: absences, convulsions, unusual movements, temporary loss of consciousness.

This is 39 year old AAM. Patient is here with several complaints. Patient has no medical condition, or long term medications. Patient denies any other issues except as listed.

Mrs. Foster is a 81 year old female who presented ED a history of dementia. Per documentation daughter reports this has been her mother's baseline for the past week. At the time of the assessment Mrs. Foster denies suicidal ideation, homicidal ideation, and symptoms of psychosis. During the assessment Mrs. Foster recent memory appear to be impaired. She would occasionally think her husband was around or she was home. This clinician spoken with Mrs. Foster daughter for collateral information. Her daughter reports she was managing her Namemba, however was out of it a week ago. she reports behavior started to worsen. Namemba is used to treat dementia associated with Alzheimer's disease. Dr. Snyder restarted medication. Patient does not appear

After R.A. arrived to the intermediate medical care unit (IMCU), she displayed an increase in confusion and alteration in her mental status. These clinical manifestations led to the physician ordering an electroencephalogram (EEG) and a computerized tomography (CT) scan to discover any epileptic activity and cerebral tissue damage. Seizures are diagnosed based on a patient’s history and clinical manifestations, and results from diagnostic testing such as blood work, an EEG, CT-scan (Mayo Clinic Staff, 2015 dx epilepsy). R.A’s blood work did not reveal any metabolic abnormalities that could have led to an epileptic episode (Bon Secours, EMR).

Epilepsy is not what you think. It is a complicated disease, a disease that doesn't just affect one type of person or age. Over fifty million men, women, and children cope with this disease daily. Epilepsy is a mysterious disease to those who are unfamiliar and uneducated about the disease. Many people have preconceived notions about Epileptics. Researching the topic thoroughly, the five preconceived notions I explored have been proven to be false.