Week 3 Summary and Plan

Female patient whose is a 13-year-old, was admitted to the hospital with complaints of progressive weakness and shortness of breath with minimal physical effort. She has experienced recurrent fevers reaching 38.8°C. Physical examination reveals a well developed teenage with good nutritional status and in no acute distress. There is no lymphadenopathy or organomegaly. Many petechial hemorrhages cover her chest and legs. Several bruises are found on her legs and thighs. Laboratory tests were ordered upon admission. The laboratory tests result were as the following:   RBC    2.24 X1012 /l   Hb           71 g/l PCV       24% Plt        8.0 X109/l WBC     1.2 X109/l Differential Segmented Neutrophils      2% Lymphocytes                      94% Monocytes                            4% Reticulocyte count                0.7%   She was referred to a hematologist who ordered a bone marrow examination. Bone marrow biopsy showed a markedly hypocellular marrow with very few hematopoietic cells and…

Male, non-perinatal pathological history. Vaccines up to date. No morbid family history.Family history. He presented recurrent infections: at 8 months of age, pneumonia with good response to amoxicillin, lower urinary tract infection with normal renal ultrasound. Response to amoxicillin, lower urinary tract infection with normal renal ultrasound; at 9 months of age, adenophygma at 9 months, left cervical adenophygmon surgically drained; at 18 months of age he was hospitalized for study of chronic diarrhea without definitive diagnosis, which progressed with pyoderma of the scalp. At 2 years and 9 months he was admitted for pneumonia without response to three antimicrobials regimens. Computed tomography (CT) scan of the chest showed right upper lobe lung disease  and hilar, mediastinal, and retroperitoneal lymphadenopathies. The fiberoptic bronchoscopy showed inflammatory granuloma, pulmonary tuberculosis was considered as the first treatment with isoniazid, pyrazinamide, ethambutol and…

Female patient whose is a 13-year-old, was admitted to the hospital with complaints of progressive weakness and shortness of breath with minimal physical effort. She has experienced recurrent fevers reaching 38.8°C. Physical examination reveals a well developed teenage with good nutritional status and in no acute distress. There is no lymphadenopathy or organomegaly. Many petechial hemorrhages cover her chest and legs. Several bruises are found on her legs and thighs. Laboratory tests were ordered upon admission. The laboratory tests result were as the following: RBC 2.24 X1012 /1 Hb 71 g/l 24% 8.0 X10/1 PCV Plt WBC 1.2 X109/1 Differential Segmented Neutrophils Lymphocytes Monocytes Reticulocyte count 2% 94% 4% 0.7% She was referred to a hematologist who ordered a bone marrow examination. Bone marrow biopsy showed a markedly hypocellular marrow with very few hematopoietic cells and there were no malignant cells present. 1- Connect these clinical symptoms with her laboratory-screening…

Mr. Hooke a 35 y/o male presented himself in the clinic complaining of shortness of breath and having fevers for the past few weeks. He is known to be infected with HIV for almost 2 years already. He returns to HIV clinic at different intervals for follow-up. He has been on stable antiretroviral therapy consisting on didanosine, stavudine, and indinavir for the past year. Patient history revealed that he is unsure about his immunization status, and thinks he got them as a child. Physical Examination as follows: General: thin, anxious, acutely ill-appearing, young white man with tachypnea Neck/LN: slight cervical lymphadenopathy, thyroid normal Lungs/Thorax: CTA, slight axillary lymphadenopathy Labs Chest X-ray: Bilateral subtle infiltrates Bronchoscopy with BAL: positive for the presence of a unicellular eukaryote, a yeast-like fungus Assessment: breakthrough opportunistic infection   question: Could any of the patient’s problems have been caused by drug therapy?

Mr. Hooke a 35 y/o male presented himself in the clinic complaining of shortness of breath and having fevers for the past few weeks. He is known to be infected with HIV for almost 2 years already. He returns to HIV clinic at different intervals for follow-up. He has been on stable antiretroviral therapy consisting on didanosine, stavudine, and indinavir for the past year. Patient history revealed that he is unsure about his immunization status, and thinks he got them as a child. Physical Examination as follows: General: thin, anxious, acutely ill-appearing, young white man with tachypnea Neck/LN: slight cervical lymphadenopathy, thyroid normal Lungs/Thorax: CTA, slight axillary lymphadenopathy Labs Chest X-ray: Bilateral subtle infiltrates Bronchoscopy with BAL: positive for the presence of a unicellular eukaryote, a yeast-like fungus Assessment: breakthrough opportunistic infection Case Study Questions: Aside from HIV, what is your diagnosis? Support your clinical diagnosis.  Could…

Mr. Hooke a 35 y/o male presented himself in the clinic complaining of shortness of breath and having fevers for the past few weeks. He is known to be infected with HIV for almost 2 years already. He returns to HIV clinic at different intervals for follow-up. He has been on stable antiretroviral therapy consisting on didanosine, stavudine, and indinavir for the past year. Patient history revealed that he is unsure about his immunization status, and thinks he got them as a child. Physical Examination as follows: General: thin, anxious, acutely ill-appearing, young white man with tachypnea Neck/LN: slight cervical lymphadenopathy, thyroid normal Lungs/Thorax: CTA, slight axillary lymphadenopathy Labs Chest X-ray: Bilateral subtle infiltrates Bronchoscopy with BAL: positive for the presence of a unicellular eukaryote, a yeast-like fungus Assessment: breakthrough opportunistic infection   question: What drug, dosage form, schedule, and duration of therapy are best for treating this…

Mr. Hooke a 35 y/o male presented himself in the clinic complaining of shortness of breath and having fevers for the past few weeks. He is known to be infected with HIV for almost 2 years already. He returns to HIV clinic at different intervals for follow-up. He has been on stable antiretroviral therapy consisting on didanosine, stavudine, and indinavir for the past year. Patient history revealed that he is unsure about his immunization status, and thinks he got them as a child. Physical Examination as follows: General: thin, anxious, acutely ill-appearing, young white man with tachypnea Neck/LN: slight cervical lymphadenopathy, thyroid normal Lungs/Thorax: CTA, slight axillary lymphadenopathy Labs Chest X-ray: Bilateral subtle infiltrates Bronchoscopy with BAL: positive for the presence of a unicellular eukaryote, a yeast-like fungus Assessment: breakthrough opportunistic infection Case Study Questions: 1.Aside from HIV, what is your diagnosis? Support your clinical diagnosis.

An 18-year-old patient reports a low-grade fever, itchy and red eyes, pain in the right ear, as well as a mild cough and runny nose.

M.L. is a 26-year-old homosexual man admitted to the hospital for progressive respiratory distress, fever, weakness, and chronic diarrhea. He tested HIV positive about 3 years ago, but his infection has remained asymptomatic until 2 months prior to admission. Pneumocystis jiroveci (carinii) pneumonia was suspected and confirmed by culture. Laboratory analysis demonstrates a low CD4+ count of 185 cells/ml. HAART treatment with the antiretrovirals azidothymidine (AZT), efavirenz (Sustiva), and ritonavir (Norvir) was started 2 months ago.   QUESTIONS:  A medical student asks you to draw a picture of the HIV virion and a CD4+ cell, and to explain the mechanism of intracellular infection and the role of reverse transcriptase. What would you show on the drawing and explain about the process?

M.L. is a 26-year-old homosexual man admitted to the hospital for progressive respiratory distress, fever, weakness, and chronic diarrhea. He tested HIV positive about 3 years ago, but his infection has remained asymptomatic until 2 months prior to admission. Pneumocystis jiroveci (carinii) pneumonia was suspected and confirmed by culture. Laboratory analysis demonstrates a low CD4+ count of 185 cells/ml. HAART treatment with the antiretrovirals azidothymidine (AZT), efavirenz (Sustiva), and ritonavir (Norvir) was started 2 months ago.   QUESTIONS:  P. jiroveci pneumonia is an opportunistic infection to which immunocompetent people are immune. What other opportunistic infections are commonly seen in AIDS patients? Are there any data to suggest that M.L. may have one of these? A medical student asks you to draw a picture of the HIV virion and a CD4+ cell, and to explain the mechanism of intracellular infection and the role of reverse transcriptase. What would you show on the drawing…

Mr. Morningstar has no history of serious medical conditions. Although  he tested negative for RPR, HBsAg and HIV, he  confided that he used to have sex with both men and women in the Bar he owned in Los Angeles a year ago. According to him, that was before his relationship with Ms. Decker. He also mentioned that before they travelled here in the Philippines two weeks ago, he shared a few bottles of beer and Kansas-style barbecue with his brother named Amenadiel in Midtown Missouri. Will you accept Mr. Morningstar as a Donor for Patient Chloe Decker? What are the following parameters that you will consider in order to accept or defer Mr. Morningstar as a Donor for Patient Chole Decker? Justify your answers.

Mr. Morningstar has no history of serious medical conditions. Although  he tested negative for RPR, HBsAg and HIV, he  confided that he used to have sex with both men and women in the Bar he owned in Los Angeles a year ago. According to him, that was before his relationship with Ms. Decker. He also mentioned that before they travelled here in the Philippines two weeks ago, he shared a few bottles of beer and Kansas-style barbecue with his brother named Amenadiel in Midtown Missouri. He  also  offered  you  (the  interviewer)  a sachet of crystal clear methamphetamine. Will you accept Mr. Morningstar as a Donor for Patient Chloe Decker? What are the following parameters that you will consider in order to accept or defer Mr. Morningstar as a Donor for Patient Chole Decker? Justify your answers.

Mrs.  A  , age 35 was given a pap test during a routine medical check-up. The test showed marked dysplasia of cervical cells but no sign of infection.             1. Discuss the purposes and uses of diagnostic testing and how it applies in this scenario                                                                                              2.Discuss how the following terms might apply to this       scenario: prognosis, latent stage, remission, exacerbations, predisposing factors                      3.Compare and contrast the various types of common cellular adaptions focusing on dysplasia and the testing for the condition.                     Question2, MRS A's baby girl, Baby C, who is 3 months old,has had severe watery diarrhea accompanied by fever for 24hours, she is apathetic and responds weakly to stimulation, the condition has been diagnosed as viral gastroenteritis question A) list the major losses resulting from diarrhea and fever. question)list other signs and data that…

Female, 26 years old, married. Abdominal pain, diarrhea, fever, vomiting for 20 hours After 24 hours of eating, the patient developed abdominal discomfort, paroxysmal with nausea, vomiting stomach contents, fever and diarrhea several times, loose stools, no pus and blood, body temperature 37-38.5°C, come to our hospital for emergency, the routine test of stool was negative. She was treated according to "acute gastroenteritis". The abdominal pain worsened in the evening, accompanied by fever of 38.6°C. Then, the abdominal pain moved from the stomach to the right lower abdomen, and there was still diarrhea, she come to see a doctor again at night, check blood routine WBC21×10%/L, and be admitted to the hospital urgently. Previous history: healthy, no history of drug allergy. Physical examination: T38.7°C, P120/min, BP 100/70mmHg, no bleeding spots and rashes on the skin all over the body, no large superficial lymph nodes, no pallor of the conjunctiva, no yellow staining of the sclera,…

explain reasons for IV therapy -unconcious -nil by mouth -only route emergency

Lin, a 5-year-11-month-boy. He-had a fever 20 days ago with no obvious trigger and reached the highest oral- temperature of- 40°C, no obvious cough, runny nose, vomiting, headache, dizziness, melena, urinary frequency, urgency, and dysuria but had nose bleeding. He visited a local hospital and-underwent a blood routine test: WBC=8.7X10°L, N=21%, RBC= 3.36X10%/L, BPC=75X 10°/L, Hb=109g/L; peripheral -blood smear shows: atypical cells 29%. The local hospital suspected "infectious mononucleosis", thus intravenous ganciclovir was given and his blood was extracted to check for anti-EBV antibody simultaneously. After 6-days of intravenous ganciclovir, his body temperature still fluctuated at around: 38°C. Anti-EBVVCA-IgM(-), anti-VCA-IgG(+) 1. Do you think the doctor's diagnosis is correct? And what do you think the next step would the doctor take? 2. How long does a normal fever and infectious fever last?

15 year old African American male presents with his mother to the ER where you are the physician assistant helping the ER attending in a very busy rural hospital.  He is complaining of abdominal pain for one day and nausea with vomiting.  His mother reports a fever and malaise.  He has no significant medical history but his mother is concerned that he may have the "kissing disease" as he has a boy friend who had mononucleosis six months ago and she does not approve of him anyway.    He describes the abdominal pain as sharp and points to his umbilical region.  He ranks it 10/10 on a 1-10 scale at its worse and he says it gets worse with sudden movements or if he sits up too quick or laughs.  He is not on any medications and his vital signs are normal except for a temperature of 101 degrees Fahrenheit.  On examination he looks sick and his skin is clammy to the touch.  Heart and lung examination is unremarkable.  Abdominal examination shows good bowel sounds and umbilical tenderness and…

5 year old African American male presents with his mother to the ER where you are the physician assistant helping the ER attending in a very busy rural hospital.  He is complaining of abdominal pain for one day and nausea with vomiting.  His mother reports a fever and malaise.  He has no significant medical history but his mother is concerned that he may have the "kissing disease" as he has a boy friend who had mononucleosis six months ago and she does not approve of him anyway.    He describes the abdominal pain as sharp and points to his umbilical region.  He ranks it 10/10 on a 1-10 scale at its worse and he says it gets worse with sudden movements or if he sits up too quick or laughs.  He is not on any medications and his vital signs are normal except for a temperature of 101 degrees Fahrenheit.  On examination he looks sick and his skin is clammy to the touch.  Heart and lung examination is unremarkable.  Abdominal examination shows good bowel sounds and umbilical tenderness and…

Case 1 A 20-year-old man presents for evaluation of a rash that he thinks is an allergic reaction. For the past 4 or 5 days, he has had the "flu," with fever, chills headache, and body aches. He has been taking an over-the-counter flu medication without any symptomatic relief. Yesterday he developed a diffuse rash made up of red, slightly raised bumps. It covers his whole body, and he says that it must be an allergic reaction to the flu medication. He has no history of allergies and takes no other medications, and his only medical problem in the past was being treated for gonorrhoea approximately 2 years ago. On further questioning, he denies dysuria or penile discharge. He denies any genital lesions now but says that he had a "sore" on his penis a few months ago that never really hurt and went away on its own after a few weeks so he didn't think much about it. On exam, his vital signs are all normal. He has palpable cervical, axillary, and inguinal adenopathy. His skin has an…

Lin, a 5-year-11-month boy. He had a fever 20 days ago with no-obvious trigger and reached- the highest oral temperature of 40°C, no obvious cough, runny nose, vomiting. headache. dizziness, melena, urinary frequency, urgency, and dysuria but had nose bleeding. He visited a local hospital and underwent a blood-routine test: WBC 8.7X 10°/L. N 21%. RBC 3.36X 10/L. BPC 75 X 10°L, Hb 109g/L; peripheral blood smear shows: atypical cells 29%. The local hospital suspected "infectious mononucleosis", thus intravenous ganciclovir was given and his blood was extracted to check for anti-EBV antibody simultaneously. 1.- What are the main symptoms found on this patient? According to the patient's history and- presentations, what are the probable issues that you will need to think of?

Ati Active templete Nursing Skill Managing a complication of IV Vancomycin Therapy

A 62-year old, recently widowed male Hispanic patient, KB. was brought in to the emergency department (ED) by his daughter for progressively worsening shortness of breath, fatigue, a lingering non-productive cough, and generalized edema. One month prior, he noticed dyspnea upon exertion, loss of appetite, nausea, vomiting and malaise, which he attributed to the flu. In the emergency department, he appeared anxious and pale, and had a dry yellow tint to the skin. He denied any chest pain, and he could not recall the last time he urinated. He has history of benign prostatic hyperplasia, diabetes mellitus type 2, hypertension, dyslipidemia, and renal insufficiency for the past two years. His ED assessment findings included: 1+ pedal edema, basilar crackles in the lungs bilaterally, and a scant amount of urine according to a bladder scan. His lab results indicated a glomerular filtration rate (GFR) of 12. Based on his subjective and objective symptoms, he was admitted with a diagnosis of…

A 62-year old, recently widowed male Hispanic patient, KB. was brought in to the emergency department (ED) by his daughter for progressively worsening shortness of breath, fatigue, a lingering non-productive cough, and generalized edema. One month prior, he noticed dyspnea upon exertion, loss of appetite, nausea, vomiting and malaise, which he attributed to the flu. In the emergency department, he appeared anxious and pale, and had a dry yellow tint to the skin. He denied any chest pain, and he could not recall the last time he urinated. He has history of benign prostatic hyperplasia, diabetes mellitus type 2, hypertension, dyslipidemia, and renal insufficiency for the past two years. His ED assessment findings included: 1+ pedal edema, basilar crackles in the lungs bilaterally, and a scant amount of urine according to a bladder scan. His lab results indicated a glomerular filtration rate (GFR) of 12. Based on his subjective and objective symptoms, he was admitted with a diagnosis of…

Give 3 cases each category in levels of care, (minimal, moderate/immediate care, total or intensive care, highly specialized/critical care) The cases could be descritive or medical diagnosis

a 58-year-old Asian male .He visited his physician because  he noticed dark colored lesions on his inner thighs,  have increased in number, size. For the last three months he has been feeling weaker and more fatigued than usual; his weight dropped from 170 to 155 pounds. Xin’s blood was drawn and testing was conducted. His hematocrit was 45% and white-blood cell count was 2,500 white-blood cells/mm3, with the differential showing neutrophils 65%, lymphocytes 25%, monocytes 10%. A biopsy was taken of one of the discolored lesions and grown in cell culture. After three days of growth the cells were confirmed as coming from malignant cancerous tissue. A magnetic resonance image (MRI) of the area around the skin lesions on Xin’s inner thigh revealed enlarged lymph nodes, a sign of potential metastasis.  What possible Diagnosis or disorders can you rule out for this paitent