PHYSICAL EXAMINATION: Mr P is alert, orientated and responds appropriately to questions. He is clean shave with low hair cut. He is Height 183cm weight 88kg, Body Mass Index (BMI) 26.3, which shows that he is overweight. He appears to be anxious and in moderate to severe distress, his hands are moist and cold. His colour is good; he lies flat with moderate chest discomfort. Vital signs: Blood pressure (BP) Right hand 167/95, left hand 170/98, and no significant difference in BP of both arms. Cardiac arrhythmias noted, heart rate (HR) 106 beat per minute; heart rhythm was irregularly irregular, but no evidence of blood loss or internal bleeding, radial pulses was strong bilaterally. Mr P was dyspnoeic, mild to moderate increased work of breath noted, respiratory rate (RR) was 28 but no hypoxia, oxygen saturation by finger probe was 96 % on room air. Therefore there was no need for supplementary oxygenation. Oxygenation is recommended to maintain saturation of oxygen above 90% in suspected ACS. No sign and symptoms of infection or sepsis, he was a febrile, temperature was 37.4 degree centigrade. No diabetes ketoacidosis (DKA), blood sugar level (BSL) 8.6 mmols was within acceptable limit. DKA is a contributing factor to nausea and vomiting in diabetic patient with acute myocardial infarction (MI). Skin: Warm, wet and sweaty (diaphoresis) but good colour. Diaphoresis is a common occurrence in patient with acute MI. No lesion, no nail clubbing and no cyanosis. Head, Eyes,
to the intensive care unit with septic shock secondary to urosepsis. The patient has a
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.
HEENT: No thyroid enlargement, masses or adenopathy, JVP was 5 cm above sternal Angle, carotid pulse was strong and regular
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.
Notified by the patient. Two patient verifier completed. Per PA Alford the patient was advised that her x-ray result were negative for pnuemonia. Currently the patient states that she is doind much better. She states that sh still has a cough but is improving. The patient denies fever, chill, SOB, and chest pain. Instructed the patient if she starts having this symptom report to the ER. Also instructed the patient if her symptoms worsen please scheudle an apt with her provider. The patient agrees and verbalize
A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he
Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.
Ht: 62”, Weight: 134 pounds, BMI: 24.5 Temp 98.4 BP 128/90 P 76 R18, even. The Oxygen saturation 98%.
Pathophysiologically analysing the signs and symptoms of Mr Smith aged 63 is the first step in substantiating differential diagnosis. Mr Smith’s temperature is within the normal ranges of 37 degrees Celsius, where a temperature of 38 would be considered high. If his temperature had been elevated, it
Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,
Cardiovascular Assessment: No visible pulsations, no heaves or lifts. Apical pulse present in the fifth intercostal space at the left midclavicular line. Auscultation of apical rate 62 beats per minute, normal rhythm regular S1 - S2 heart sounds present. Pulsations present when supine and disappear at a 45 degree angle position. Extremities are brown color without redness, cyanosis, lesions or varicosities bilaterally. Temperature warm bilaterally, Allen test was negative. Homan’s sign negative. Carotids: +2 and present bilaterally. Right Radial +2, left radial +1 , Right Brachial: +2
The primary assessment of this patient is the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. According to the ABCDE approach, it is crucial to check the airway first to see if the airway is patent. Then, check the patient’s breathing. Determining the respiratory rate, inspecting movement of the chest wall, measuring pulse oximeter and using the stethoscope to auscultate the lung sounds are the possible way to check if the breathing of the patient is sufficient (Thim et al., 2012). Next, check the circulation. Skin changes, such as check the colour and sweating, relate to the circulatory problems. Also, heart auscultation, blood pressure measuring and electrocardiography monitoring should be involved in this procedure (Thim et al., 2012). When measure the blood pressure, using the AVPU score (A for ‘alert’, V for ‘reacting to vocal stimuli’, P for ‘reacting to pain’, U for ‘unconscious’) to assess the consciousness, which is for the disability part. Moreover,
As I did the physical exam I explained to the patient that I would listen to the arteries with a stethoscope for an abnormal sound which will let me know if there is poor circulation due to plaque? I also explained to the patient that by checking the pulse in the ankle and legs it would also indicate if
Cardiac: Regular rhythm without murmur, normal S1and S2. One plus edema to bilateral lower extremities. Capillary refills are presents and carotid bruits are absent.