NUR 807 Case Study by Allyson Dean https://padlet.com/degrawal/Hematology Hematology Part 1 en-us 2019-06-24 22:02:39 UTC 2023-04-06 23:21:17 UTC hello@padlet.com https://imgglb.padletcdn.com/v13/image?t=g_auto&url=https%3A%2F%2Fpadlet.net%2Ficons%2Fpng%2F1f469-2695.png Meet J.W. degrawal https://padlet.com/degrawal/Hematology/wish/369028570 86 year-old female that came to the ER on 6/9/19 with complaints of shortness of breath that had gradually worsened over 3-4 days.  

She always experiences some shortness of breath and fatigue, however this episode was worse than what she normally experiences. ]]> 2019-06-25 01:10:59 UTC https://padlet.com/degrawal/Hematology/wish/369028570 Review of Systems on June 12, 2019 degrawal https://padlet.com/degrawal/Hematology/wish/369028763 J.W. complains of:
  • BLE swelling
  • dizziness and lightheadedness upon standing 
  • fatigue
  • nocturia
  • RLE weakness, state she is not able to put any weight on her right leg due to it feeling “like it is going to give out,” but denies it being painful.   

Fell within the last year at assisted living facility after using the bathroom  

Denies any pain, fever, chills, headaches, or nausea/vomiting
]]> 2019-06-25 01:13:04 UTC https://padlet.com/degrawal/Hematology/wish/369028763 Significant History degrawal https://padlet.com/degrawal/Hematology/wish/369035095
  • coronary artery disease
  • hypertension
  • Non-ST elevation myocardial infarction (April 2019)
  • hyperlipidemia
  • left lower extremity deep vein thrombosis
  • depression
  • cerebrovascular accident
  • right hip arthroplasty (March 2019)
  • denies a history of smoking 
  • widow and lives at an assisted living facility
  • 2 sons - one lives 45 minutes away and other lives out of state
  • enjoys participating in activities but fatigue and leg weakness prevent her from participating as often as she would like
    • ]]>     2019-06-25 02:07:28 UTC https://padlet.com/degrawal/Hematology/wish/369035095     What are potential differential diagnoses? degrawal https://padlet.com/degrawal/Hematology/wish/369684485 Please write them in the comments below. ]]> 2019-06-30 00:33:15 UTC https://padlet.com/degrawal/Hematology/wish/369684485 Focused Assessment on June 12, 2019 degrawal https://padlet.com/degrawal/Hematology/wish/369685280 Alert and oriented to person, place, and time
    Vital signs: 98.3 F, 90bpm, 116/65, 25, 97% on 3L/NC.  
        
    Respirations regular, moderate depth, and slightly labored on 3 liters of humidified supplemental oxygen.  Respirations increase and become more labored during conversation and after transferring to bedside commode.  Lung sounds course and diminished throughout.
     
    Patient denies chest pain, palpitations, and dizziness at this time. No lifts, heaves, or thrills.  Apical rate 92 and irregular.  S1 and S2 audible but faint.  Telemetry rhythm is sinus arrythmia with occasional PVC’s and PAC’s. 

    Skin is pale with light pink undertones throughout.  Small ecchymosis spots scattered over arms and legs.  Capillary refill brisk in bilateral upper and lower extremities.  2+/4+ pitting edema in bilateral feet and ankles.  

    Poster erect, bilateral upper extremity grip strength and against resistance 5/5, right lower extremity strength against resistance 4/5 and left lower extremity strength against resistance 5/5.  She is able to stand and transfer with one person assist. 
    ]]>     2019-06-30 01:02:44 UTC https://padlet.com/degrawal/Hematology/wish/369685280     Labs degrawal https://padlet.com/degrawal/Hematology/wish/369685567 2019-06-30 01:12:34 UTC https://padlet.com/degrawal/Hematology/wish/369685567 What are you thinking now? degrawal https://padlet.com/degrawal/Hematology/wish/369686092 What concerns do you have?  Any hematology concerns?]]> 2019-06-30 01:26:09 UTC https://padlet.com/degrawal/Hematology/wish/369686092 Have you narrowed down your differential diagnoses? degrawal https://padlet.com/degrawal/Hematology/wish/370032754 What are additional information would you like to know?]]> 2019-07-03 03:07:12 UTC https://padlet.com/degrawal/Hematology/wish/370032754 degrawal https://padlet.com/degrawal/Hematology/wish/370035883 2019-07-03 03:36:54 UTC https://padlet.com/degrawal/Hematology/wish/370035883 degrawal https://padlet.com/degrawal/Hematology/wish/422541609 2019-12-11 03:00:44 UTC https://padlet.com/degrawal/Hematology/wish/422541609