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 extraca
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R9.
N.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
Do ASAP.
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- N.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.L.M. is an 81-year-old female who lives in a nursing home. She had a stroke 2 years ago and has residual right-sided weakness. She also has gastroesophageal reflux disease, hypertension, and stress incontinence. She currently takes the following medications: Omeprazole 20 mg PO daily before breakfast Captopril 50 mg PO BID Furesomide 20 mg PO daily Today she tells the nursing assistant that she has a lot of pain when she urinates. The charge nurse completes a physical exam and notifies the provider of the exam findings and patient’s painful urination. A urinalysis is ordered. Subjective Data Pain with urination began 2 days ago States she usually doesn’t drink much because of the stress incontinence and not wanting to have “accidents,” and now she is drinking even less because doesn’t want to have to urinate due to the pain and burning Wearing feminine hygiene pads she had in her closet since the painful urination started because her stress incontinence “is worse”…Patient C., 32 y/o, complains of excessive weight, shortness of breath, defective memory, performance decrement, feeling cold, emotional retardation. It is known from the case history that the patient is suffering from primary hypothyroidism. Objectively: the skin is dry, waxlike, swollen, periosteal reflexes are lowered, body mass index: 33.5 kg/cubic meter, TSH (thyroid-stimulating hormone) – 25 µU/dL (norm 0.5 -5.0). Obesity is homogenous. Arterial pressure: 150/100 mm column ob mercury. What type of obesity can be suspected?A. Endocrine hypothyroidB. Endocrine accompanying dysfunctions of hypothalamopituitary systemC. Alimentary constitutionalD. HypothalamicE. Androidal with the developed symptoms of metabolic syndrome
- L.M. is an 81-year-old female who lives in a nursing home. She had a stroke 2 years ago and has residual right-sided weakness. She also has gastroesophageal reflux disease, hypertension, and stress incontinence. She currently takes the following medications: Omeprazole 20 mg PO daily before breakfast Captopril 50 mg PO BID Furesomide 20 mg PO daily Today she tells the nursing assistant that she has a lot of pain when she urinates. The charge nurse completes a physical exam and notifies the provider of the exam findings and patient’s painful urination. A urinalysis is ordered. Subjective Data Pain with urination began 2 days ago States she usually doesn’t drink much because of the stress incontinence and not wanting to have “accidents,” and now she is drinking even less because doesn’t want to have to urinate due to the pain and burning Wearing feminine hygiene pads she had in her closet since the painful urination started because her stress incontinence “is…Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Mr. H suggests hypoxemia and respiratory alkalosis which might be an indication of serious illness such as pulmonary embolism. Part 1: His arterial-venous oxygen content (Ca-vO2) difference is 5.73 mL/dL Part 2: His extraction ratio (ER) 0.276 or 27.6% What is clinically happening to the patient? Please explain.Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Part 1: What is his arterial-venous oxygen content (Ca-vO2) difference? Part 2: Calculate his extraction ratio please.
- Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough,hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago.Blood work values on room air:Blood Gas Blood Gas Arterial Venous pH 7.51 7.40 PaCO2 30 mmHg 45 mmHg PaO2 60 mmHg 30 mmHg HCO3 24 mEq/l 21 mEq/l BE - 1 - 4 SaO2 90% 60% Hb 15 g/dl 15 g/dl Part 1: Interpret the ABGPart 2: What is the arterial- venous oxygen content (Ca-vO2) difference for this patient?CASE: H.I, a 60-year-old male office worker was admitted to the emergency room due to complaints of severe chest pain whileat work. The pain was relieved by taking nitroglycerin and thrombolytics. The patient also complained of easy fatigabilityand inability to perform heavy tasks at home and work. 3 weeks ago, the patient experienced chest pain after doingmoderate heavy chores while at home. This occurred 3 times and was relieved by rest. The patient also experience shortnessof breath when climbing stairs or walking long distances. The patient has been taking maintenance medication forhypertension. The patient was diagnosed with myocardial ischemia secondary to coronary artery disease 1. What are the risk factors/ causes of the medical condition?2. What are the ways to prevent these risk factors/ causes?3. What is the effect of aging on the body system involved?Case Scenario: Mrs. J. is a 25-y/o gravida 2, para 1, who was admitted at full term at 5:00 p.m. She stated that she had been having contractions at 8 to 10-minute intervals since 4 p.m. They lasted 25 seconds. She also stated that she had been having "a lot of false labor" and this makes her still able to feed and able to maintain a conversation and is getting excited. But now she hoped that this was "the real thing". Her membranes were intact. Mrs. J.'s temperature, pulse, and respirations were normal and her blood pressure was 115/70. The fetal heart tones were 140 and regular. The nurse examined Mrs. J. and found that the baby's head was at +1 station, and the cervix was 4 cm. dilated and 70 percent effaced. As the labor progresses, there will be some discomforts Mrs. J will experience. By accomplishing the table below, you will be able to anticipate these discomforts then may be able to apply measures to alleviate or assist Mrs. J to have a safe delivery. Stages of Labor Other…