Patient: 66-Year-Old Black / African-American Female With Complaint of Sudden Onset of Mid Upper Epigastric Pain
Pertinent PMH
During the initial medical exam, it is critical to gauge the severity of the pain. The healthcare practitioner should inquire as to the presence of previous medical conditions such as colitis, Crohn's disease, and IBS which could be the cause of the sudden onset. In the instance of abdominal pain, the provider should determine the precise location of pain as much as is possible even though referent pain is often an issue. Even though the pain is located in the upper abdominal quadrant, greater specificity is needed to eliminate possible causes. For example, "pain in the patient's right-upper abdomen can indicate gallstones or inflammation" or "duodenal ulcers, acute pancreatitis, acute cholecystitis, and acute hepatitis" (Lipman 2009; Karnath & Mileski, 2002, p. 46). In contrast, pain in the right mid-upper abdomen, may indicate "stomach or pancreas problem" or "gastritis, gastric ulcer, acute pancreatitis, and splenic infarct or rupture" (Lipman 2009; Karnath & Mileski, 2002, p. 46). The provider should also inquire as to any medications the patient may have taken and apparently unrelated but significant conditions such as heart disease.
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When presenting abdominal pain, palpation of the abdomen is the usual first step. But it is advised that "prior to palpation of the abdomen," the provider should "ask the patient to point with one finger to where the pain is greatest. This will assist you in determining whether the pain is localized or diffuse" (Mistovich, Krost, & Limmer, 2008). Palpitation, done correctly, can be an extremely useful source of information. "In patients with cholecystitis [inflammation of the gallbladder], Murphy's sign can be elicited by having the patient take a deep breath while the right subcostal area is palpated" (Karnath & Mileski, 2002, p. 46).
The age of the patient is significant in determining what tests to perform given that "in patients age 60 years or older, biliary disease and intestinal obstruction are the…
COPD Chronic obstructive pulmonary disease (COPD) year-old male -- pt known to me -- recently admitted to the ward with Non-STEMI & LVF. Discharged five days ago. Was found collapsed in his house by his niece. Duration not known. Could not get up from the floor, no chest pain/SOB. No dysuria/constipation -- ? Incontinence Pt was discharged with a package of care last week. Detailed history not available as the pt is confused and not answering any
(16) The drug has better coverage against Gram-positive cocci and atypical pathogens, and it is able to achieve excellent penetration into respiratory fluids and tissues. One particular adverse effect of the drug is that it may result in gastrointestinal disturbances, and thereby affect the individual's metabolism. (17) e) How does metabolism influence clearance, bioactivity and elimination? At times, the metabolism does tend to affect the absorption and the clearance of
The use of aspirin and other NSAIDs has not been eliminated by studies as possible causes of PUD. H. pylori infection generally occurred less among patients with complicated ulcer disease than in those with uncomplicated ulcer disease. Many studies point to aspirin or NSAIDs as the other identifiable risk or cause of PUD. PPI has been shown to reduce dyspeptic symptoms, which develop from NSAID use. In the past,
Pelvic inflammatory disease, a critical problem Occurence or recurrence of pelvic inflammatory disease or PID has been linked to STIs such as C. trachomatis or Neisseria gonorrhoeae. Patient education and simplified guidelines are needed to develop accurate diagnosis. In order for changes to take place, more research must be done to understand the complex nature of the disease and the most effective and cost effective method of treatment. This paper delves
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This note discusses on certain complications pregnant women encounter during their pregnancy, labor and birth. Appropriate patient education is necessary in prepregnancy, ante partum, labor and delivery settings to address complications and risk factors that could harm the mother and infant during labor and birth. Several of these risk factors can be eliminated by proper patient education. Nurses are not simply health care providers and caregivers; they also functions as
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