• SP—1 A 26-year-old Korean woman who is gravida 1, para 0, in her thirty-seventh week of gestation. She is 5’6” (168cm) tall and weighed 160 pounds (72.7kg) prior to becoming pregnant (prepregnancy BMI of 25.8kg/m2). She now weighs 190 pounds (86kg), and her pregnancy has been uncomplicated. She is considering breastfeeding and questions her childbirth provider (you) about it and whether she can continue after she returns to work 8 weeks postpartum. She had been trying to lose weight before she got pregnant. She plans to lose her pregnancy weight quickly and fears dieting will keep her from producing enough breast milk to feed the baby adequately. Case Questions to Consider: 1—What advice can be given to her to help her decide whether …show more content…
He has smoked one pack of cigarettes per day for 30 years (30-pack year history). Family history: His family history is negative for the presence of heart disease, stroke, cholesterol, and lipid disorders, or neurologic disorders. ROS: General—the patient reports lethargy, decreased appetite, and recent bloating; he relates that his pants are tighter in the waist than usual GI/abdomen—no vomiting or diarrhea Neurologic—No history or seizures, no tinnitus, no syncope. He has reported some memory loss Vital Signs: Height—5’8” (173cm) Current weight—160 lb (73kg) Usual weight—(1 month ago) 150 lb (68kg) Exam: General—well-dressed male who appears to be in mild distress Skin—jaundiced; spider angiomas on the upper chest Eyes—pale conjunctiva, sclera icteric; no ophthalmoplegia or nystagmus Cardiac—resting tachycardia; heart sounds are normal; no murmurs are present Chest/Pulmonary—lungs clear to auscultation and percussion bilaterally; mild gynecomastia Abdomen—Distended abdomen; presence of abdominal fluid wave and shifting dullness; enlarged liver size (14cm span) with a firm, non-tender edge; no splenomegaly Extremities—slight (1+) bilateral lower extremity edema Neurologic—decreased vibratory sensation in the lower legs; bilaterally decreased knee reflexes; no asterixis; decreased vibratory sensation in the lower legs; bilaterally decreased knee reflexes; no asterixis; normal sensation and position sense in upper and lower extremities; cranial nerves II
ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen.
Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys, pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the abdomen appeared unremarkable. No free air was seen.
Generally, this is a well-developed man sitting comfortably in no acute distress. Skin is warm and dry. HEENT: Head is normocephalic, atraumatic. Pupils equal, reactive to light and accommodation. Sclerae are anicteric. Oral mucosa is moist without lesions. No JVD. No thyromegaly. Lymphatics: No cervical, supraclavicular, axillary, or inguinal adenopathy appreciated. Respiratory: Lungs are clear to auscultation bilaterally. Heart: Regular rate and rhythm. Abdomen: Soft, nontender. Positive bowel sounds. Liver and spleen not palpable. Strength is 5/5 throughout. Neurological exam is
Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.
“Breast feeding rates in developed countries such as the UK, Australia and the US are typically lower than World Health Organisation goals” Parkinson (2010) 3. From a study carried out by Queensland university stressed the importance of not only the delivery of literature on how effective breastfeeding is for your babies health but that what was also needed to increase the number of breast feeders was to give personal support and explains social and environmental benefits also. When they looked at the UK in particular, Parkinson (2010) 3 stated “women already understood that breastfeeding was good for their baby, and what they needed were the tools to help them to breastfeed longer. From this it is clear that although effective and sufficient information around the benefits of the child is being addressed, there is no sufficient information or skills being given direct to the parents in order for them to carry this out for any length of time. Another piece of research was carried out in 2010 on ways to change the paradigm of breastfeeding, from encouraging promotion of breast feeding within the employment setting.
Complete Blood Count: The white blood cells count is relevant. The cholesterol is elevated, but the hemoglobin is reasonable. She doesn’t have anemia.
□ Presentation includes weight loss, increased appetite, enlarged thyroid gland, exophthalmos, heat intolerance, restlessness, rapid heartbeat, nausea, and vomiting
It is recommended to breastfeed exclusively for at least six months. This will be hard for Molly because she is going back to work in two months, she has a full time job and is eager to get back to work. Molly might become embarrassed of having to pump her milk at work every couple of hours and may get very overwhelmed with breastfeeding while holding her full time job.
His chief complaint, however, is low back pain. This has been an ongoing thing. The CT scan done ___ showed evidence of hypertrophic degenerative change L3-L4 and L5, also of suspected posterior bulge at L3, L4 and L5. He has an MRI scheduled for ___ and an appointment in neurosurgery apparently in ___. That seems rather long wait, perhaps they can get that pushed up. I do not see that on his scheduled appointments here, but he said he received a letter. Other then the back problem, he is doing fairly well. He maintains that his home glucose range is 120 to 130. His most recent hemoglobin A1c resulted from ___ of last year (___). A hemoglobin A1c of 8.7 which translates more likely to be around 200. However, todays lab results are
It’s a beautiful summer day. The sun is shining and the breeze is blowing. You decide to make a run to Sonic for a creamy shake that’s ice cold. Once you make it there, place and receive your order, you decide to sit outside and sip on your tasty treat. A few minutes pass and you notice something strange. People are staring at you. Their faces show nothing but pure disgust. You begin wracking your brain; looking for an explanation as to why these people are looking at you the way they are. Nothing comes to mind. You hear someone behind you say, “Really? Does he have to do that here?” You immediately begin feeling insecure. You make your way back to your truck and start driving away. As you sit there, in the driver’s seat of your Chevy Silverado,
In an 82 bed Level III NICU the Spatz Ten Steps for Promoting and Protecting Breastfeeding for Vulnerable Infants was implemented. Low birth weight infants weighing fewer than 1500 grams were participants. The Ten Step Method was implemented during a three year period. Interventions included nursing staff education on implementing the ten steps. The steps included factors such assisting mothers with correct breastfeeding techniques, developing procedures and approaches to feeding the infant, and assisting the mother with the establishment and maintenance of milk. Results showed positive effects of the Ten Step Approach regarding breastfeeding. The implementation of the Ten Steps Method resulted in significant improvement
World Health Organization (2002) has announced that women should be encouraged if possible to breastfeed their child(ren) exclusively for the first six months of the child’s life and once the child is six months of age to continue breastfeeding along with appropriate, healthy food for up until the child reaches the age of two years old or older so that the child can receive all the nutrients that the child needs in order to achieve optimal growth, health and development. While the child is growing and developing to meet his or her milestones, it is crucial to monitor the child’s health. National Heart, Lung and Blood institute (2017) mentions that obesity is related to unwanted, potential life-threatening disorders such as; diabetes, heart
What is the highest priority of a new parent? Keep their child safe and provide the ecstatic comfort to their baby. In that case a pacifier plays one of the most vital roles. But for that you have to pick the best pacifiers available in the market!
Patient is a 71-year-old right-handed white male whose spouse was recently diagnosed with being HIV positive. He was tested and in June was found to also be HIV positive. Since three weeks ago, he started having numbness in his legs. He has not started his antiviral medications. This numbness started on the anterior lateral calves and throughout his feet, but now has risen up to his hips and including his groin area. In his legs, it is mostly laterally. It is a numbness and a sensation that his legs are wrapped. It is not in itself painful. However, he is very tender to touch over his right calf. He is currently using a cane, as he tends to fall forward. He notes that he has complete numbness in his
Statistical Product and Service Solutions for Windows (SPSS) 12.0 software package and SAS 8.0 software. SPSS 12.0 was used for all statistical analysis except linear regression which used SAS 8.0.