S/L Walker Case Study

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

I asked Mrs. Arrick, what happened. Mrs. Arrick advised me that Mrs. Leann Mercer came into her office and stated that she was about to pass out. Mrs. Mercer started jerking and not responsive. Mrs. Arrick immediately called code blue.

Case Study: D.Q. is a 57-year-old male who worked in a water treatment plant for many years. He also smoked heavily for approximately 30 years. He has been diagnosed with COPD. During an extremely hot summer, he arrived at the emergency department in severe exacerbation of the COPD. The patient’s heart rate is 123, blood pressure is 163/90, respiratory rate is 34, oxygen saturation is 86% on 2 L NC, and temperature is 37.5 celsius.

On 10/14/2015 SO EMT Perez was dispatched to HS-406 to apply a bandage. SO EMT Perez knocked and anounced his presence at the door and was verbally invited in by the resident. The resident, a Mrs.Martha Doyle was sitting in her living room chair and was bleeding from the forehead. Mrs. Martha Doyle was washing her face when she attempted to remove a bandage over a previous wound and she wanted it re-bandaged as she stated. SO EMT Perez asked Mrs. Martha Doyle if she wished to go to hospital before he assesed her to which she denied. Mrs.Martha Doyle also denied any care besides the application of a new bandage. After assesing that Mrs. Martha Doyle was A&Ox3 SO EMT Perez applied a head bandage. While Applying the bandage Mrs. Martha Doyle stated

HEENT: No thyroid enlargement, masses or adenopathy, JVP was 5 cm above sternal Angle, carotid pulse was strong and regular

On 2/14/17 at approximately 1138 ICS was activated for offender Peltier OID158563 for a medical ditress. Upon arrival at the scene offender was lying in bed anxious, restless , crying but in no acute distress. Offender was put on the wheel chair and brought to the clinic for evaluation. Offender was evaluated in the clinic by the provider and was treated. Offender returned back to her unit in a stable condition and was informed to contact medical if her symptoms worsens.

We arrived at Clearview at 2231 Hrs. and took the patient to room 14. I went back outside and began to put our unit back together when Supervisor Carlock approached me and in a very agitated voice said: “WHY DID YOU PULL OFF?” Surprised, I said “What are you talking about?” He said loudly, “I TOLD YOU TO STOP AND YOU DIDN’T!” I replied, “Jeff was telling me not to stop because we had a pulse back.” He said “I DON’T CARE WHAT JEFF SAID, I’M YOUR SUPERVISOR AND I TOLD YOU TO STOP!” I said “Dennis, I think you’re talking to the wrong person, you need to be talking to Jeff, I was doing what he told me to do.” He replied “WHO’S YOUR SUPERVISOR, WHO’S YOUR SUPERVISOR, I AM, NOT JEFF, YOU DO WHAT I SAY!” I said ”yes, you are the supervisor, but at that moment I was doing what the Paramedic in charge of patient care was telling me to do, and what I felt was best for the Pt., since we had a 41 Y/O patient who had a pulse.” He said “I DON’T CARE, YOU DO WHAT I SAY!

Per RN taking care of the patient, at 0500 on 5/22/2017, the patient got up, sat at the edge of the

At 2330 T.B. spikes a temperature of 38.6° C (tympanic). His SaO2 on 2 L O2/NC is now 90%, so you immediately increase the flow rate to raise his O2 saturation. You inform the on-call surgeon, and she orders a STAT chest x-ray (CXR) and a broad-spectrum antibiotic—imipenem and cilastatin 500 mg IV q6h (check renal function; this medication must be dose adjusted if patient has renal impairment, or there is an increased risk for seizure).

Pt is seen in the ER room and states that he is tired and had tremors so he came to the ER to be on the safe side. Daughter also states that he had tremors in the morning and. Patient's CC is that was tired and had tremors in the morning. States that he stays alone, was worried, and has no past history. Assessment of the head shows no sign of deformities or trauma. Neck shows no sign of deformities or trauma. Chest shows no sign of

The patient was located on the fifth floor and as I was bringing them down the elevator, there was a family member of a patient in the elevator. Under HIPAA regulations, I cannot allow others to view the patient confidential information that I had in my hand. As we got to our stop I told the patient to follow me through the mechanical doors. I told the patient to wait in cubical 2 and that the nurse will be with then in a few moments. In addition, I will be getting them a warm blanket once I come back. I headed to leave the binder at the receptionist desk in the OR where they had another patient pick-up waiting for me. Before I left, I went to get the patient a warm blanket from the storage area that had temperature control. I gave it to the patient and left. Ronnie saw me and asked me if I did the patient pick-up alone, I said yes and he was surprised. Usually he needed to teach others in order to know what exactly they had to do. The only reason why I knew that I had to do everything that I did was because Ronnie told me everything verbally. He did not have to show me what to

When I arrive to the Trauma ICU 4800 unit, all of the nurses were already being followed by other students. The nurse in charge had me follow several different nurses, so I was able to observed several different patient cases. The first patient had received a triple bypass open-heart surgery. The patient had received a creatinine blood test. The patient had a dialysis machine next to them, which was used to function as the kidneys since the patient’s kidneys were not functioning correctly. Also, the patient’s body temperature was lowered from having a taken cool liquids so the nurses were keeping him warm with a bair hugger, which was a machine that helped regulate the patient's’ body temperatures.

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

Joanna is an experienced nurse taking care of Mrs. Kelly, who was Joanna’s patient many times in the past for her primary problem which is COPD. This time Mrs. Kelly was admitted with complaints of abdominal pain what was different from her primary diagnoses. Her vital signs were with normal limits and no significant changes from privies results, but for the nurse she looks sick, and Joanna know that something is wrong. She calls the resident doctor, but he tell her to watches and calls back with series changes. Joanna multiple attempts to report that something needs to be done to evaluate the cause of Mrs. Kelly pain was ask to calm down. However nobody took patient symptoms series and the next day patient died.