Thank you very much for referring Glenys along for further investigation of the abnormalities detected on the CT scan of her chest which was done for investigation of night sweats. As you have mentioned, she has seronegative rheumatoid arthritis for which she is normally on prednisolone, methotrexate and Arava, but the methotrexate and Arava have been stopped recently due to an elevated liver function test.
The CT scan of her chest, abdomen and pelvis did not reveal any cause for her night sweats but did reveal the presence of mild, mid and upper lung paraseptal emphysema with some non-specific scarring in the basal segment of the right lower lobe basal lingula and anterior basal left lower lobe. There were multiple scattered small irregular cysts elsewhere throughout the lung. Alongside this, there were also two small pulmonary nodules in the right middle lobe and right lower lobe which were 3mm.
Glenys is a heavy smoker who quit one week ago, after the
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He chest was clear, peripherally there was no clubbing and she was saturating at 97% on room air. Examination of her cardiovascular system revealed soft heart sounds. I could not appreciate any murmurs and there was no evidence of cardiac failure.
Impression/Management:
The mild to moderate emphysema is an expected find with her smoking history. It appears that she seems relatively asymptomatic, but we will perform some lung function tests to see whether or not she does have underlying COPD. The pulmonary nodules are non-specific but given her smoking history, she will warrant a further CT scan in three months ' time to assess for stability. We will organise this at our next appointment.
With regards to her likely obstructive sleep apnoea, we will organise a sleep study at La Trobe Private Sleep Centre and I will see her following this with some lug function test to discuss the results and management moving
Al Waysmoking was a 72 year-old retired factory worker who was a chain smoker. He is experiencing fatigue, shortness of breath, but continues to smoke. Upon exam his Nurse Practitioner notes that he has a prolonged expiratory phase, expiratory wheezes, and an increased anteroposterior chest diameter. His nail beds were cyanotic and he had moderate pitting edema. Pulmonary Function Testing (PFT) revealed that Al had a decreased VC and an increased RV and FRC.
Thank you for reviewing Ronald Cocks, an 89 year old gentleman with an array of medical comorbidities. Ronald has a history of prior asbestos exposure and is an ex-smoker of approximately 20 pack years. He is quite frail, although still ambulates independently with a 4-wheel frame and is currently living at a retirement village. Ronald was referred to me just prior to Christmas with a two month history of sudden onset voice hoarseness. He was noted to have a 4.5cm left upper lobe cavitatory mass in close proximity to the left upper lobe pulmonary arteries and abutting the left upper lobe pleura.
Gait Markedly antalgic. Equivocal Romberg. DTRs 2+ in the upper extremities and knees, trace at the ankles. Labs/Studies CAT scan and C-spine are as noted
2. Explain the functions of the respiratory system. Cite the definitions and the differences between external and internal respiration. The respiratory system is responsible for bow we intake air into our bodies and out.
Case 3 Part A Mr. Chapman is a forty-six year old man, and he has been receiving home-based hospice care, for the past three weeks. Mr. Chapman is an avid smoker, who has smoked two to three packs of unfiltered cigarettes for thirty years. Currently, he is experiencing wheezing, fatigue, weakness, poor endurance, and frequent coughing spasm. He is consistently losing weight, and he can only swallow clear soup and a few sips of water.
5. Approach to the diagnosis. 5.1. Is it cardiac or not? 5.2.
2012). An anticholinergic nebulizer, ipratropium was given to mrs.Smith as per the order which helped to reduce dyspnea and cough slightly. Her Early warning score still remains 6. On detailed examination, Ed doctor suspected mrs.Smith may be having heart failure. ECG done on her which shows sinus tachycardia.
Some of the early signs and symptoms of lung cancer are a persistent cough, shortness of breath, bloody sputum, loss of appetite, and unintentional weight loss. Recognizing these signs and symptoms gives a better chance for diagnosing lung cancer at an early stage when the treatment is more effective than in later stages (Ohio Department of Health, 2010). Sometimes it is harder to recognize the sign and symptoms in smokers than non-smokers due to already having chronic coughing or hoarseness due to smoking. Having regular follow-up with a physician may help to diagnose the lung disease or lung cancer at an early
He says he used to smoke up to an ounce in a week and feel proud of himself. Later, he realized he didn’t want to live a stoned life and decided to quit for
As a result, these patients can’t bring the carbon dioxide out, they become retain the carbon dioxide which makes it so hard for them to breathe
Review of Symptoms General: denies fever, night sweats, significant weight gain or loss, exercise intolerance, depression, sleep disturbances, or fatigue HEENT: denies dry eyes, irritation, vision changes, difficulty hearing, ear pain, sore throat, runny nose, or sinus pressure Neck: denies swollen glands or stiff neck Pulmonary: denies cough, wheezing, or shortness of breath Cardiovascular: denies chest pain or palpitations Gastrointestinal: denies abdominal pain, nausea, vomiting, diarrhea, constipation, acid reflux, or melena Genitourinary: reports dysuria and vaginal itching, denies incontinence, hematuria, increased frequency, abnormal bleeding, or vaginal odor Musculoskeletal: denies muscle aches, weakness, joint pain, back pain, or edema Integumentary: denies any rashes, lesions, or change in hair Neurological: denies numbness, headache, seizures, tingling or sensation changes Endocrine: denies bruising, excessive sweating, thirst, hunger, heat or cold intolerance Objective Data Physical Exam Vitals: blood pressure - 130/77, heart rate - 97, respiratory rate - 17, temperature – 97.9 , oxygen saturation –97% on room air, weight – 183 pounds, height – 5 feet 4 inches, body mass index –
The patient was diagnosed for polyps and multiple diverticula at the age of 68. The Patient suffers of painful osteoarthritis of both knees, shoulder hips. Patient?s mother deceased at the age of 79 from breast cancer and her father deceased at the age of 54 from heart attack. The patient noted with bilateral lower extremities edema, and claimed that she uses 2 pillows as a comfortable position to sleep,
Also, her BMI was >30, I educated on daily exercise and healthy diet, and referred to the dietitian. For the patient with ER follow up with cough, the patient was sent home with albuterol inhaler as needed. He was using it every 4 hours for last 4 days. He was still having cough and bronchospasm. I ordered him oraphred for 5 days, drink water with honey, mucinex prn and Zyrtec daily for his pollen allergy.
She finds it very difficult to sleep more than 6 hours per
In the 1980s, Acquired Immunodeficiency Syndrome(AIDS) struck the United States and initially impacted the gay community the hardest. A homosexual man himself, Thom Gunn saw, firsthand, the effect AIDS had on the gay community when he lost many friends. An elegy to those taken too soon and an ode to those still fighting, Gunn wrote “The Man with Night Sweats.” In “The Man with Night Sweats,” Gunn utilizes tactile, visual, and kinesthetic imagery to convey the threefold progression of confusion, reflection, and helplessness those face when battling AIDS.