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- 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…Mr. Henry is a 50-year-old male who presents to the office for headaches. he has a known history of sinus infections when the seasons change, high blood pressure and depression. his medications include Lopressor 50mg, daily and Claritin 10mg daily. he has a family history significant for aneurysms and depression. His vitals are BP 196/86 right arm seated, HR 87 regular, RR 13, Temp 98 oral. What is a NANDA approved diagnosis you could give her?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
- A 10-year-old boy with known HbSS disease presented to the Paediatric Emergency Department with a oneweek history of fever and severe pain in his right leg, severity 9/10 for the last two days. On examination:Pulse – 100 beats/min, BP – 110/70 mmHg, Capillary refill < 2sec and Respiratory rate – 20 breaths/ min. He has point tenderness anteriorly on proximal tibia. There is no joint swelling.X-ray of the affected limb shows marked periosteal elevation.His complete blood count is: Hb – 6.5 g/dL WBC 30 x 10 /L Plt – 120 x 10 /L with a reticulocyte count of 1%.Of the following the MOST appropriate management in this patient would bea. Ibuprofen, Cefotaxime and top-up transfusionb. Morphine, Ampicillin and hydration therapyc. Morphine, Cefotaxime and hydration therapyd. Morphine, Cefotaxime and top-up transfusionMr. Reddy is a 62 yo presenting to ED at 1500hrs. He was preparing the gas cylinder for a Sunday BBQ when it suddenly exploded while he was trying to connect the hose. Family standing by tried to extinguish the fire with their hands and tried to remove his clothing. Burns 30% TBSA – Face, hands, bilateral lower limbs. Complaints of severe pain and burning 10/10. Past Medical History: Hypertension, Type II DM Regular medications – Candesartan 8mg, Glimepiride 4mg, Metformin 500mg and Pravastatin 20mg. Fully vaccinated against COVID. Airway. - Patent, superficial burns to right side of face Breathing. - Spontaneous, RR-22mt, SPO2-92% RA, air-entry equal Circulation- Lower limb odema, cap refill 3 seconds, bilateral dorsal pedis pulses weak. BP- 88/50 mmHg, HR- 127/mt, sinus tachycardia, Disability - GCS-15 E4V5M6, PEARL- 3mm, Exposure - Temperature 35.9 deg Celsius. Full thickness burns to right lower limb and right arm, partial thickness burns to left lower limb, bilateral hands.…Mr. Cardia has been admitted to your ward and care is assigned to you. Information from the history you have taken includes reporting 4 days of anorexia, nausea, vomiting, and occasional diarrhoea before he sought medical attention. His wife says he'd started falling asleep frequently, looked pale, and mentioned seeing yellow spots. Current medications: 0.25 mg of digoxin once a day and 20 mg of frusemide twice a day for heart failure. Vital signs: BP 110/60 P 46 RR 26 T 36.5 What may the signs and symptoms indicate? (two words)
- This patient is a 55-year-old male, known to me for several years. He is here, today, for his annual physical examination. Vitals are of concern, as he is showing an elevated blood pressure (152/92 mm Hg) and his weight is 50 pounds over where it should be. Patient complained that he has been feeling sluggish and fatigued more often than not. Patient stated that he has been taking his BP medication and believes that he sleeps well. However, the patient shares that his wife has been complaining recently about his loud snoring and told him that he appears to be breathing irregularly when asleep. I am recommending that he go through diagnostic testing for suspected obstructive sleep apnea (OSA). Why should you query this physician and what would you ask? A. Missing detail: Does the patient have OSA or not? B. Missing detail: Does the patient have OSA or not? C. Ambiguous information: Was the wife's assessment accurate? D. Contradictory information: Does the patient have elevated BP or…Mr. Smith complains to the doctor that he feels weak, has a headache and feels dizzy. This is considered a: symptom assessment sign clinical finding aMiss Josepovic (80 year old) was admitted yesterday following a fall at home. She did not sustain any serious injury but has been kept in for monitoring, medication review and further investigations. Her past medical history is:, Congestive Heart Failure (CHF), mild renal impairment, hypertension, type 2 diabetes. Since admission she has been diagnosed with Atrial Fibrillation (AF) Her medications are: Enalapril 10mg daily, Metformin 1g BD, Paracetamol 1g prn (max dose 4g in 24hors). She has commenced Dabigatran 150mg BD, Metoprolol 50mg BD. Outline the mechanism of action of Dabigatran and Metoprolol and explain the rationale for commencing Miss Josepovic on these drugs.
- 10:28 ull NCM 112 RLE 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. At clinical examination, his right leg was extremely painful and pale. He had absent pedal pulses on both sides, and a mild sensory loss on the right side. Allen's test of upper extremities was negative. Echo Doppler was suggestive of a bilateral common iliac occlusion and of a three-vessel occlusion on the right leg. A computerized tomography (CT) angiography detected the presence of an intraluminal aortic and iliac clot and a bilateral ibial essels occlusion. The patient was fully anticoagulated with…Donald has a history of DM I. There's an order to administer 10 units.The nurse is using a U-100 syringe. How many units should the nursedraw up in the syringe and administer?18 year old male, brought in by ambulance following an alleged altercation where patient struck head on road curb at 2300 hrs. Patient is denies loss of consciousness but unable to recall all events. Patient appears alert but teary and takes a couple of moments to answer questions. On examination, 4cm laceration noted with slow ooze from wound. Dressing insitu. Vital signs and GCS recorded at 2325 hrs as per chart. No other obvious injuries. Patient denies drug use, states has had approximately ‘five beers since 7pm’. Breath alcohol taken at 2330 hours 0.06%. Patient reports pain to be 5/10 at occipital region, no analgesia taken prior to presentation. Patient states is usually fit and well. Past medical history Childhood asthma, up-to-date with immunisations (last tetanus 12 months ago).Not on any medications and no known allergies. Intervention: The decision is made to keep Zac in hospital overnight, for observation. Paracetamol is charted for pain. No other medications are…