Nursing Case Study Omeprazole

The author read Mrs. X’s medical notes prior to their initial consultation to afford herself the knowledge she required should she need to prescribe for her when fully qualified. It was evident from reading her medical notes that there were a few considerations to take note of before commencing any treatment, such as her medical history, drug history and allergies. Her past medical history consisted of Type 2 diabetes mellitus, which was diet controlled, hypertension, hypercholesterolaemia, neuropathy, rheumatoid arthritis and raynauds syndrome.

SKIN: She has some mild ecchymosis on her skin, and some erythema. She has patches but no obvious skin breakdown. She has some fissuring in the buttocks crease. PULMONARY: Clear to percussion and auscultation bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, nontender, protuberant, no orgonomegaly, and positive bowel sounds. NEUROLOGIC EXAM: Cranial nerves II through XII are grossly intact. Diffuse hyporeflexia. MUSCULOSKELETAL: Erosive, destructive changes in the elbows, wrists, and hands consistent with rheumatoid arthritis. Has bilateral total knee replacements with stovepipe legs, and perimalleolar pitting edema 1 +. I feel no pulses distally in either leg. PSYCHIATRIC: Patient is a little anxious about these new symptoms and their significance. We discussed her situation and I offered her psychologic services. She refused for now.

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.

Martha is a 65 year old lady who suffers from insomnia based on the preliminary symptoms of sleeplessness. She is also under severe stress from her mum’s dependence condition which makes her unhappy with her retirement. Martha’s mum’s condition is of great influence to her insomnia disorder for she only thinks of her through out the day, caring for her leaving Martha with little time to check on her health. Insomnia is a disorder that mostly affects the elderly though it may affect people from all ages. It is the lack of sleep even when one feels to have some sleep. It is not a stand alone disease but a symptom which is defined by the duration one lacks quality sleep. Transient insomnia is not having sleep for a week, short term insomnia is lack of adequate sleep for 2-3 weeks, while sleeplessness for a month is termed as chronic insomnia. Various studies have shown that insomnia affects women more often than men and that 30%-50% of elderly Americans experience difficulty in initiating and maintaining adequate sleep. Diagnosing insomnia in a patient the health practitioner would evaluate the patient medical record and other factors that may contribute to insomnia. For example, snoring, psychological factors such as stress levels and drug use. Martha’s physician would check on her medical

constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination.

Her doctor performed laboratory tests of blood and stool matter, as well as X-rays of the upper and lower gastroesophageal tract (GI).Sharon had to have a colonoscopy to obtain a biopsy of the colon. Sharon was diagnosed with Crohn’s disease.

Marcy is a 34-year-old female here today with her daughter for a followup regarding her chest pain and GERD. The patient tells me following her last evaluation on July 1st, she did take the Nexium as was recommended. She was taking 40 mg for about a month. She said that worked very well. Her symptoms lessened and ultimately resolved. However, when she ran out of the Nexium, the symptoms are back again. She feels a pain in the lower sternum area, as well as in the upper epigastric area and was relieved when it went away with the Nexium. She has not continued to take it and wonders what she should do next. She is eating and drinking normally. She did try to cut back on dairy as she initially thought that might be related, but found that was not the case and now has that back in her diet. She is up three pounds since I last saw her and is at her highest weight that I have in the office. She is having no nausea, no vomiting. No early satiety. There is no diarrhea. No constipation. No blood in the stool. No melena. She wonders what the next step should be. She does tell me that when she was talking with her family, her mother has had an ulcer and her sister has been diagnosed with "stress ulcers" in the past.

The first most likely diagnosis would be acute gastroenteritis. According to Aftab and Churgay (2012), the patient has acute gastroenteritis is “often defined as the onset of diarrhea in the absence of chronic disease, with or without abdominal pain, fever, nausea, or vomiting”. This 18-month year old patient has had 6 episodes of diarrhea and 4 episodes of vomiting per day that occurred for two days. The patient also has no history of having a chronic disease.

On November 19, 2015, we attended the disciplinary hearings at the Missouri State Board of Nursing. The first case we heard was that of T. O., who had violated the terms of her settlement agreement with the State Board that took effect back in June. Originally disciplined for being under the influence and testing positive for benzodiazepines and opiates, she failed to call the third party administrator of her random drug screens daily on several occasions. She also tested positive for oxazepam on at least one occasion.

The beneficiary was a 65 year old woman who had been diagnosed with mild gastritis. She complained of abdominal pain for approximately 5

Based on the medical report dated 12/15/16, the patient complains of constant pain to her neck, bilateral shoulders and bilateral knee/leg. Pain is described as sharp, stabbing, achy and

long-term difficulties with sleep. As you are aware, for the last ten years she has been under to excellent care of Andrew Kyoong, but was keen for a second opinion.

Her emergency room reports from Exeter Hospital as well as the studies were reviewed with her here in the office.

rovider of onset of black tarry stools, diarrhea, abd pain, persistent headache, fever & development of diarrhea.