Concept explainers
48-Year-Old Female with Gallstones
Ms. Burton, 48, presents at the clinic complaining of abdominal pain. She is a middle-aged woman, overweight, pale and sweating, with jaundice (yellowish skin and sclerae). Her heart rate is 102 beats/min and BP is 145/98 mm Hg. She describes the pain as “severe” and “steady” over the past night, accompanied by nausea and vomiting. She sits leaning forward and indicates that the pain is in the epigastric region radiating up to the tip of the right shoulder.
Ms. Burton’s medical history shows that she has had several episodes of biliary colic (pain caused by gallstones going through the bile duct). She says her current pain is "sort of like that, but it’s lasted longer." She says her last meal was a seven-cheese pizza the previous night, and that the pain began 3–4 hours after eating. She denies drinking or smoking.
2. Why would pain related to gallstones begin after a high-fat meal?
Want to see the full answer?
Check out a sample textbook solutionChapter 23 Solutions
HUMAN ANATOMY + PHYSIOLOGY + MAST AP
- T.H., a 48-year-old man, was an admitted IV drug user and occasionally abused alcohol. Over 4 weeks, he had experienced fever, night sweats, malaise, a cough, and a 10-lb. weight loss. He was also concerned about several discolored lesions that had erupted weeks before on his arms and legs. T.H. made an appointment with a physician assistant at the neighborhood clinic. On examination, the PA noted bilateral anterior cervical and axillary lymphadenopathy and pyrexia. T.H's temperature was 39°C. The PA sent T.H. to the hospital for further studies. T.H's chest radiograph showed paratracheal adenopathy and bilateral interstitial infiltrates, suspicious of tuberculosis (TB). His blood study results were positive for HIV and showed a lymphocytopenia. Sputum and BAL (washing) fluid were positive for AFB, and a PPD skin test result was also positive. Based on these findings, T.H. was diagnosed with HIV, TB, and Kaposi sarcoma related to past IV drug abuse.arrow_forwardpathophysiology Frank Charrom [FC] is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal (GI) bleeding for which he has been hospitalized on six separate occasions over the past 5 years. He continues to drink and exhibits common manifestations of alcoholic cirrhosis. He was recently hit by a car and hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 1.8. FC’s family reports his mental functioning has deteriorated significantly over the past few months. What are the common manifestations of alcoholic cirrhosis?arrow_forwardpathophysiology Frank Charrom [FC] is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal (GI) bleeding for which he has been hospitalized on six separate occasions over the past 5 years. He continues to drink and exhibits common manifestations of alcoholic cirrhosis. He was recently hit by a car and hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 1.8. FC’s family reports his mental functioning has deteriorated significantly over the past few months. What is the most likely underlying cause of FC’s progressive mental deterioration?arrow_forward
- pathophysiology Frank Charrom [FC] is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal (GI) bleeding for which he has been hospitalized on six separate occasions over the past 5 years. He continues to drink and exhibits common manifestations of alcoholic cirrhosis. He was recently hit by a car and hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 1.8. FC’s family reports his mental functioning has deteriorated significantly over the past few months. What secondary problem is likely to occur with FC’s abrupt cessation of alcohol intake while hospitalized?arrow_forwardMrs. C is a 50-year-old woman who presents with joint pain. She reports the pain has been present for about 2 years. The pain affects her hands and her wrists. She describes the pain as a “dull aching” and “a stiffness.” It is worse in the morning and improves over 2 to 3 hours. She says that on particularly bad days she uses aspirin with moderate relief. She is otherwise well, except for a history of mild hypertension managed with angiotensin-receptor blocker. She reports no other joint pain. She does not have a history of psoriasis. Her vital signs are: 37.1 C; B/P 128/84; P 84; R 14. There is a 2/6 systolic ejection murmur. Joint exam revealed limited range of motion of the MCPs and wrists bilaterally. There is swelling of the third and fourth MCP on the right and the third on the left. There is pain at the extremes of motion and a boggy quality to the joints. A detailed skin exam is normal. Rheumatoid arthritis (RA) is suspected. 1. What type of hypersensitivity is rheumatoid…arrow_forwardThe patient denied hematemesis. What question did the doctor ask the patient regarding this term?arrow_forward
- Mr. D Mr. D is a 90-year-old man who was admitted to the hospital with complaints of nausea, vomiting, left arm pain, and chest pain. An electrocardiogram (ECG) is performed, and he is diagnosed as having a myocardial infarction. Mr. D has a long history of comorbidities including hypertension, diabetes, and congestive heart failure (CHF). With this in mind, the physician asks Mr. D if he wants life-sustaining measures taken (e.g., CPR, mechanical ventilation, etc.) should he experience cardiopulmonary arrest. Mr. D tells the physician that he wants all measures taken to save his life. Imagine that you are the nurse assigned to provide care to Mr. D, and address the following: Considering Mr. D's advanced age, what are the benefits/risks associated with providing life-sustaining measures? What factors should you consider based on the Mr. D's age and health history?arrow_forwardN.H. is a 76-year-old male admitted to the hospital through the emergency department. He fell outside his home. It appears that he may have sustained a fracture to his left hip. He has a history of type 2 diabetes mellitus and has a 40 pack-year smoking history that is now complicated by chronic obstructive pulmonary disease. Data Collected (use only those that apply) Complains of excruciating pain and tenderness in left hip Pain not relieved with morphine BP 166/94 mmHg Diaphoretic and pale skin Respiratory rate 36; crackles, expiratory wheeze X-ray of left hip reveals extracapsular fracture Hematocrit 30%; hemoglobin 15g/dL; WBC 15,000/uL Discussion Questions: Considering the nursing process, list in order the steps in transferring patient from bed to chair post operatively.arrow_forwardPathophysiology of a UTI (easy)arrow_forward
- Patient R., 32 y/o, was delivered with complaints of fatigue, decrease of appetite, intensification of pigmentation in the open areas of the body, palms of the hands, cyanosis, losing weight, nausea and vomiting. The symptoms began to aggravate during 1-2 weeks after acute poisoning. Objectively: arterial pressure – 60/30 mm column of mercury, pulse – 140 beats/minute, skin turgor is lowered, the colour is dark with intense pigmentation of the elbows, scars, skin folds on the palms; clearly low levels of sodium and chlorine, high levels of potassium in the blood; glycemia – 4.3 mmol/l. What is your diagnosis?A. Addisonian crisisB. Uremic coma C. Brain comaD. Acute cardio-vascular insufficiencyE. Hypoglycemic comaarrow_forwardS.R. is a 65- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered. The nurse is assessing the patient’s pulses. Which locations should the nurse check? What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legsarrow_forwardCare plan for a patient with cellulitisarrow_forward
- Human Anatomy & Physiology (11th Edition)BiologyISBN:9780134580999Author:Elaine N. Marieb, Katja N. HoehnPublisher:PEARSONBiology 2eBiologyISBN:9781947172517Author:Matthew Douglas, Jung Choi, Mary Ann ClarkPublisher:OpenStaxAnatomy & PhysiologyBiologyISBN:9781259398629Author:McKinley, Michael P., O'loughlin, Valerie Dean, Bidle, Theresa StouterPublisher:Mcgraw Hill Education,
- Molecular Biology of the Cell (Sixth Edition)BiologyISBN:9780815344322Author:Bruce Alberts, Alexander D. Johnson, Julian Lewis, David Morgan, Martin Raff, Keith Roberts, Peter WalterPublisher:W. W. Norton & CompanyLaboratory Manual For Human Anatomy & PhysiologyBiologyISBN:9781260159363Author:Martin, Terry R., Prentice-craver, CynthiaPublisher:McGraw-Hill Publishing Co.Inquiry Into Life (16th Edition)BiologyISBN:9781260231700Author:Sylvia S. Mader, Michael WindelspechtPublisher:McGraw Hill Education