A 45-year-old woman presents complaining of fatigue, 30 pounds of weight gain despite dieting, constipation, and menorrhagia. On physical examination, the thyroid is not palpable: the skin is cool dry, and rough: the heart sounds are quiet and the pulse rate is 50 bpm. The rectal and pelvic examinations show no abnormalities, and the stool is negative for occult blood. The clinical findings suggest hypothyroidism. Questions A. What other features of the history should be elicited? What other findings should be sought on physical examination? 8. What is the pathogenesis of this patient's symptoms? C. What laboratory tests should be ordered, and what results should be anticipated?
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- A 30-year-old male demonstrated a subtle onset of the following symptoms: dull facial expression; droopy eyelids; puffiness of the face and periorbital swelling; sparse, dry hair; dry, scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (hematocrit 27); enlarged heart (upon radiological exam); constipation, and hypothermia. Serum free T4 0.3 ng/dL (low).Radioimmunoassay (RIA) of peripheral blood indicated elevated TSH levels. A TSH stimulation test, using recombinant human TSH, did not increase the output of thyroid hormones from the thyroid gland. What endocrine organ is involved here? a. Is this a primary or secondary disorder? What is a primary vs secondary disorder? b. Why? What data is presented that supports your answer? Is a TSH and/or TRH determination necessary for your diagnosis? 3. a. Describe the normal complete feedback loop involved. b. How is it affected in this…Clinical History:This 29-year-old male's illness began 10 weeks prior to death, with an episode of "flu". Two weeks later his urine became "smoky". He was found to have hematuria, albuminuria and elevated BUN (180 mg/dl). He died from a pulmonary embolus. Photos include throat photo, blood agar, and grain stain. What specimens should be taken, aside from blood? What tests should be run? Include both a rapid test option and a lower cost test option. What signs and symptoms should have alerted the patient to come in for testing during or after his viral flu episode? What was the most likely cause to the embolus? No references, just homework please include referencesPatient C: An 18 y/o healthy female presents for a routine physical examination. Patient has great difficulty producing a very small volume of urine despite not having urinated since early morning. During discussion with physician it is revealed that she has had only 2 cups of coffee and a donut to eat all day 1) What are the abnormal findings? 2) What is your diagnosis? 3)What suggestions might you have for this patient? 4) Why does the body form concentrated urine? and where in the kidney does urine concentration occur? 5) Why is an extended water fast a bad idea?
- Case ScenarioA 22-year-old woman, gravida 2, para 1, presents at the maternity clinic for a prenatal visit. She is unsure of her due date and states that her last menstrual period was about seven or eight months ago. She had one prenatal check-up in the community health center, although she does not have any records from her physician or nurse-midwife. She reports that she has had an uncomplicated pregnancy so far and that earlier ultrasonography indicated that she is going to have a girl. Her medical history is unremarkable aside from a full-term cesarean delivery performed in the government hospital four years ago because of “complete breech presentation.” She is not taking any prenatal vitamins. On examination, her vital signs are unremarkable, her fundal height measures 27 cm, the fetal heart rate is 165 beats per minute, and the fetus is cephalic by Leopold’s maneuvers. 1. What is your insight on the patient’s case concerning her pregnancy? 2. How can you best minimize risks…A 24-year-old male presented with confusion, shortness of breath, and painful calves. It was reported by a friend that he had been lying on the floor for several hours. He was a known intravenous heroin and alcohol abuser. On examination he appeared dehydrated and cold (tem- perature 35°C); his pulse was 75/minute and blood pres- sure 110/70 mmHg. Intravenous injection sites were apparent. His urine was dark coloured. His chest was clear. Arterial blood gases were done in the casualty department and a blood sample was sent to the pathology department and gave the following results (reference ranges are given in brackets): Arterial blood pH PCO₂ PO₂ HCO3- Serum Sodium Potassium Creatinine Calcium Albumin Phosphate Creatine kinase C-reactive protein 7.276 4.82 KPa 12.7 kPa 18.0 mmol/L 138 mmol/L 7.6 mmol/L 236 μmol/L 1.66 mmol/L 32 g/L 2.43 mmol/L >140,000 U/L 73 mg/L (7.35-7.45) (4.7-6.0) (12.0-14.6) (24-29) (135-145) (3.8-5.0) (71-133) (2.10-2.55) (35-50) (0.87-1.45) (55-170) (<10) The…Patient M., 36 y/o, was found in the street unconscious. The patient has a medical history of diabetes. There is a smell of alcohol from the mouth. The skin is moist, warm, arterial pressure -145/90 mm column of mercury, convulsive twitching of muscles. Breathing is shallow, eye ball tone is retained, pupils are dilated, hyperflexion. How would you treat this patients?A. Intravenous introduction of 40-80-100 ml 40% glucose solution B. Injecting 20 units of insulin subcutaneouslyC. Injecting 20 units of insulin intravenouslyD. Injecting 500 ml 5% glucose solution intravenouslyE. Injecting 500 ml 0.9% sodium chloride intravenously
- 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.Clinical Case: A 37-year-old female and her 37-year-old husband present with the complaint of a possible fertility problem. The couple has been married for 2 years. The couple has been trying to conceive since then and reports a high degree of stress related to their lack of success. The patient reports good health, stated that her periods were regular, having periods with a normal cycle. She works as a cashier, runs 12-24 miles each week for the last 2 years, and has no history of STDs, abnormal Paps, smoking, alcohol, or other drugs. She has had no surgery. The patient's partner also reports good health and reports no problems with erection, ejaculation, or pain with intercourse. He has had no prior urogenital infections or exposure to STDs. He has had unprotected sex prior to his current relationship but has not knowingly conceived. He has no medical problems or past surgery. He works as a long-distance truck driver and is on the road for 2-3 weeks each month. He smokes a pack of…Patient X, 47 years old was admitted last April 15, 2021. During admission the patient experiences dark brown to bright red vaginal blessing for the last 3 months, severe nausea and vomiting, pain on the pelvic area and notice some grapelike cyst pass on her vagina. She also mentioned feeling of dizziness and fatigue. Her admitting diagnosis is: - Gravida 7; Para 3 (6016) - Gestational Tromphoblastic NeoPlasia IV:16 High Risk - Hypertension Stage 2 Controlled -Status Post Exploratory Laparotomy for Total Abdominal Hysterectomy with bilateral salpingo-oophorectomy (10-18-20) Based on the following data, answer the following:1. As a nurse on duty, give at least two (2) priority nursing diagnoses based on the admitting diagnosis.
- Mr. B is a 57-year-old man who was admitted yesterday after starting to pass black stools. He has a two-day history of severe stomach pains and has suffered on and off with indigestion for some months. He is a life-long smoker, with mild chronic heart failure (CHF) for which he has been taking enalapril 5 mg twice daily for 2 years. He also recently started taking naproxen 500 mg twice daily for arthritis. He works a stressful job and drinks large amounts of caffeinated coffee daily. Yesterday his hemoglobin was reported as 9.3 g/dL, hematoocrit 30%, RBC's 3.2, platelets 162, INR 1.1 with Liver Function Test normal. He was mildly tachycardic (110 bpm) and had a slightly low blood pressure of 100/77 mmHg and was given 1.5 L of saline. He has just returned from an endoscopy this morning and has been newly diagnosed as having a bleeding duodenal ulcer. They took a biopsy to determine if he is positive for H-pylori. He has been written up for his usual medication for tomorrow if he is…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 comaA 47-year-old male comes to the physician with a 3-month history of bone pain. In addition, he has had nausea, constipation, depression, and muscle weakness for the past 2 months. He also notes some bumps on his fingers. His temperature is 37.1°C (98.8°F), pulse is 61/min, respiration is 14/min, and blood pressure is 145/98 mmHg. Physical examination reveals generalized bone tenderness and small hard nodules on his fingers. An x-ray of his hands shows generalized bone thinning and small cystic lesions. Which of the following sets of findings are most likely seen in this patient? Answers A - E A A B B C C D D EE