J. P Case Studies

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.

Patient was in the ER room when first seen. PT was with her family members and family states that she speaks little English and that she has had abdominal pain for the past day along with bloody stools. Family states that she is on calcium supplements and no other medications. Last oral intake is 24 hours ago. Family states no known past medical history. Pt is in the hospital bed in the fetal position and towards the right side. Patient's airway is clear and breathing is normal. Skin is warm and dry. Patent is AAOx4. Assessment of head, neck, and chest show no signs of deformities. Abdominal area not assessed due to severe pain. Back is without deformity. The upper extremity shows no sign of deformities or trauma. The lower extremity shows

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

Consider J.M. J. M. a 43-year-old Hispanic female with type 2 diabetes, with lipid abnormalities and hypertension. LDL 174, HDL 52 and Triglycerides 32, A1C 9.3, microalbumin 32, and fasting blood glucose of 216 with average glucose variance of 200mg/dl, blood pressure 145/89, morbidly obese at 262 pounds. She has been diabetic for 10 years and has not seen an educator since her diagnosis. She previously danced for exercise, but has not done so in a while to work and family obligations. She has three children age 16, 14 and 10. She is married and the primary source of income for the family, which presents significant stress. J.M. presents with numerous comorbidities that contribute to the development of cardiovascular disease. Current medications

An attending physician statement completed by Dr. Peter Chweyah (Internal Medicine), dated 06/16/2016, indicated that the claimant presented with complaints of lower extremity weakness, neuropathy, weight loss, acute renal failure, and gout, as well as anemia. Objective findings showed an extreme weakness of the legs and pain in the feet. He also had diabetes mellitus type 2, chronic kidney disease, and hypertension. It was noted that the claimant was totally disabled from 05/30/2017 through 06/15/2017 and 05/23/2017 - 05/26/2017 secondary to gout.

Our client, Ertha Williams is a 99 year old female who lives alone in a low-income apartment complex on the second floor in Monroe, Michigan. Ertha suffers from chronic kidney disease and has a history of hypertension and type one diabetes. Due to her chronic kidney disease Ertha has regular scheduled dialysis appointments three times a week, but since the death of her son and husband and her inability to drive it is difficult for Ertha to get to her dialysis appointments. She also has difficulties preparing the multiple medication she is required to take to manage her hypertension and diabetes. After her last dialysis appointment the nurse reported that Ertha appeared frail and emaciated. Ertha herself also stated that she worries about financial issues frequently and has good and bad days occasionally. Based on these findings Ertha is in need of some assistance to help alleviate some of the problems and stresses she is undergoing. Several nursing diagnoses can be established based on Ertha’s current situation and through these diagnoses it will be easier to establish what kind of services Ertha will need from the surrounding community of Monroe and what types of barriers she might encounter in attempting to access these services.

The primary nursing diagnosis for this patient is impaired gas exchange, related to abnormal ventilation and perfusion ratio, as evidenced by restlessness, irritability, anxiety, decreased level of consciousness, abnormal arterial blood gases, and abnormal skin color (Gulanick & Myers, 2014, p. 82). A.C. has an endotracheal tube (ETT), and there is a note for the next day to have surgery to put in a tracheostomy. She is currently a smoker, her C02 is 74.6mEq/L which is high, her pH is low at 7.19, and the bicarbonate is 28.6mEq/L which is high. Her oxygen saturation is maintaining at 90%. Her PA02 is 56mm Hg and FI02 is 0.60. The patient is very anxious and restless in the bed, despite sedation and pain medication, and her skin is pale in color and she is diaphoretic.

The patient is an 86-year-old female who was brought to the emergency room because of bilateral leg swelling. She was recently discharged from the Arbor Glen Reha and she's developed increasing bilateral leg edema. Her medical history is significant for hypothyroidism, chronic kidney disease stage II, anemia which is a chronic, ulcer in the sacral ulcer stage III and she denies any other symptoms. Review of the lab work does show a bump in her creatinine from 1.27 baseline in February of 18 to 1.54 on this admission with an increase in her BUN. She also demonstrates a mild anemia of 10 with a MCV of 90. Her edema is described as massive by the attending physician. PT examination reveals she needs significant assistance to moneuver her

The patient is an 88-year-old gentleman who is brought to St. Joe's ER complaining of inability to walk. The patient 6 days ago began to having trouble walking with his walker. He reported left arm pain which radiated up his left arm. The patient had pain in the left foot. The patient was taken to St. Joseph's Hospital in Wayne. In the ER he was diagnosed with gout and begun on Colchicine. Since that time he has shown no improvement. He has become essentially chair-bound and unable to walk so he is brought to St. Joe's ER. His medical history is significant for atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease and the patient also has a colostomy bag he had a procedure done and they were unable to connect is

Deficient fluid volume happens when there is a significant loss of fluid and electrolytes as with excessive sweating. Dehydration can occur from an insufficient fluid intake, excessive fluid loss, and fluid shifts. The first sign of dehydration is thirst. If the patient would have drunk water when he first became thirsty, him collapsing may not have occurred, and no further treatment may not have been needed. If fluids continue to be lost, the heart pumps faster but is rapid and weak and causes orthostatic hypotension, explaining his pulse being 136 and blood pressure being 88/52. Orthostatic hypotension may have caused him to collapse due to the

The first nursing diagnosis based on the finding of my prior assessment would be, impaired urinary elimination, related to multiples causes, which is evidence by frequency, nocturia and urgency. One patient centered intervention would be to avoid any liquids after 6:00PM, and the use of a bedside urinal. The Second nursing diagnosis based on my assessment would be, disturbed sleep pattern, related to multiple causes, which is evidence by the verbalization of difficulty falling and staying asleep, reported fatigue and unsatisfied with the quality of sleep. One patient centered intervention would be, to explore and identify the reasons for sleep deprivation (Lippincott, 2017)

The patients pulse, blood pressure, temperature, skin condition, and circulation may need to be checked frequently. The physician may order blood coagulation tests, a Doppler ultrasound, or a venography. Blood-thinning medications, such as heparin or fondaparinux, may also be injected into the patients’ bloodstream. If blood thinners can’t be taken, a filter may be inserted into the vena cava to prevent clots. These filters break loose in the leg veins preventing clots from lodging into the lungs. Compression stockings help prevent swelling and reduces the chance of complications.

2. Regularly check WBC count to ensure that patient is maintaining a level close to their baseline.

The first nursing diagnosis is-Ineffective coping related to impatient treatment, as evidenced by patient statements “I have been feeling depressed and can’t make it stop” and objective data such as visualizing the patient crying and avoiding eye contact, isolating herself from her peers, and appearing withdrawn. For this I would encourage the patient to attend programming, group therapy, and individual therapy. We will use therapeutic communication skills when engaging, encourage verbalization of thoughts, concerns, and accept expressions of sadness, anger, and rejection. I will assess the patient on the coping skills she has learned and encourage her to continue using them.