Pedatric Evaluation for Gabriel Essay

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

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.

PHYSICAL EXAMINATION: Vital signs are WNL. Apparently he has had no chills, night sweats, or favors. Generalized malaise and a lack of energy have been the main concerns. HEART: Regular rate and rhythm with S1 and S2. No S3 or S4 is heard at this time. LUNGS: Bilateral rhonchi. No significant amphoric sounds are noted. ABDOMON: Soft nontender. No hepatosplenomegaly or masses are detected. RECTAL EXAM: Prostate smooth and firm. No stool is present for hemoccult test.

At this time we don’t have a status on his medical condition. We will continue to follow this story as it develops.

Lungs: Diminished breath sounds in all lung fields. Resonant to percussion. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored.

The prescribing of antibiotics for AOM can have an impact on the health of the treated children and increases the cost of providing care. Watchful waiting is the recommendation from the AAFP & AAP in cases of uncomplicated AOM that are a result of other illnesses such as an upper respiratory virus. In the past doctors would immediately prescribe antibiotics for the signs and symptoms of an ear infection, however new evidence shows that over time bacteria have become resistant to certain antibiotics and so other means of treatment must be explored. If a child presents with symptoms of AOM and has no other underlying illness or condition, then watchful waiting is an appropriate avenue of treatment for the child. The research showed placebo trials had favorable outcomes and children responded without antibiotic interventions. If watchful waiting is used the child is not exposed to unneeded antibiotics and this reduces the chances of antibiotic resistance in the future. In addition, it also reduces the amount of money spent on health care needs in the form of purchasing medications. It should be noted that watchful waiting should only be considered in cases of uncomplicated AOM and that education should be given to care givers on when to follow up if symptoms do not improve within 48-72 hours. In the even that symptoms do not resolve then antibiotics may become necessary.

States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

As such, the diagnosis and management of AOM has a significant impact on the health of children, cost of providing care, and overall use of antibacterial agents (AAFP, 2004). Watchful waiting can have many benefits for the children and the provider if used properly. Diagnosing AOM can be tricky. The signs and symptoms can also be related to other illnesses such as an upper respiratory virus. Throwing antibiotics at any illness use to be the course of action. However, now that there is evidence that bacteria have become resistant to some antibiotics, clinicians are testing out other means of treating illnesses. If the child presenting with symptoms of AOM has no underlying conditions and has means to follow up with the doctor if the symptoms progress, watchful waiting is an appropriate approach for treating the child. According to the research, placebo controlled trials have shown that children have responded well without antibacterial intervention. Giving the opportunity for the illness to resolve without antibacterial intervention not only benefits the child but, the caregivers and the clinician. It benefits the child by not being exposed to antibiotics that are not needed, therefore creating a potential resistance to that antibiotic. It benefits the caregiver by not spending money on a medication their child does not need. Last, it benefits the clinician by preventing resistance to an antibiotic that may be useful in the near future.

Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.

In the early morning hours on a Sunday, a worried mother brought in a 22-month old child to the emergency room. The young girl was exhibiting signs of a common cold, including a low-grade fever and runny nose that had been persisting for the last 48 hours. The child also had a hoarse cough and forced, noisy breathing. Her larynx was raw and swollen and she had mucus coating her red throat. Upon examination, the pediatrician also noticed mild inflammation of the ears and cloudy eyes. A rapid Strep test performed on the child came back negative, and a warm vaporizer helped to alleviate her difficulty breathing.

He was diagnosed with dehydration. He was admitted 02/26/18 after about 4 weeks of decrease appetite according to wife. Full code is in place and he is allergic to shellfish containing products, and penicillin. He was in aspiration and fall precautions. The vital signs were as followed: blood pressure 100/68 mm Hg, heart rate 118, temperature 97.5 °F, respiratory rate is 18. Past medical history includes shingles, atrial fibrillation, deep venous thrombosis, hypertension, stroke, and hypothyroidism. Labs are as follow: WBC- 6.85, Hgb- 10.4, Hct 33.2, sodium 146, potassium 3.3, chloride 104, magnesium 1.6, phosphorus 2.8, calcium 9.8. BUN 25, creatine 0.9. He had dry mucous membranes, poor skin turgor (“tents”), and cracked lips. The patient was pale. The urine output was 25 ml/ hr. The patient was confused, agitated, and slowly responded to asked questions. He was alert and oriented only to person, not place or

PMH: Charles has history of Intermittent asthma since he was 2 years old, uses Ventolin inhalers as PRN. Mother reports that prior to current illness Charles was having asthma symptoms requiring inhaler use 1-2 times/week, typically during the day, lasting 1-2 hours, without effect on Charles’ activity. Attacks have occurred both at home and outdoors. Charles is a full term baby, product of NSVD, with no antenatal complications. Birth weight was 3000g, with apgar score of 9 in both 1 and 5 minutes. History of adenoid hypertrophy diagnosed at the age of 2 years. Patient is followed up by ENT. History of recurrent URTI, the last visit to ER was last month due to fever, coughing, and runny nose, treated as viral infection. History of otitis media 3 months ago that was treated with Azithromax. Up to date with vaccinations, the last Flu shot given on April 2,

The patient is a 73-year-old gentleman who presents to the ED complaining of shortness breath at rest. It occurred at home. It was of sudden onset. It started on the day of presentation. He was also complaining of dizziness. The patient's medical history is significant for BPH, hypertension and asthma. He also reports that he had a sore throat for several days prior to presentation. He denied any fever at home but in the ED his temperature is measured 102.3. He has an elevated white count of 15.7 which goes to 18.8 the day after admission. His hemoglobin dropped from 14 to 12.5 and platelets are 127 down to 125. He has a left shift both days. The day after presentation his has 20% bands. He is also tachycardic and tachypnea, as

In February 2000, a 19 year old patient presented to a family practice physician and nurse practitioner with problems associated with her nose and sinuses. Upon on the initial evaluation, the nurse practitioner determined that the patient’s symptoms were consistent with allergies and prescribed the patient Amoxicillin. Ten days later the patient was prescribed a second course of antibiotics. The patient returned six months later, in August 2000, for complaints of epistaxis and was diagnosed with sinusitis by unknown mentioned provider in this case study. In August 2000, it was noted that the patient also complained of multiple other symptoms which included anosmia, regular nosebleeds, diurnal pain located in the frontal region of the