Mary Filipino Case Summary

S.P. should be up out of bed post-op day 1 and wearing TED hose continuously, as well as wearing SCDs overnight in bed. Constipation prevention should e achieved by administering scheduled doses of Colace. Proper nutrition should be encouraged to include plenty of protein to ensure proper wound healing and avoid development of pressure ulcers (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). S.P. should practice coughing and deep breathing throughout her hospital stay to avoid lung congestion and occurrence of pneumonia infection, educating the patient about smoking cessation assistance can be helpful as well.

The patient is a 65-year-old gentleman who presents to the ED on the 28th complaining of fever and chills. He has a long complicated medical history. The patient had a left total hip revision done on 8/19/2016 for presumptive infection of a continued seroma collection. He is known to have continues seroma collections on a recent CT in the outpatient setting. He presents now because of chills and fever. It is to be noted he is already been scheduled for surgery on the 29th. In view of the chills and fever he was sent in the evening prior the surgery. His temperatures were recorded when seen in the ED as 99. He is awake, alert and oriented. He does have an elevated C-reactive protein. His medical history is also significant for hypertension,

Past Medical History: Although the patient is Hispanic, she can speak English and provides her history to the nurse. She reports that two weeks ago she was in the hospital for a femoralpopliteal bypass graft that was performed on her right leg. She noted some drainage coming from her incision and thought she should have it checked out. She has a history of diabetes, for which she takes insulin.

In transport, patient received O2 at 4 liters via nasal cannula, baseline EKG, Normal Saline IV started in left hand, 325 mg aspirin by mouth (po). Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

Mrs Abu has had a considerable change in her vital signs (blood pressure lowered, her pulse is rapid, her respirations increased and temperature has dropped) form the baseline taken before surgery. These findings alone would be reported to the Registered Nurse and monitored. But because of the changes in vital sings, coupled with Mrs Abu reporting light-headedness and

Mr. Bishop is here for routine followup of his chronic illness. He is treated with Alvesco 160 mcg two puffs twice daily, Atrovent two puffs three times daily and Ventolin as needed for his COPD. He reports good compliance and uses these inhalers as prescribed. He generally uses his Ventolin with exercise. He reports that he is running 1-2 miles a day and also doing a step tape daily and reports good exercise tolerance. He does not wake at night coughing or feeling short of breath. For his hypertension, he takes hydrochlorothiazide 25 mg, and amlodipine 5 mg, and simvastatin 20 mg for his hyperlipidemia. He takes these as prescribed and denies any side effects. He denies

Past Medical History: The patient has a history of end-stage renal disease secondary to IgA nephropathy, hypertension, alcohol abuse, biopsy proven liver cirrhosis, history of right leg cellulitis,

This is a 50 year-old male who required inpatient hospitalization due to dizziness, abdominal pain, headache, and nausea after taking atenolol. Mr. A came to the Emergency Department with complaints of some dizziness two-day prior to admission and collapsed several times. For the past 2 weeks, he had not been taking his blood pressure medications due to financial reasons. He was given clonidine and atenolol from his dialysis center while he was unable to afford his normal hypertension medication. He was dialyzed three times a week through his arteriovenous fistula and had not missed any sessions. He also had increased dyspnea on exertion over the past 3 weeks, orthopnea and usually sleeps on several pillows which worsened between his dialysis. His medical history is significant for hypertension, diabetes mellitus type II, morbid obesity and end stage renal disease on dialysis.

The patient is 67-year-old gentleman who was discharged from a nursing home 2 days ago after 3 months stay. The patient had a right ruptured quadriceps tendon which was repaired in a Morris Town hospital and he was in the Atrium of Wayne for rehabilitation and discharged home. Since being discharged home he has presented himself three separate times to the emergency room, the final one being on 6/10 here at St. Joseph's where he was admitted. He presented the previous day and he was discharged. The patient presented because his right leg was collapsing while using a walker. CT done in the ED of his right knee shows that he has severe tricompartmental arthritis and loose bones. The patient is in severe pain and he is unable to ambulate. The patient lives alone in his own home. The decision was made that the safest thing was for him to be admitted acutely inpatient to try to sort through the issues that have led up to this point. No arrangements have been made for him to have any outpatient therapy. or any from the Atrium at Wayne. His medical history is significant for having previous cardiac caths. He developed MRSA infection after a quadriceps rupture in Morristown. He has allergic reactions to Metformin (not quite sure what the reaction is). As previously stated he lives alone in a home in Totowa. Physical therapy evaluation reveals the patient is not safe ambulating with a walker and obviously needs intervention. He will need some type of assistive help in the home or long-term care. After much discussion the Atrium agreed to take the patient back while we work through the issues of how he could be cared for in a

Member remains alert orient and able to make needs known. Member stating today that one day after finishing Prednisolone his breathing went back to the way it was before the Prednisolone. Member reporting shortness of breath today. Member report 02sats range 77-88% while up ambulating and 90-91% during no activity. Member stating he started back to using inhalers and Nebulizer treatments. Member is to follow back up with Pulmonologist on 05/05/2017. Member has an upcoming routine appt with PCP on 04/06/2017. Member report no falls. Member continues to be able to perform all ADL's without help. Member did not have any appts with PCP since the last visit. Member has not had any ER visits since the last visit. Member has not been hospitalized

O: Mr. P is alert but restless. His vital sign are Temputure-97.3, Pulse-88, resperatin-22, Blood Pressure 155/88, Oxygen Saturation on room air is 96%, Weight-210lbs, and Height 5fl 9in. Normal breathing, lungs clear on auscultation, hyperactive bowel sounds in all four quadrants, and heart sounds are normal on auscultation with regular S1 and S2 rhythm. His abdomen is soft, non-tender, extremities without clubbing, cyanosis or edema. A 12 lead EKG was done and result are pending for lipid panel, CK-MM, CK-BB, chest x-ray, Troponin I and Troponin T, CBC, BMP, and myoglobin levels.

This week in clinical I was assigned a 44-year-old male patient who presented to the ER complaining for abdominal pain for the past 10 days and was found to have gallstones. The patient needs a cholecystectomy, but the family wants a second opinion before the patient undergoes this procedure. The patient was alert and orientated x4. The patient said that is pain is 0/10 and that he felt fine. His vital signs were normal. His past surgical history included lithotripsy, which is treatment for kidney stones where ultrasound shock waves are sent to break kidney stones into small particles that can be passed out by the body. The patient was a on NPO diet, something that the patient did not like very much. The patient said that he wanted to drink water, but I told him that he couldn’t because of the NPO diet.

Due to the patient’s cardiac history, I would ask the patient’s onset of her fatigue and how long her fatigue has it been. Fatigue can be a warning sign of heart attack. I would try to find out the time her fatigue occur and worsen. According to Jarvis (2012), decreased cardiac output may cause fatigue and it worsens in the evening. Likewise, I would ask S.P when did she started taking Metoprolol and Aspirin. Many heart and high blood pressure medications can cause fatigue. They may slow down the pumping action of the heart, tone down the nervous system. It seems like S.P is exhibiting signs of Congestive Heart Failure such as: fatigue, 2+ edema of the bilateral ankles, and bilateral lower lobes crackles. A tired feeling and difficulty with

My patient J.R., was a 76 year old Caucasian female who presented to the emergency department on February 23, 2015 with complaints of worsening dyspnea at rest, shortness of breath and hypoxia. Her past medical history is pertinent for coronary artery disease, myocardial infarction, angina, COPD, congestive heart failure, hypothyroidism, arthritis, hypertension, deep vein thrombosis, and diabetes mellitus. J.R. 's surgical history includes right carotid artery

Anxiety, hyperlipidemia, recurrent basal cell carcinoma, genital herpes, recurrent prostatitis, osteoarthritis, hypertension, atrial fibrillation, gastric ulcers, chronic gastritis, insomnia, HIV positive, paresthesias, right knee total knee replacement, status post cardioversion 2013, H. pylori positive, right shoulder bone spur removed, fracture of the right ankle.