Meroid Dosing Case Study: Mrs. Lambert

Narrowing the problem down takes a CT scan of the abdomen and pelvis. Which could reveals a mass. When your examine the patient start with the left iliac region, this area is dull to percussion: when you palpate it, you will comment on a mass (if this is the diagnosis). Always ask patient where does it hurt? How long has she had this pain? Check her blood work, look for discharge, sourness, or check her urine, if often tells or leads to localized pain. Since some causes are life threating abdominal pain patients need to be triage rapidly and precisely. (Simmons,

Amanda L Bowles is a 35 y.o. female enrolled on CTN 1302 who presents today for Cycle 1 Day 15 of maintenance Ixazomib. Patient reports having heart palpitations that started Saturday and were continuous. She has had palpitations in the past but were intermittent. On Monday she began experiencing 4/10 chest pain, lightheadedness, SOB, and headache. That day she went to her local emergency department for work-up. Based on the paperwork provided by the patient she was diagnosed with palpitations and atrial bigeminy. They increased her metoprolol dose from 25mg to 75mg. She was not admitted to the hospital and reports the chest pain and palpitations have since resolved.

She reported feeling sleepy, abdominal pain, and muscle weakness. It was noted that she was seen by an MS doctor and was told that her current symptoms were not an MS flare up. She had hyperthyroxinemia symptoms that include palpitations, anxiety, fatigue, weight loss, and abdominal pain. Her blood pressure was 196/118. Thyroid testing dated 08/04/2017 showed elevated levels of total T3 at 295, thyroxine at 18.7, and T4 free at 2.64 with a low TSH at <0.005. She was diagnosed with Graves disease, hyperthyroidism, abnormal TSH, and abnormal thyroid test and thyroid uptake. Methimazole was

Cano, the patient is status post right carnal tunnel release. She has been on physical therapy for the last three weeks. She states she is doing much, much better. Her left hand will be operated on 5/03/16. She complains of severe insomnia. This has been chronic with headaches and chronic depression. She states she is hearing voices, hearing auditory hallucinations with paranoia. This started after the oral steroids. She is psychotic and severely depressed. There is a past history of post-traumatic stress disorder (PTSD), generalized anxiety, and chronic depression. Previous antidepressants included Celexa, BuSpar and Xanax. She states she has been clean. There is no evidence of any type of drugs in her. She brought what she had and had thrown those out and had detoxed a few months

Patient A.S. is 87-year-old female with a diagnosis of Acute onset chronic systolic heart failure, Afib, CHF, and hypothyroidism. She has a past medical history of Hypertension, diabetes mellitus, CAD (Stent 2001). The patient was admitted to Lutheran Augustana Center on January 4, 2016 and was evaluated for therapy on January 5, 2016. Her current medications include Albuterol and Ipratropium via nebulizer to address shortness of breath. A combination of drugs to treat the symptoms of congestive heart failure and other comorbid diagnosis include: Eliquis, Furosemide, hydralazine, and metoprolol. Other medications include Synthroid to treat hypothyroidism, Tradjenta for hyperglycemia, and Zocor for hyperlipidemia. The patient also presented with skin problems. She has bilateral ecchymosis in her lower extremities and abdomen. Lotrisone lotion was prescribed for atopic dermatitis. Edema was also present in her lower extremities.

A review of her medical record indicates that she suffers from multiple myeloma currently being treated with Revlimid. She suffers from co-morbidities of HTN-stable, Insomnia-stable, depression-stable and hypothyroid-stable.

Another important heuristic to consider in the case is when diffuse, dull abdominal pain is associated with nausea and vomiting, it is essential to consider a diagnosis of pancreatitis (Banks, Conwell, & Toskes, 2010). Another significant heuristic to consider for Ms. Roe is that since she had a recent extensive surgery and has been on nonsteroidal anti-inflammatory drugs, it would be important to consider PUD as a differential diagnosis (Ramakrishnan, & Salinas, 2007).

A 17-year old female presents to the office with a history of abdominal pain, distension, and diarrhea for the last ten days. She

The patient tells me she actually been doing well from a GI standpoint. She was evaluated by Brian Hyett, MD again regarding her chronic reflux. She tells me she underwent an EGD, however I do not have the results of that testing. She also had a breath test for bacterial overgrowth, which she reports was positive and she was placed on Xifaxan for three weeks. She says that she was completely well for several weeks. She has been able to stop the Zantac, but has remained on the Dexilant with the hopes that she would be able to taper down and stop that completely. Her plan with Dr. Hyett was to do that this past Sunday. However, her symptoms started in the mean time, and she did not feel comfortable doing so. She tells me that her symptoms started at the end of last week. She happened to get an allergy shot

The patient is a 49-year-old female who I saw last on July 8, 2015. Please see details of that note. She states ever since increasing her dose of citalopram from 20 mg one p.o. daily to one and a half p.o. daily, she has been feeling much better. She is much more motivated to take better care of herself. She is doing things like getting her eyes checked, new eyeglasses, exercising more, trying to be more social. She continues to see her counselor from Exeter Counseling and likes her a lot. She will be talking with her about finding couples counselor as well, to see if this will help with her relationship with her wife. She continues on her Adderall XR 10 mg one p.o. daily and does find that this is helpful.

Patient F.C. is a 63-year-old African American male, who presents to the emergency department with intense left upper quadrant pain that radiates to his back and under his left shoulder blade; stating, “It feels like I have a knife in my stomach”. He reports the upper abdominal pain is intermittent, onset 3 weeks ago; however, the pain has been increasing in severity for the past four days. He states “he has been feeling very warm with episodes of nausea for the past 4 days” with a noted an 8-10 pound weight loss in the past 45 days. He denies any diarrhea or blood in his stool; however, he notes a reduction in the frequency of his bowel movements.

The drugs I am taking are levothyroxine, metoprolol, Lasix, and KCl. Levothyroxine 50 mcg po daily. This drug is used in cases of hypothyroidism to restore normal hormonal balance (Deglin, Vallerand and Sanoski, 2017). Through his therapy, I may be able to halt or reverse the fluid accumulation around my heart (Harvard Health Letters, 2017).

I have also requested further imaging of her upper abdomen given the ongoing epigastric pain. Mandy will contact me for the results. If the scan is clear, I would suggest we take an approach of observation and if Mandy does develop another infection, consider early introduction of an inhales steroid such as 160-320mcg daily as she probably has been suffering with some degree of post-infective airway inflammation. If her symptoms take a more chronic pattern, then we will certainly need to interrogate further. If the abdominal scan is unremarkable and the epigatric pain continues, I have suggested she be referred along to have a gastroscopy.

Abdomen-Active Bowel Sounds X 4 quadrants. Fundal Height-30cm. No massed were noted. States that she does get slight cramping in the lower pelvic region. There was no rebound or guarding.

Abdomen Assessment – The patient’s abdomen does not display any striae, scars, prominent veins, or spider nevi. It is flat with no bulging, and the umbilicus is midline and inverted. There is no pulsating above the umbilicus. Bowel sounds are active x4. No heard bruits over the abdominal areas. There is no complaints of pain upon percussion of the abdomen. Tympany is heard over the abdomen, and dullness is heard over the liver. Patient feels pain with fist percussion on the right flank. She also expresses discomfort in the lower abdominal quadrants upon palpations.