Case Report A 32-year-old man was referred to the emergencies of our hospital because of a right lower limb critical limb ischemia. Past medical history included chronic alcoholism and a three- month history of bilateral intermittent claudication. He did not report any episode of superficial thrombophlebitis. He smoked about 10 cigarettes since the age of ten and 10 cannabis joints daily since the age of twelve. He had no other cardiovascular risk factors.
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- T.H., a 48-year-old man, was an admitted IV drug user and occasionally abused alcohol. Over 4 weeks, he had experienced fever, night sweats, malaise, a cough, and a 10-lb. weight loss. He was also concerned about several discolored lesions that had erupted weeks before on his arms and legs. T.H. made an appointment with a physician assistant at the neighborhood clinic. On examination, the PA noted bilateral anterior cervical and axillary lymphadenopathy and pyrexia. T.H's temperature was 39°C. The PA sent T.H. to the hospital for further studies. T.H's chest radiograph showed paratracheal adenopathy and bilateral interstitial infiltrates, suspicious of tuberculosis (TB). His blood study results were positive for HIV and showed a lymphocytopenia. Sputum and BAL (washing) fluid were positive for AFB, and a PPD skin test result was also positive. Based on these findings, T.H. was diagnosed with HIV, TB, and Kaposi sarcoma related to past IV drug abuse.History of Present IllnessTwo hours prior to admission, at 4am, patient Jake was jogging along LacsonStreet when a group of bystanders had approached him and stabbed himmultiple times. He claims that he does not know these people. He tried todefend himself resulting to multiple injuries in his upper extremities where hehad 3 lacerations, cheeks where he had a laceration on the left, right chest andright upper abdominal quadrant. Medications: Tetanus Toxoid 0.5 ml/amp, give 1 ampule via deep IM, now at right deltoid ATS 3,000 IU/amp, give 1 ampule via deep IM, now, ANST at left deltoid Piperacillin Tazobactam 2.25 grams/vial, give 1 vial via IV drip to run for 3 hours Q8H Tramadol 50 mg/amp, give 1 ampule very slow IV push now then Q6 PRN for pain Omeprazole 40 mg/amp, give 1 ampule via IVTT ODHS Latest Vital Signs : Blood Pressure: 90/60 mmHg Heart Rate: 121 bpm Respiratory Rate: 26cpm Temperature: 37.3 ⁰C Pain Scale: 10/10 NURSING CARE PLANWhat are the Pathophysiologic changes associated with Distributive shock
- HISTORY OF PRESENT ILLNESS: Edith Martens is a 66-year-old female who is recovering fromviral pneumonia. When her daughter came to check on her, she found Edith in bedcomplaining of weakness, constant fatigue and abdominal pain.For the past few days, Edith has been complaining of thirst and frequent urination. She alsoreports that she cannot see very well. Edith has lost approximately 4 lbs over the last week.Her daughter brought Edith to the ER. PAST HISTORY: There is a history of osteoarthritis that responds well to ASA. Edith wasdiagnosed with Type 2 diabetes approximately two years ago. She takes glyburide 10 mg everymorning before breakfast and is on an 1800 calorie diet, which she follows closely. SOCIAL HISTORY: Edith has lived alone since the death of her husband. She is not physicallyactive; her activities consist of light housework and occasional shopping trips. FAMILY HISTORY: Edith’s father had Type 2 diabetes complicated by peripheral vasculardisease. He died at the age of…what is the pathophysiology of ditributive shockHISTORY OF PRESENT ILLNESS: Edith Martens is a 66-year-old female who is recovering fromviral pneumonia. When her daughter came to check on her, she found Edith in bedcomplaining of weakness, constant fatigue and abdominal pain.For the past few days, Edith has been complaining of thirst and frequent urination. She alsoreports that she cannot see very well. Edith has lost approximately 4 lbs over the last week.Her daughter brought Edith to the ER. PAST HISTORY: There is a history of osteoarthritis that responds well to ASA. Edith wasdiagnosed with Type 2 diabetes approximately two years ago. She takes glyburide 10 mg everymorning before breakfast and is on an 1800 calorie diet, which she follows closely. SOCIAL HISTORY: Edith has lived alone since the death of her husband. She is not physicallyactive; her activities consist of light housework and occasional shopping trips. FAMILY HISTORY: Edith’s father had Type 2 diabetes complicated by peripheral vasculardisease. He died at the age of…
- put together care plan for a patient with bstructive shockwhat are the nursing responsibilities for cardiac catheterization for a child with tetralogy of fallotMr. 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. The ABG analysis of Mr. H suggests uncompensated respiratory alkalosis with mild hypoxemia, with base excess of -1 in her arterial side, whereas -4 in her venous side. Part 1: Her actual arterial-venous oxygen content difference (Ca-vO2) is 5.31 mL/dL. (Normal range considered here is 3.5 to 5 mL/dL) Part 2: Patient's actual oxygen extraction ratio (O2ER) was 29%. (Say normal range is 20-28%) What is clinically happening to the patient?