PA Alford's Case Summary

HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around

He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very small bowel movement earlier this morning that was not normal for him. He has not passes has the morning. 'he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ without radiation at this point. He has never had a colonoscopy.

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

¬¬Donald Marshall Jr championed the fight for Mi’kmaq fishing rights in Nova Scotia. In 1993 Marshall was confronted by RCMP while fishing eel out of season with no license and selling the catch for profit. This lead to a court case defending the right to fish as a means of self-sustainment for all Mi’kmaq, which he pointed out was outlined within his treaty rights with the crown. This was a historical victory for indigenous people across Canada. Law passed as a result of the supreme-court case known as the Martial decision, which recognized that Mi’kmaq in Nova Scotia were guaranteed right to fish and hunt across the province as to survive and make a living as it is stated in the Peace and Friendship treaties of the 1700’s.

Ms. Fuhrman was complaining of pain to the abdomen and nausea when Dr. Babar first saw her. A CT scan was ordered and a GI consultation requested. It was the following day that she and Dr. Wang saw Ms. Fuhrman together, however the results of the CT were not available at that time. As the CT was not a stat order she had no reason to be concerned about them not be available at that point.

Based on the medical report dated 04/14/16, the patient presents for medication maintenance. He reports ongoing pain, withdrawal symptoms such as increased pain,

DS is a 57-year-old white female whit a history of diverticulitis who presents to the clinic for an evaluation of abdominal pain. She stated that she began experiencing left lower quadrant pain last night that worsened through the night and into this morning. The pain is described as dull, occasionally cramping, rated 7/10 in severity. The patient also stated that this pain is similar to previous episodes of diverticulitis. The patient stated that she took Gas-X this morning with little relief. She was able to move her bowels yesterday and this morning, both reportedly normal. The patient denied any fever, chills, chest pain, shortness of breath, nausea, vomiting, diarrhea, melena, hematochezia, or any other symptoms. At this time, there were

Telephone contact made to the patient. Two patient verifier completed. The patient states that on last Friday, Jan 8. she recieved a small pox vaccination to her left on arm. The patient state a couple day later she starts having pain in her left armpit and to the top of her left breast with very mild swelling. The patient rates her pain level 7/10 and is constant. She denies, lump or mass with palpated. She also denies, reddness, fever, chill, change in deodrant or body wash. The patient states that she has an appt sheduled with he provider on next Tuesday, Jan 19 but like to be seen sooner. Offered the patient an appt with Major Blount for today at 1420 or 1440 but the patient refused due to a meeting. Encourage the patient to keep

The second identified area where the process broke down was when the patient’s family called the hospital to tell them that she was having emesis and severe pain rated nine out of ten. The triage nurse instructed them to take Tylenol and informed them that the physician was unavailable. The physician eventually called back and instructed them to give her one Tylenol and some soup. In this stage, the physician downplayed the concerns and did not consider the possibility of pancreatitis, the most frequent complication after having had an ERCP (Johnson, Haskell, & Barach, 2016, p. 80). The

III. REASON FOR SEEKING CARE (CC): 38 y/o female c/o abdominal pain throughout the entire abdominal cavity, states that she has always had abdominal discomfort, but the past 3 days’ pain has become unbearable. She describes the pain as a burning, churning throughout 8/10. Pain is intermittent c/o of sour stomach after meals accompanied by nausea, denies vomiting, diarrhea or anorexia, last bowel movement 4 days ago. States she moved bowels 2-3 times a week. She states this happened about 2 years she went to the emergency room, CT was done, no blockage, she was sent home without medications, CT contrast helped her move bowels at the time, symptoms eventually resolved on their own. Patient c/o of waking up feeling unrested, had trouble falling asleep ever since she could remember, wakes up frequently with difficulty getting back to sleep. She reports sleep disorder sometimes coincide with inability to get comfortable due to shoulder and neck pain especially in the winter months. Patient states the head and shoulder pain are the result of an MVI in 1995 where she had spinal nerve damage and bulging disc.

I s/w Dr.Kim he will see pt at rad dept pt is there now for Paracentesis he is waiting for a room s/w nurse at PIH she will contact Dr.Kim once Pt is in a room. Also I s/w sister Teresa whom stated pt has been declining for the past week c/o confusion, nausea, loa, abd pain also states patient is on lactulose.

Abdominal pain is commonly experienced by individuals along the age continuum and presents with symptoms that may be vague in nature. A thorough assessment of the patient including, a history of their symptoms and a physical exam are imperative for a timely diagnosis. The condition may range from acute to chronic depending on the cause. Abdominal pain ranks second to chest pain as the most common need for presentation to the emergency department in individuals ranging from ages 15 and older (Purysko et al., 2011). The presentation

The patient is a 70-year-old female who presents to St. Joseph emergency room with sharp abdominal pain for the past 2 weeks which are actually worsening. She does not have any significant aggravating or relieving factors. She just complains radiation to the right lower back. It is sometimes aggravated with food. She was recently seen as an outpatient by the gastroenterologist. She underwent an EGD but does not have any results. She does not have any improvement in her symptoms and hence has presented to the emergency room. She is known to have a medical history of hypertension, depression, asthma, and a history of anxiety disorder. In the ED a CT scan of the abdomen and pelvis revealed acute colitis. The patient was begun on IV fluids,

Notied by the pt. Two pt verfier completed. Per PA Wu, the pt advised that her xray shows pericardial effusion. The pt instructed to take ibuprofen 600-800mg no more than 2400mg per dayfor 4 weeks. Pt instructed the pt to go to the ER if he should have SOB, chest pain, epigastric, pain in left shoulder that radiates down the arm, and numbness and tingling. The pt agrees and verbalizes