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- Male, 50 years old, had undergone subtotal gastrectomy for gastric ulcer 20 years ago. In the recent half a year, he had upper abdominal distension after eating, black stool in the past 2 months, and wasting and fatigue. Physical examination: a 6×5cm mass can be reached under the xiphoid process. The texture is hard and can be pushed, accompanied by light tenderness. The first diagnosis considered is: Ulcer recurrence Postoperative input loop obstruction Output loop obstruction Remnant stomach cancer Gastric emptying disorderDuring my clinical rotation in the emergency department, Imet Grace Gilligan. She was a 28-year-old woman who cameto the emergency department with complaints of severeepisodes of nausea and vomiting over the last 48 hours. She has a past medical history of Crohn’s disease, a gastrointes-tinal (GI) problem for which she underwent bowel resection surgery 1 month ago. “I thought the surgery would help myproblems.” The patient was dehydrated and needed IV fluidtherapy.My co-assigned nurse attempted to start a peripheralvenous access not once, but six times. The patient was already upset by her recurrent abdominal symptoms, butnow had to deal with the continuous painful stick of aneedle. During the course of attempts to start the IV, thepatient stated that a nurse on the IV team always had to becalled to insert her IVs. Although my nurse acknowledgedthe information, she continued trying to start the IV. Finally,on the sixth try, as the patient was in tears, the nurse wassuccessful. It…GASTROINTESTINAL SYSTEM: Mhiema Mou, 14 years of age, presents to the clinic for an annual checkup. Nurse Roque updates the patient’s history by asking her if she has had any gastrointestinal pain associated with meals, at rest, or with activity, or with having a bowel movement. Nurse Roque also asks the patient if she has had any unexplained weight loss or weight gain since her last annual checkup. Nurse roque asks the patient if she has had any changes in her bowel habits or changes in the usual stool characteristics. The patient stated she has had no such problems. Nurse Roque works in the gastrointestinal (GI) lab, in which many endoscopies (with contrast dye) and scope procedures are done. What age-related considerations should the nurse utilize when performing the focused physical assessment for the gastrointestinal system? What are considerations prior admission of client for contrast dye GI series? What are consideration that the nurse should anticipate before, during, and…
- 87 years old was admitted into the acute unit for gastroenteritis,2 day duration, he is vomiting, have sever,watery diarrhoea and he he complaining of abdominal cramping,his serum electrolyte are consistent with hyponatremia related to excessive sodium loss 1.nursing management of client with hyponatremia 2 2.what is the relationship with,vomiting, diarrhoea and hyponatremia 3. What sign and symptoms should the client be monitored for that indicate the presence of sodiumJeanette is a 46-year-old woman who has visited her general practitioner (GP) today, brought in by her husband, Steve, with a 5-day history of nausea, mild abdominal pain and constipation. She decided to see the doctor today, as the pain and nausea were much worse when she woke up this morning and she has vomited twice in the past 3 hours. She also reports her abdomen feels distended and bloated. Jeanette says she had tried to drink more water and eat more fruit and was having bran for breakfast for the past 3 days, as she initially thought she was simply constipated. With the increased generalized abdominal pain and vomiting this morning, she thought she should get a medical opinion. Jeanette has a past medical history of hypercholesterolemia, hypertension, atrial fibrillation and type 2 diabetes mellitus (T2DM) and her BMI is 32 kg/m2. She experienced appendicitis 6 months ago,for which she had an appendectomy. Her current medications are simvastatin, warfarin, and metformin. The GP…Male, 30 years old, who was admitted to the emergency room with abdominal pain for 4 hours The patient felt upper abdominal discomfort after drinking and overeating 5 hours ago, and felt sudden acute pain under xiphoid process 4 hours ago, accompanied by nausea and vomiting of stomach contents for several times, abdominal pain spread to the right middle and lower abdomen 3 hours ago. The patient refused to press the abdomen because of pain, fidgeting坐立不安, cold sweat. PE: flat abdomen, extensive muscle tension, obvious tenderness under xiphoid process, right middle and lower abdomen, most prominent under xiphoid process, bowel sounds occasionally heard. For further diagnosis and treatment, she was admitted to the emergency department. Intermittent epigastric pain for 8 years, apparent hunger, without systematic diagnosis and treatment. PE: T37.6℃, P104 times/min, R24 times/min, BP90/60mmhg. Acute painful appearance, irritability, no obvious changes in cardiopulmonary examination, flat…
- Male, 30 years old, who was admitted to the emergency room with abdominal pain for 4 hours The patient felt upper abdominal discomfort after drinking and overeating 5 hours ago, and felt sudden acute pain under xiphoid process 4 hours ago, accompanied by nausea and vomiting of stomach contents for several times, abdominal pain spread to the right middle and lower abdomen 3 hours ago. The patient refused to press the abdomen because of pain, fidgeting, cold sweat. PE: flat abdomen, extensive muscle tension, obvious tenderness under xiphoid process, right middle and lower abdomen, most prominent under xiphoid process, bowel sounds occasionally heard. For further diagnosis and treatment, she was admitted to the emergency department. Intermittent epigastric pain for 8 years, apparent hunger, without systematic diagnosis and treatment. PE: T37.6℃, P104 times/min, R24 times/min, BP90/60mmhg. Acute painful appearance, irritability, no obvious changes in cardiopulmonary examination, flat…Mrs. Vera W. is a 60-year-old white woman, who emigrated from Germany to the United States at the age of 18. She has come to her primary care physician's office with her daughter. She tells you, "My daughter made me come here because I have had bad stomach pains for about 6 weeks." After you ask about the character, onset, location, duration, severity, and pattern of the pain as well as associated symptoms (COLDSPA), such as what relieves the pain and what unctions are affected by pain, you learn the following information. The pain is aching epigastric pain, fairly continuous, and worse at night. It radiates to her back when she lies down. The pain gets progressively worse, is not affected by eating, and interferes with her daily function (it prevented her from attending her grandson's birthday party and it also wakes her up at night). In addition, in the interview, Mrs. W. relates loss of appetite, mild nausea, heartburn, and fatigue. For the past several months she has felt full soon…SCENARIO Identifying Data: This 72-year-old female presents with a biopsy proven adenocarcinoma of the sigmoid colon at 20 cm. History of Present Illness: The patient has been noted to have some bright red bleeding intermittently for approximately 8 months, initially presumable of a hemorrhoidal basis. She recently has had intensification of rectal bleeding but no weight loss, anorexia, or obstructive pain. No significant diarrhea or constipation. Some low back pain, probably unrelated. Recent colonoscopy by Dr. Scoma revealed a large sessile (attached by a broad base) polyp, which was partially excised at 20-cm level, showing infiltrating adenocarcinoma at the base. The patient is to enter the hospital at this time after home antibiotic and mechanical bowel prep, to undergo sigmoid colectomy and possible further resection. 1. Using the scenario above, answer the following questions: A. What chronic symptoms did this patient have? Describe the symptoms using medical…
- In the clinical setting, one often uses a differential diagnosis. This proccess differentiates between possible diagnoses bases on the person’s symptoms. Here you will demonstrate your knowledge of the gastrointestinal system to either confirm or reject potential diagnosis. A 50-year old, slightly obese individual presents to your clinic with the following symptoms: severe abdominal pain, especially in the left side. However the patient also complains the pain radiates to the right side. They have nausea and have been vomiting for the past several days. Upon examination, you find abdominal tenderness and constipation. The patient is of Asian descent, has been a smoker for the past 20 years, reports frequent alcohol use (>7drinks/week) and takes aspirin on a daily basis (nonsteroidal anti-inflammatory drug). Will age, weight, lifestyle and ethnicity play a role in your diagnosis? Based on the patient’s symptoms, the list of differential diagnoses is extensive as follows: Acute…Write the nonpharmacological treatment/approach for the Gastro Esophageal Reflux disease (GERD)? please shortly write at your own words. Answer should be specific (3-4 lines).Ken is a 42-year-old male who presented to the ER complaining of severe flank pain on and offfor the past six hours. He is complaining of fever and chills along with nausea, but has notvomited as yet. He also reports difficulty with voiding, stating that “It feels like I have tourinate, but when I try, I only pass a small amount of urine and there is some blood in it.” Hedescribes the pain as a sharp, stabbing type of pain that started in his lower back on the leftside and then traveled around to the front and down into his groin area. He has taken twodoses of ibuprofen 400 mg with minimal relief.1. Based on Ken’s symptoms described above, what diagnosis is most likely in this case?2. Based on Ken’s symptoms, explain what most substantiates the diagnosis?3. What other relevant information might there be in Ken’s past history, social history, andfamily history that could assist the ER physician in supporting the diagnosis?(Must answer with 6 possible outcomes)4. What diagnostic tests…
