Chamberlain College of Nursing - NURSING NR603 week 5 part 1 predictor/Already Graded A

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Week 5 predictor ass Dr Martin and Class, Chief Complaint – upper abdominal pain and feeling sick Demographics - 40 yo Caucasian female PMHx – Hypothyroidism, seasonal allergies (worse in fall... ) PSHx – appendicitis as a teen, C-section x 2, Home Meds Levothyroxine 100mcg PO daily - compliant Loratadine 10 mg PO prn Tylenol 1000mg PO prn (taking BID x 7 days) Allergies - PCN (unknown reaction, as a child), bees, strawberries Immunizations – received all childhood vaccines, receives annual influenza vaccine, tdap 2018 after laceration repair, did not receive vaccines prior to South America trip, unsure of hepatitis B vaccine status Lifestyle  employed in sales with daily local travel, eats at restaurants with clients several times/week  traveled to South America for 2 weeks about a month ago  recently divorced, 1 new sex partners, sexual interest men  former smoker – 4 years in early 20’s ½ PPD  ETOH 2 glasses wine/night, 2 time/week out with friends and drinks 5+ drinks  denies any illicit drug use  Usually participates in exercise classes 3/wk but has not gone in 2 weeks b/c pain is worse with jumping and quick movements. HPI – 10 days ago URQ abdominal pain with fatigue, decreased appetite, body aches and nausea. Noticed very dark urine and slightly yellow eyes 2 days ago. Pain is constant and not related to food intake. Has been taking Tylenol 1000mg BID for 5 days, to help with body aches, it has not improved. Pain is a deep dull ache, 6/10 that is worse with any jarring movements. This study source was downloaded by 100000831988016 from CourseHero.com on 04-19-2022 08:55:13 GMT -05:00 https://www.coursehero.com/file/64804497/nr603-week-5-part-1-predictor-docx/ Associated risk factors/demographics that contribute to the chief complaint and differential diagnoses Female gender Age – 40 BMI -overweight Unknown hepatitis B vaccine status Recent travel out of country without travel vaccines Frequent restaurant meals Tylenol use Alcohol use New sexual partner ROS Constitutional: + body aches, + decreased appetite - chills, - fever Skin: - itching, - color changes, - rash, - bruising HEENT: +sclera slightly yellow Respiratory: -SOB, -cough Cardiovascular: -CP, -edema Neurological: -dizziness, -HA, -syncope Musculoskeletal: +myalgia -swelling GI/GU: +URQ abd pain, +nausea, + heartburn, +dark colored urine - diarrhea, -constipation, - stool changes, -vomiting, - bloody stool, -dysuria, - urinary frequency Psychiatric: - anxiety, - depression, - increased stress PE Height 5'3", Weight 156 pounds, BMI 27.6 (overweight) This study source was downloaded by 100000831988016 from CourseHero.com on 04-19-2022 08:55:13 GMT -05:00 https://www.coursehero.com/file/64804497/nr603-week-5-part-1-predictor-docx/ Vital signs : BP 119/62, T 99.8, P 93, R 18 Sao2 98% on RA PE: General: 40-year-old Caucasian female appears stated. Alert, oriented, and cooperative, speaks in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color has slight yellow tone, no cyanosis or pallor. HEENT: Normo-cephalic Eyes: sclera mildly jaundice bilaterally, without injection or discharge Ears: TM pearly gray Nose: Nares patent, no drainage Throat: pink and moist, tonsils 1+ without exudate. Tongue pink and dry. Teeth intact Lungs: BBS=clr, equal BL chest expansion with no retraction CV: S1 and S2 clear, RRR, no M/R, PP +2 x 4 ext, no edema Abdomen: Abdomen round, soft and not distended, bowel sounds +x 4Q, tender to palpation in RUQ with palpable liver below right costal margin, unable to palpate spleen DDx Viral Hepatitis – Viral hepatitis is a viral infection and can have several origins including Hep A, Heb B and Hep C, which are the most common in the US. There are also Hep D and Hep E which are less common in the US but must be considered in some travelers. Hep A is a fecal-oral contamination spread condition, it does not produce a chronic state and has been increasing in the US in isolated outbreaks some related to food service (Goroll & Mulley, 2014; Kwo et al., 2017). Hep B is spread by direct contact with body fluids, primarily blood, is seen in MSM, injectable drug users, those with multiple sex partners and occupations with a risk of direct exposure and is decreasing in the US due to vaccination (Hektor et al., 2019). Hep C is spread from direct injection and is most commonly associated with blood transfusion, which is eliminated due to screening, and needle sharing among drug users (Goroll & Mulley, 2014). The clinical presentation of hepatitis initially begins with prodromal symptoms such as fatigue, malaise, and abdominal pain and can include fever and chills, although many patients may be asymptomatic. With the progression of disease, the abdominal pain increases with nausea, vomiting and can present with jaundice, dark urine and pale stool. ALT and AST are elevated, as may be with WBC, there may also be an elevated bilirubin level in blood and presence in urine and alk This study source was downloaded by 100000831988016 from CourseHero.com on 04-19-2022 08:55:13 GMT -05:00 https://www.coursehero.com/file/64804497/nr603-week-5-part-1-predictor-docx/ phos level may or [Show More]

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