Longitudinal Pain In The Emergency Room

The medical assistant should listen to the patient and try to make him as comfortable as possible, then ask questions such as; Why are you feeling this way? Are you in pain? Is there anything we can do to change how your feeling. The medical assistant should also inform the Dr. of all of this information.

The disease progression was discovered, annotated and observed over a several periods. The 1st period, the classical period, described the cutaneous disorder

REASON CHIEF COMPLAINT: Bilateral groin lesions. BLANKLINE The patient was referred for a new itchy and tender bilateral groin lesions that the patient says will drain pus. He also has multiple other complaints. He gives a history of being allergic to DOXYCYCLINE. As previously stated, he has tender sites which can drain pus off and on in his groin for years. There is also history of facial acne and scalp acne since his late teens. He took Accutane during his 20s with improvement by history. He flared and repeated Accutane about one year after completing the first course by his history. He is bathing with unscented Dove and uses cocoa butter lotion. He also has a second problem of itching over his back, shoulders, and arms, and legs

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Skin BB’s skin presents as pink, warm and dry. No obvious signs or symptoms of abnormal bruising or lesions present however, the patient states that the skin has of late has

No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.

1. What is the working diagnosis? The working diagnosis is that this patient is suffering from Angioedema as a result of Anaphylaxis and developing Urticaria. Angioedema is the swelling of deep layers of the skin due the accumulation of fluid, symptoms of Angioedema include swelling of the eyes, lips, hands and feet.

Review of the Systems The general health of the patient is currently being compromised due to present illness mentioned above, but is stable. L.H. reports his usual health to be, “normal and not too crazy like this”. Patient has some fatigue noted while conducting daily activities; No recent weight change, fever or sweat. The skin noted to some discoloration on upper right side of back. There is no pruritus, rash or lesions present. Bruises noted bilateral on arms. Patient reported taking baby aspirin as daily medication. His hair is greying and thinning with no hair loss.

Case Study Mr. P, a 27-year-old African American man, was brought to the emergency department (ED) by his wife. The patient reported polyuria for the past three days, few episodes of vomiting prior to arrival and polydipsia. On assessment, the patient appears flushed, and his lips and mucous membranes are dry and cracked. His skin turgor is very poor. He has deep, rapid respirations and there is an acetone smell to his breath. He is alert and oriented X 2 and is having trouble focusing on the questions.

Upon inspection the contour of the patients abdomen was rounded, symmetric, color appropriate to genetic background, striae present, 6 to 8 round bruises from subcutaneous injections. No apparent pulsations, masses, lesions, rashes, wounds, ascites, scars, or hernias present. Auscultated bowel sounds in all four quadrants; hyperactive sounds heard in lower right quadrant, hyperactive sounds heard in upper right quadrant, normoactive bowel sounds in upper left quadrant, and hyperactive bowel sounds heard in lower left quadrant. Auscultated the aorta, renal arteries, and iliac arteries for vascular sounds, no bruits heard. Lightly palpated the abdomen in all four quadrants, patient felt tenderness on bruised areas, no masses present, abdomen distended. Percussed the abdomen in all four quadrants noting the predominately tympanic in all four quadrants and minimum dullness. The patient’s last bowel movement was around 0830, loose, with no pain. The patient stated having three to five loose bowel movements daily and that, “several bowel movements a day was common for her.” The patient describe the characteristics of her bowel movement as “watery, stinky, and not a large amount”. No prescription medication related to the abdomen. However, patient takes over the counter medication for frequent bowel movements at home. No surgeries related to the abdomen. No laboratory data related to the

This is an 82-year-old gentleman, who was referred from Dr. Gretchen Marsh’s office because the patient’s BUN and creatinine were high, as he has acute kidney injury. The patient went to Dr. Marsh’s office yesterday and was having generalized weakness. He does not have any vomiting. No diarrhea. No fever.

L.F, age 91, diagnosed with hypertension, dementia, and hx of falls. The clients general skin pigmentation had no deviations or abnormals from normal skin color, expect for on the clients left buttock. The area on the buttock was red, but still blanchable. The skin was warm to palpate in all areas of body expect for her hands. The clients hands were cold to touch but no problems or complaints noted from the patient. Skin turgor tested on clients sternum and top of hand. Skin turgor was loose and returned to normal baseline within one second. The clients skin was soft to touch, with only small area of dryness located on the clients buttock. Client had many winkles all over body. There was no odor detected on client. Deodorant was used during

Nursing Care Plan CLIENT CLINICAL PICTURE Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x

List three differential diagnoses for epigastric pain in adults. Include rationale, diagnostic testing, and treatment. Epigastric pain is common and the causes can vary from simple indigestion to serious conditions like Myocardial infarction. The three differential diagnoses for epigastric pain are the following: 1. Gastro Esophageal Reflux Disease (GERD) GERD is a condition that

CC Continued abdominal pain radiating to back. S The patient is a 44-year-old female who I saw for her physical in June 18, 2015. At that point, she was complaining of epigastric pain that radiated into her back. I did ask her to start Prilosec over the counter, daily. Initially, we had called her and she reported that this was helpful, although now, she reports that at the same time, she had a cold and she was more focused on the cold than the epigastric pain. Subsequently, she states her pain really has not changed and she continues to have epigastric pain, which does radiate to her mid-back. Her bowel movements have been soft, she has been somewhat nauseous, but no vomiting. She has not see any blood in her stools. She does think