Hydronephrosis Case Study

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Mr. P, a 27-year-old African American man, was brought to the emergency department (ED) by his wife. The patient reported polyuria for the past three days, few episodes of vomiting prior to arrival and polydipsia. On assessment, the patient appears flushed, and his lips and mucous membranes are dry and cracked. His skin turgor is very poor. He has deep, rapid respirations and there is an acetone smell to his breath. He is alert and oriented X 2 and is having trouble focusing on the questions.

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

Renal insufficiency, proteinuria. The patient has seen a nephrologist in the past for a kidney lesion. I do think it would be a good idea to check in with the nephrologist, once again. She will get me his name and we will go ahead and set this up. When I did this.

The patient is 66 year-old male who is brought to St. Joe's ER by BLS after being found with altered mental status at home. The patient reports he used heroin 2 days prior to admission. The patient was found by his brother hallucinatin with bladder or bowel incontinence the morning of presentation. The patient has not eating in approximately 4 days. The patient himself denies having any complaints, but he is a very poor historian. His medical history is significant for prior heroin and cocaine abuse, alcohol abuse of unknown duration, hypertension, cirrhotic liver, he has had an anterior cervical discectomy of C5-C7 with anterior compression in May of 2012 and a closed reduction of C6-C7 billateral dislocation , cholecystectomy in the

This patient is a 73-year-old female who required inpatient hospitalization due to end stage renal disease secondary to persistent bacteremia and other underlying conditions. She was admitted to Truman Medical Hospital for further treatment and evaluation due to complaints of severe bilateral flank pain for three days that worsened with movement. She also reported shortness of breath and had been constipated for 3-4 days.

The patient is an 87-year-old female who was recently hospitalized here at St. Joseph's Medical Center and discharge to rehabilitation spent approximately 3 weeks in the rehabs setting and was home for a day before she represented to the emergency room complaining of inability to move, profound weakness, right hip pain and right thigh swelling, as well as bilateral leg edema. The patient's medical history is significant for afib, coronary disease, congestive heart for diabetes mellitus, GERD, thyroid disease, sick sinus syndrome with permanent pacemaker. She has undergone CABG, nausea, profound vascular disease, anemia, severe gastroparesis, as well as having had polio, she presents with profound weakness and she is essentially bedbound.

The patient is a 78-year-old female who had a recent fall. She fell on the left side. She has a very large left medial thigh hematoma. She continued to feel weak and unable to care for herself at home and presented to the ED. She is known to have hypertension, insulin dependent diabetes mellitus, a TIA in 1998 with some minimal left-sided weakness and she has had nephrolithiasis. In the ED she was found that her creatinine has gone from 1.2-1.82. Sodium on admission was 130 with a glucose of 360 which suggests that she has some hyponatremia not as profoundas the 130 would suggest. The patient has a complained of pain all over her body, her neck, her arms and her back. She is evaluated by physical therapy who feels that she is unsafe

This 60 year old Hispanic male presents at the clinic today with a chief complaint of urinary frequency, decreased urine flow, increased nocturia, slight terminal dysuria and low grade fever. The patient was experiencing these symptoms for the past two years, but they had increased a whole lot more during the last two weeks. Upon assessment, it is noted that the patient has a

Harm-Reduction Model Substance abuse affects people and their environments in diverse ways. Families crumble under its power. Societies restructure to accommodate areas subject to higher rates of substance abuse, as the issues seem to exist comorbid with mental illness and homelessness. That is not to imply that all people suffering from the relentlessness of the disease that is addiction are all mentally ill or homeless, but rather, there are some common threads that can be detected within the different cultures of substance abuse and addiction.

Food insecurity is defined as when an individual has inconsistent and inadequate access to a sufficient amount of nutritious food preventing him or her from maintaining a healthy lifestyle. It is typically associated with limited financial  It is sometimes classified as a public health concern and is currently a growing issue as the number of individuals suffering from food insecurity is increasing according to Statistics Canada.   Food insecurity has its greatest impact on the individual itself and an impact on the Government of Ontario and mayors of the cities within Ontario.  It is an important issue as it can more issues to branch out from it  such as famine (long term hunger), increased health care costs and more. Thus, food insecurity has many impacts on the person itself and it can cause more issues to build upon this one issue.

This is a 68-year-old gentleman who presents to the ED stating that his legs are really swollen and draining yellow stuff. It is to be noted this patient was originally placed in observation status by the attending physician. After my clinical review of the chart and discussion with him I believe this patient warrants acute inpatient hospitalization. In the ED on presentation he is found to be anemic with a hemoglobin of 8.9, hematocrit of 27.1. He is also dehydrated with specific gravity urine greater than 1030. He has a low-grade temp of 99. On his physical exam he is noted to have a 2+ bilaterally pedal edema from his feet up to his knees, as well as chronic bilateral stasis changes in his legs with erythema and increased warmth.

The patient is a 97-year-old female who presents to the ED because of urinary incontinence with hematuria and vaginal bleeding. The patient is very weak, unable to walk prior to admission despite her 97 years of age she is able to ambulate her home with the assistance for walker. In the ED she was found to be positive for influenza. The rest of her medical history she is chronic kidney disease, increased lipids, she is anemic and has hypertension. Urologic consultation indicates that catheterization of her urine in the ED showed it to be amber. Besides having influenza she probably is having vaginal bleeding. I believe that this patient warrants acute inpatient hospitalization. She is 97 years of age with a multiplicity of comorbidities

For the purpose of confidentiality, the patient will be identified by the initials A. S. A.S was a 52- year old African American woman who was admitted to the hospital when she started to experience severe urinary retention and shortness of breath. She has three adult children and eight grandchildren, but recently lost her husband of 25 years to diabetes. The patient appears to be very independent because she lives alone in her home and is aware of the disease process. She has a past medical history of acute renal

presented with chest pain and an exacerbation of chronic iron deficiency anemia. The patient was examined and given a chest x-ray along with and ECG to assess heart function. The patient complained of shortness of breath and a tight feeling in his chest when he was breathing. The patient has history is sick sinus syndrome, therefore the patient was aware of the symptoms and has felt them before. The patient’s medical history also includes obesity, hypertensive heart disease, A-Fib, CAD, venous stasis ulcers, and a history of EtOH abuse. The patient presented with +1 pitting edema in the lower extremities, with a cool temperature symmetrically. The patient’s capillary refill was less than 3 seconds with Dorsalis pedis pulses +1 and Posterior tibialis pulses +1 symmetrically. The patient’s vital signs were BP-112/69, RR-20, P-70, T-36.2 degrees C and SpO2 94% on room air. The patient’s white blood cell count was within normal limits, therefore an infection is not suspected. The patient’s BMI was 35, therefore considering him obese. Since the patient presented with chest pain, the patient was given a medication to control his heart rhythm and