History Of Present Illness : Dr. Xxxx

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.

Deborah Lupton is a sociologist and a research professor at the University of Canberra, Australia. She received bachelor degrees in sociology and anthropology at the Australian National University, as well as a Masters in Public Health and a doctorate from the University of Sydney. She has written 14 books and 130 academic journals on the topics of medicine and public health from a sociological perspective. She is currently researching topics such as sociology in a digital culture and digital health analysis (Lupton, 2012).

As the second part of this reflection paper, I selected a book ‘A Short History of Disease’ by Sean Martin. He is a writer and filmmaker also known for his other famous books like The Knights Templar, Alchemy and alchemists, the Gnostics. His films include Lanterna Magicka: Bill Douglas & the secret history of cinema. The most alluring thing which conceives me to cull this book is a history of the disease, as a medical professional, it's always tantalizing to know from where all these begins and this book reaches up to my expectations as it started from the first ever recorded disease in the history of mankind. He isn’t lying when he say this a history of the disease. He starts from the earliest bacteria to evolve on the earth, long before there was anything around to infect. This book is divided into seven chapters, each chapter describes the history of diseases in a particular era. Chapter One: Prehistory, Chapter Two: Antiquity, Chapter Three: The Dark and Middle Ages, Chapter Four: The New World, Chapter

BH was referred to a cardiologist in May, 2015 for complaints of chest pain. He denies chest pain or tightness at present.

Mr. Howard, a 57-year-old man, had a 3-month history of progressive typical anginal chest pain. He reported that the symptoms first occurred with heavy exertion and involved what he described as“heaviness” in his chest. The symptoms were promptly relieved with rest. Over the past weeks, he had been experiencing increasingly frequent episodes of chest pain and diaphoresis. The episodes had become more prolonged, and he had experienced one episode of pain occurring at rest after a heavy meal. Mr. Howard was moderately obese and had a 20-year history of hypertension, which was being treated. Other risk factors in Mr. Howard’s history include hypercholesterolemia (350 mg/dL), which he was attempting to treat with dietary modifications, and a 30-year two-pack-a-day smoking history which continued up to the present time. Mr. Howard previously had surgery for a bilateral inguinal hernia repair, cholecystectomy, and arthroscopic surgery on his left knew. He also gave a history of problems with gastric reflux and was currently taking cimetidine (Tagamet).

In the story, Clinical Histories: From Soldier’s heart to PSTD, the author laid his foundation for understanding the reasons behind PSTD stress after combat engagement in veterans. PSTD is generally considered to be a mental illness. Combat stress is defined as the “expected and predicable emotional, intellectual, physical, and/or behavioral reactions of service member who have been exposed to stressful events in war or military operation other than war”. The American military community realized that engaging in combat could have physiological effects on individual. After World War 1, physiologist concluded that individuals reacted in wide ranges of ways during wartime, and it was their predisposition that resulted in neuropsychiatric disorder,

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

c. 34 years old male who complained of shortness of breath. He was obese and had a history of COPD. He was on two liters nasal cannula. After admitting at the ER, he was tranfered to med-surge floor for further evaluation.

Derick is sixty-one years old male who lives with his wife and two of their three daughters, ages 21 and 17. Derick was the third of four children. His oldest brother is eleven years older than him, his sister is eight years older than him, and his youngest brother is nine years younger than him. His Dad, Edwin, passed away 15 years ago and his Mom, Rosemary, is 90 years old. Until five months ago, she, lived alone, worked full-time, and drove herself to work and to Northern California to visit her sister. Five months ago, she fell and broke her neck. The family has had to pull their resources together to take care of her. Unfortunately, it is also triggered Doug and the other siblings to relive issues from their childhood.

Present Illness- Miss B reports left ear pain for the past two day. She states that the pain started as a dull left sided ache that was a 2 on the 0 out of 10 verbal pain scale and has slowly progressed to a 7 at present. She relates the pain as an ache that is not aggravated or relieved by anything. Miss B reports that she was unable to attend school today due to ache and came in for treatment. She reports that she has taken an over the counter pain reliever, unknown name and dosage, with little relief. She denies fever, nausea, vomiting or diarrhea. Miss B does report that she has not been eating as much as it seems to hurt to chew but denies difficulty swallowing. She denies change in hearing, ear canal discharge and dizziness during the ache.

The practice of medicine has been shaped through the years by advances in the area of diagnostic procedures. Many of these advances were made possible by scientific breakthroughs made before the 20th century. Modern medicine arguably emerged. Both normal and abnormal functions (physiology and pathology) were increasingly understood within smaller units, first the tissues and then the cells. Microscopy also played a key role in the development of bacteriology. Physicians started to use stethoscope as an aid in diagnosing certain diseases and conditions. New ways of diagnosing disease were developed, and surgery emerged as an important branch of medicine. Above all, a combination of science and technology underpinned medical knowledge and

Countless of different patients come to seek healthcare and advice for a variety of reasons including certain signs and symptoms they feel that their health is threatened by. It is a crucial skill that health practitioners have a working knowledge of different pathologies patients can present with to direct the patient appropriately towards the correct diagnosis and thus, prescribe the most effective treatment in return. Mr Smith is a 63-year-old male suffering from hypertension and diabetes for the last 20 years. He irregularly monitors blood pressure and blood glucose levels as well as inconsistently uses Minidiab and Tritace for treatment. He presents with shortness of breath worsening over the past five weeks as well as other multiple symptomologies. Throughout this case study, we will examine the pathophysiology of Mr Smith’s health concerns, clarify and interpret the physical examination outcomes and laboratory tests. Through the exams, we will then propose a number of possible and justified diagnoses and after that lead to further diagnostic tests suggested as a result of these interpretations.

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.