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Pediatric case study appendicitis
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Patient Sex: Male Ethnic Group: Malay Age: 14 years old Ward: Surgical Ward 18, Hospital Taiping Occupation: Student Marital Status: Single Date of Admission: 12th November 2015 Chief Complaint(s) He is admitted to the ward with the chief complain of pain at right lower quadrant of the abdomen for 8 hours prior to his admission. History of Presenting Illness This was his second episode since 10 days ago where he develop the same pain at his right flank. He suddenly experienced severe pain 8 hours before admission when the pain shifts to his right lower quadrant of his abdomen. The onset is at 6.30 am before worsening at 10 p.m to 2 p.m. He described the pain as continuous sharp pain and gradually increased in severity. There is no radiation of the pain. The pain was exaggerated on movement and touch. There were no relieving factor and he scale the severity as 7/10. He experienced fever for 1 day prior to admission. It was a mild grade continuous fever. He does not experienced chills and rigor. The patient does not experience any nausea or vomiting, no dysphagia, no pain during micturition and no alteration in bowel habit. He experienced loss of appetite but not notice any weight loss. Systemic Review Central Nervous System: He doesn’t have any parasthesia and no experienced of unconscious or fits. He doesn’t have any weakness of limbs and no hearing problems as well as visual disturbance. Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling. Respiratory System: He does not have shortness of breath, no cough and no hemoptysis. Genitourinary system: He doesn’t have pain during urinating and no increase of passing urine and he doesn’t need to get up in the middle of the night to pass urine. There is no blood in the urine. Musculoskeletal system: He doesn’t have any stiffness and swelling at any joints. He can walk normally and never had history of falls. Endocrine system: He doesn’t have any intolerance towards hot and cold. He doesn’t have any excessive thirst. Other: He doesn’t have any skin rash or any bleeding or bruising at any part of his body. Past Medical History This is his first admission to the ward after having his second episode of the same pain. The first episode was 10 days prior to his admission. The first episode was relieved after taking pain killer at the clinic. Past Surgical History The patient does not have past surgical history. Drug History He is not currently on any medication.
Examination revealed an oxygen saturation of 98% and blood pressure of 145/90. Oropharyngeal inspection revealed significant crowding (Mallampati class 3) with macroglossia. Chest auscultation was clear and two heart sounds were audible with nil else.
In general, he was a chronically ill-appearing white male in no acute distress. HEENT: The nasal mucosa on the right was erythematous and questionable polyp was present. No stridor over the neck. Chest increased AP diameter. Lungs: Diminished breath sounds through all lung fields with prolonged expiratory phase and expiratory wheezing. No crackles. No accessory muscle use. Heart: Very distant S1, S2. No murmurs, rubs, or gallops. Abdomen: Obese, nontender. No organomegaly. Extremities: 1+ pitting edema. No clubbing. No
This can be investigated by a range of procedures. These include a CT scan of the kidneys and bladder in conjunction with an abdominal X-ray. Results obtained from the diagnosis and tests enable judgments’ relating to the stage to which the problem has developed and will inform decisions on the appropriate treatment
What? The patient is 65-year-old man Mr. John Douglas who is suffering from dysphagia and have been admitted to the surgical ward for insertion of a percutaneous endoscopic gastrostomy (PEG). Apart from that, he is a Type 1 diabetes patient and has weakness in his right leg and arm because of right-sided hemiplegia. He is thin in appearance and has stage 1 pressure sore on his right heel.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Since admission to the hospital he has had irregular heartbeats which have dropped down into the 40s and was asymptomatic. On 3/18, a telemetry was placed on him for monitoring, but it has since been removed.
We have documented that there is no weight loss, nausea, or vomiting. That despite his complaints of not being able to eat, he has not lost weight. He denies any blood per rectum. On physical examination, his abdomen is also benign, it is slightly rounded but firm. I do not detect any mass and there is no guarding or
On my third day of clinical course I had an African America patient age 72, female, a retired high school teacher who was admitted for an Acute Diverticulitis with Perforation. She is diabetic and had a medical and surgical history of diverticulitis, High Cholesterol, Non-Insulin-Dependent Diabetes Mellitus (NIDDM), Hysterectomy, and Scoliosis. She has been on clear liquid diet since she was admitted then she was Nothing by Mouth NPO for the CT scan for that day. When I got the assignment that I was going to be taking care of a patient with an acute diverticulitis, the first thing on my mind was that she will be in a severe abdominal pain, high fever due to infection because my aunty had same disease. To my surprise, she claimed a 0 /10 on a 0-10 pain scale. Her blood sugar and vital signs were normal except for respiratory that was 22. All her laboratory test results were normal including WBC. Patient concern was that she couldn’t have a bowel movement. She was medicated on Colace- a stool softener, morphine for pain, sulfran for nausea, and azactam an antibiotics.
In February of this year the patient did present to a local emergency department, with a chief complaint of chest pain. However, he left the emergency
Choice “E” is the best answer. This patient has Zollinger-Ellison Syndrome (ZES), which is caused by a gastrin-secreting tumor of the GI tract. The gastrin secretion in turn activates the ECL cells in the stomach. These cells release histamine which stimulates the parietal cells in producing acid. ZES can occur as a part of a genetic syndrome (MEN 1) or sporadically. The offending tumor is located in the duodenum, pancreas, or abdominal lymph nodes. Abdominal pain, heartburn and diarrhea are the most common symptoms in ZES patients. In patients in whom MEN1/ZES is suspected, a history indicative of kidney stones, elevated calcium levels(i.e., hyperparathyroidism), and pituitary disorders (i.e., adenomas) should be sought. The diagnosis of Zollinger–Ellison
Dr. Murray, the chief resident who arrived around 8:00pm, charted Lewis’ heart rate as normal and noteds a probable ileus; however, nursing documentation at the same time recorded a heart rate of 126 beats per minute (Monk, 2002). Subsequent heart rates at midnight and 4:00am arewere charted as 142 and 140 beats per minute respectively without documented intervention (Monk, 2002 ). On Monday morning Lewis noted that his pain suddenly stopped after being very constant and staff charted that they were unable to get a blood pressure recording in either arm or leg from 8:30-10:15am despite trying multiple machines (Monk, 2002; Solidline Media, 2010).
His vital signs and blood work are all within normal range. Additional blood work test include, amylase and lipase measurements to rule out pancreatitis, erythrocyte sedimentation rate (ESR) to detect inflammatory activity in the body, abdominal x-ray to look for any masses and endoscopy to inspect the esophagus for any lesions. A CT scan or an MRI may be done to identify the cause of epigastric pain as well depending on the other symptoms he may be experiencing (Kerkar, 2016). There are other variables to consider while evaluating TJ case. He has a previous history of bleeding ulcer that was treated with multiple prescriptions although he did not complete his therapy course. TJ is at a risk of peptic ulceration due to usage of over-the-counter (OTC) NSAIDs that he takes for his osteoarthritis pain. NSAIDs are linked with gastric mucosal damage and ulcer formation which consequently result to gastrointestinal (GI) bleeding. NSAIDs should be
Case Description: The child was a 21/2 year old girl diagnosed with Caudal Regression Syndrome. The family did not want to amputate her leg at this age. She was seen in the natural environment through the
Symptoms are generally radical and usually exacerbated by a racing heart palpitations, dizziness , fainting, fatigue and shortness of breath on exertion . The other differential diagnosis were right heart failure , symptoms includes the lower extremity oedema. When the legs are elevated at night, the fluid redistributes centrally causing pulmonary edema resulting in orthopnea or paroxysmal nocturnal dyspnea ( Otto,2014) . Another differential diagnosis is the bicuspid aortic valve disease , this type of valve has only two leaflets ,with this deformity, the valve doesn’t function perfectly, but it may function adequately for years without causing symptoms or obvious signs of a problem(Otto, 2014). These differential diagnoses were discussed and explained to the patient and family as well as with the multidisciplinary team who recognized that these diagnoses were suitable in the situation of Mr
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.