Chief Complaint: “I have a bad cough with phlegm”
History of Present Illness: The patient is an 84-year-old Pacific Islander woman who presented to the clinic with complaints of a “bad” cough with phlegm which she notes to have started two weeks ago. She describes the cough as productive and the phlegm as rusty-colored. She states that the cough has been constant. Patient does not know what brought on the cough. She has been taking cough drops with no relief. She came to the clinic today because the cough has gotten worse. She reports that the cough is usually worse at night and sometimes prevents her from falling asleep. She has not tried any over the counter medication. She complains that her symptoms interfere with her daily activities.
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She uses a hypoallergenic pillow cover and her mattress is less than one year old
• Screening tests: Women over age 65
1. Blood pressure screening: Has blood pressure checked every year at annual physical, no high blood pressure readings reported
2. Cervical cancer screening: Last pap-smear was 15-20 years ago with no abnormal result
3. Cholesterol screening: Patient has hyperlipidemia that is controlled with medicine. Lipid panel check every three months at the clinic
4. STDs: Denies ever having STDs
5. HIV: Denies any history of HIV or receiving any blood transfusion
6. Diabetic screening: Admits to diabetes. A1c check every 3months
7. Dental exam: Last dental visit 2017
8. Eye exam: Last eye exam about a years ago
9. Physical exam: Last annually physical exam 2017
10. Breast Exam: Denies any breast problem
11. Last mammogram: 10 years ago
12. Bone density test: 2013
• Safety measures: Patient always use her seatbelt while driving. Patient has smoke detector and a fire extinguisher in her home
• Immunizations: o Patient states that her immunization record is up to date. o Had chicken pox in 3rd grade o Influenza vaccination received in October
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
R.S. has chronic bronchitis. According to the UC San Francisco Medical Center “Chronic bronchitis is a common type of chronic obstructive pulmonary disease (COPD) in which the air passages in the lungs — the bronchi — are repeatedly inflamed, leading to scarring of the bronchi walls. As a result, excessive amounts of sticky mucus are produced and fill the bronchial tubes, which become thickened, impeding normal airflow through the lungs.” (Chronic Bronchitis 2015) There are many things that can be observed as clinical findings. R.S. will have a chronic cough that has lasted from 3 months to two years or more, and a lot of sputum. The sputum is due to
My disease is Streptococcal pneumonia or pneumonia is caused by the pathogen Streptococcus pneumoniae. Streptococcus pneumoniae is present in human’s normal flora, which normally doesn’t cause any problems or diseases. Sometimes though when the numbers get too low it can cause diseases or upper respiratory tract problems or infections (Todar, 2008-2012). Pneumonia caused by this pathogen has four stages. The first one is where the lungs fill with fluid. The second stage causes neutrophils and red blood cells to come to the area which are attracted by the pathogen. The third stage has the neutrophils stuffed into the alveoli in the lungs causing little bacteria to be left over. The fourth stage of this disease the remaining residue in the lungs are take out by the macrophages. Aside from these steps pneumonia follows, if the disease should persist further, it can get into the blood causing a systemic reaction resulting in the whole body being affected (Ballough). Some signs and symptoms of this disease are, “fever, malaise, cough, pleuritic chest pain, purulent or blood-tinged sputum” (Henry, 2013). Streptococcal pneumonia is spread through person-to-person contact through aerosol droplets affecting the respiratory tract causing it to get into the human body (Henry, 2013).
Jorge’s last lipid panel test shoed ↓Cholesterol 78 L [112-200] and ↓HDL 35 [>39]. He is currently taking Lovaza 2 gram oral cap twice a day for Dyslipidemia and a statin Lipitor 10 mg PO tab daily at bedtime for ↑ASCVD risk (Atherosclerotic Cardiovascular Disease). His last EKG on 7/20/17 indicated NRS with no acute changes, QTC
Safety is a primary concern in the health care environment, but there are still many preventable errors that occur. In fact, a study from ProPublica in 2013 found that between 210,000 and 440,000 patients each year suffer preventable harm in the hospital (Allen, 2013). Safety in the healthcare environment is not only keeping the patient safe, but also the employee. If a nurse does not follow procedure, they could bring harm to themselves, the patient, or both. Although it seems like such a simple topic with a simple solution, there are several components to what safety really entails. Health care professionals must always be cautious to prevent any mishaps to their patients, especially when using machines or lifting objects, as it has a higher
His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis, which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the most common reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and respiratory crackles in chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010).
Safety is focused on reducing the chance of harm to staff and patients. The 2016 National Patient Safety Goals for Hospitals includes criteria such as using two forms of identification when caring for a patient to ensure the right patient is being treated, proper hand washing techniques to prevent nosocomial infections and reporting critical information promptly (Joint Commission, 2015). It is important that nurses follow standards and protocols intending to patients to decrease adverse
Reducing risks- blood pressure monitoring, maintenance of personal care records, and regular eye, foot, and dental examinations – general practitioner, endocrinologists, cardiologist, opthomalogist, and dentist (Francis, 2007).
Patient safety one of the driving forces of healthcare. Patient safety is defined as, “ the absence of preventable harm to a patient during the process of healthcare or as the prevention of errors and adverse events caused by the provision of healthcare rather than the patient’s underlying disease process. (Kangasniemi, Vaismoradi, Jasper, &Turunen, 2013)”. It was just as important in the past as it is day. Our healthcare field continues to strive to make improvement toward safer care for patients across the country.
Whooping Cough These days, whooping cough, also known as pertussis, is not a serious disease because there are vaccinations available to prevent its occurrence. However, when I was five years old a vaccination was available but neither my siblings nor myself had been vaccinated against it and due to its highly contagious nature, I contracted whooping cough from my older sisters. Both of my older sisters had whooping cough, but they were lucky and managed to get well fairly quickly. Unfortunately, they passed it on to me and I suffered much more from it because I was a few years younger than them both. It started out as just a runny nose and a slight cough, which most people would attribute to the common cold or the flu.
The rate of errors and situations are seen as chances for improvement. A great degree of preventable adversative events and medical faults happen. They cause injury to patients and their loved ones. Events are possibly able to occur in all types of settings. Innovations and strategies have been created to identify hazards to progress patient and staff safety. Nurses are dominant to providing an atmosphere and values of safety. As an outcome, nurses are becoming safety leaders in the healthcare environment(Utrich&Kear,
It is right of a patient to be safe at health care organization. Patient comes to the hospital for the treatment not to get another disease. Patient safety is the most important issue for health care organizations. Patient safety events cost of thousands of deaths and millions of dollars an-nually. Even though the awareness of patient safety is spreading worldwide but still we have to accomplish many things to achieve safe environment for patients in the hospitals. Proper admin-istrative changes are required to keep health care organization safe. We need organizational changes, effective leadership, strong health care policies and effective health care laws to make patients safer.
Patient profile: Heterosexual Muslim Woman who has been in the United Stated for three years. She came from Pakistan. She is 42 forty-two years old, from low socioeconomic standing, English language barrier, and is Muslim rituals and practices. She came to emergency department with her husband due to shortness of breathing, high fever, severe cough. She was dignosed with new onset of pneumonia and currently on antibiotic. she also has history of Vitamin D deficiencies and diabetes mellitus type II. She admitted to medical-surgical floor for observation...
The text written by Dylan Thomas is an interesting semi-autobiographical one, that may seem to be a simple piece of prose at a first glance, but goes a lot deeper, by playing with the language, and cultural peculiarities.
The patient has also been suffering from frequent fevers in the past two months. He has also suffered from frequent headaches but has always taken painkillers (Bloland & Williams, 2003, p. 58). On fevers, the patient has frequently visited a local health clinic that has never done any diagnosis but has given medication, which reduces the fever.