Left Fallopian Salpingectomy

It is very rare to have any one patient with all of these symptoms below:

Day 2 (OB) – Vaginal Birth and preparation for birth. Hanging Pitocin, and Lactated Ringers, and being able to watch an epidural insertion.

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.

Peripheral pulses posterior tibial and dorsalis pedis 2+ bilaterally. No edema on legs. Apical pulse regular rate and rhythm; s1, s2 noted. No murmurs, rubs or gallop rhythms. Denies dizziness, and fainting. Resp RR between 36-40 SpO2 85% per oximetry on 2 liters oxygen by n/c. Difficulty breathing and complaints of chest tightness. Patient unable to lay flat. Lung sound bilateral wheezes and crackles in right lower lobe. All other lobes clear A&P. Cough with yellow sputum. Tachypnea. Head of bed 45 degree. GI Last bowel movement 2 days ago, hard, long brown stool. Complains of constipation related to medication. Bowel sound are WNL in all 4 quadrants. Abdomen is soft, with no palpable masses. Poor appetite. Like sweet foods. Does not like vegetable or fruits. Like sodas, beer, scotch. Little water intake. GU Urinates every 2-3 hours. Yellow. No odor of urine. No history of UTI. One vaginal infection 2 years ago. No abnormal periods, last menstrual period 3 weeks ago. No pain or discharge. Skin Hair poorly groomed, dirty and oily. Nail are dirty and appear to be bitten. Skin clammy and moist with flushed color. IV IV of D5W at 125 mL in left forearm with 18

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,

The working diagnosis is that this patient is suffering from Angioedema as a result of Anaphylaxis and developing Urticaria. Angioedema is the swelling of deep layers of the skin due the accumulation of fluid, symptoms of Angioedema include swelling of the eyes, lips, hands and feet.

Deborah Hollowood alleges her mother Shirley Emo was seen by Dr. Hastings on three occasions complaining of a sore raised lesion on her scalp. Dr. Hastings treated the area by freezing it to make the lesion fall off. It was not until over a year later, when her mother told her about the lesion and treatments Ms. Hollowood asked for a biopsy. The biopsy results showed invasive squamous cell carcinoma. Ms. Emo was immediately referred to a plastic surgeon for treatment, and underwent 20 radiation treatments as well.

Mouth. Oropharynx absent of lesions and/ or exudates. Mucus membranes, gingivae pink and moist. Upper and lower teeth are present. Multiple fillings in good repair. Tongue pink and smooth. Protrudes midline. No abnormal movements/ tremor noted.

Stevens-Johnson Syndrome (SJS): is a life threatening reaction. Many manifestations are involved such as detachment of the epidermis, acute blisters, erosion, severe purulent conjunctivitis, stomatitis and purpura macules. The main etiology is medications. Usually started  as a high fever and flu-like symptoms followed by mucocutaneous symptoms. SJS patients are managed like a burn patient.

Skin- she has some mild equimosis on her skin and some anathema. She has patches but no obvious skin breakdown. She has no fissuring in the buttocks crease.

Clinical manifestations include fever, myalgia, rash, papules, macules that lead to sloughing and eventually necrosis, the skin can look like a scalding burn, mucosititis, and respiratory distress from interstitial edema, gastrointestinal issues ranging from diarrhea to ulceration and bleeding, ocular issues such as conjunctivitis to inflammation, photophobia up to and including loss of vision (Cooper, 2012). Any body system that has epithelial tissue can be subsequently affected. The further the condition progresses the higher the degree of mortality. Being alert to the possibility of the condition and trying to get as much information from the patient regarding medication usage, to include over the counter and herbal is vital because time is critical factor (Cooper, 2012). Misdiagnosis

The skin appears well healed. The heart sounds are normal with no murmurs or extra heart sounds. Her lung fields are clear to auscultation and percussion. The previous carbuncle is completely healed although there is some residual scar. The previous areas of vasculitis do still have some superficially open areas of skin, but there is no purulent drainage and these do not look frankly infected at this time. The right knee is slightly swollen when compared with the left; however, there is no joint line tenderness and she is able to perform range of motion of approximately 70-80 degrees. She is not able to extend completely.

Her past medical and surgical history consisted of childhood diseases, heart and cardiovascular problems, and cancer. The childhood diseases she had were chicken pox, mumps, and scarlet fever. Regarding to her heart and cardiovascular problems, she has had high blood pressure, ankle swelling, and dizziness. She had cervical cancer as well, which was removed

For women presenting with abnormal uterine bleeding with or without findings of a pelvic mass by clinical examination, differential diagnosis should include leiomyoma uteri, adenomyosis, ovarian tumors and endometrial polyps. Characterizing the pattern of uterine bleeding in association with the size and contour of the uterus, palpation of an adnexal mass and the presence of pelvic pressure, urinary and/or bowel dysfunction are important considerations when considering these other pathologies.