Nursing Case Study Naomi Louise Lungstrom

No history of skin disease. Skin is pink, dry, and void of bruising, rashes, or lesions. No recent hair loss; head is normocephalic. Pupils equally reactive to light; no history of glaucoma or cataracts. Ears are in normal alignment; no history of chronic infections, hearing loss, tinnitus, or discharge. Nose and sinus history includes clear nasal discharge “since last October”, and occasional nose bleeds; states she use to get nose bleeds often as a child. Mouth and throat are absent of lesions; no bleeding gums, sore throat, dysphagia, hoarseness, or altered taste. Neck is void of pain, swelling,

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.

J.F. is a 50-year-old married homemaker with a genetic autoimmune defi ciency; she has suffered from

Her other past history includes mastoid surgery when she was forty. She has several environmental allergies and is also allergic to Sulfa, Slow-K, Ranitidine and Zinc. She doesn't smoke.

She continues to take the following medications: GABAPENTIN 400MG , ASPIRIN 81MG, Oxaprozin 600mg and

Ms. B.T. is a Seventy-seven years old African American female who was brought to Southern Maryland Hospital by her son and daughter in-law on 11/21/14 with a chief complaint of increased fatigue and shortness of breath that has been on going for about 3 days. She has been a smoker of 3-4 packs of cigarette since she the age of 16 years old, but claimed to have stopped smoking since the on set of the symptoms. She is a retired elementary school history teacher that was diagnosed with acute exacerbation of COPD, and was transferred to the medical surgical unit for further evaluation.

The client reports no medical problems. Her mother stated she was a healthy baby and was an early walker. During childhood, she had the chicken pox, measles, and a severe case of head lice. She was a physically active child, preferring outside sports, with boys. She denies taking any medication or any over the counter medications. No allergies of food sensitivities were reported. She states she dates, but she is still a

4. From the investigations in section 2 of Chapter 5, there is reason to believe that

She has disc herniation at L5/S1 that may also be a contributor and mimicker of her symptoms.

only uses her inhaler while exercising. There is no history of surgeries. She has a history

A.B. is a four-year-old African American female born on September 24, 2011 residing in the city of Euclid, Ohio in a three-bedroom house with her mother, father, and older brother (10 years old). The family has lived in this home for the past five years. The home is approximately 30 years old with central heating and cooling; wood flooring; a basement with no history of flooding or water leakage; and no mold growth, insect or rodent infestation. The mother denies exposure to loud noise and toxins. The family has two small dogs (Yorkies) and there are no smokers in the home. All utilities are in working order.

History of Present Illness: I last evaluated Ms. Dall at the end of June for a chronic cough. She had previously been given the diagnosis of COPD, as she is a 240 pack-year smoker who continues to smoke. She states that her cough is similar to when she has last seen me as previously believed she had an acute viral illness that led to her persistent cough She does have some shortness of breath which is stable, but worse on hot, humid days like today. Once again, she is smoking up to a pack to two packs a day and she does not have any interest, at this point, in quitting.

As she has now returned back to baseline, she has no cough, no shortness of breath and no wheeze. She has recently seen David Marty who does not believe there are chronic sinus issues that are contributing here and that it is acute sinus issues with post-nasal drip causing tracheal irritation as a cause of her prolonged episodes of cough. A laryngotracheal cause for her cough is certainly consistent with other past ENT opinions and her clinical presentation. What we have not ruled out is a chest cause. He did a bronchoprovocation test in February last year which showed a borderline response, but there was no benefit from Alvesco at the time and this was during an acute episode. Her chest x-ray was clear.

She was seen in our Nurse Clinic in December but cancelled the appointment in January. Next one is on May 19th. Her hep B, C, TB test were negative. Chest x-ray was fine. Her AS activity scores

This patients condition is complex due to central and peripheral nervous system sensitization observed clinically and confirmed by Dr. Beth Hogans of neurology and pain management.