Find and correct all93errors.Number 1-93, write what is incorrect...

Question Answered step-by-step Find and correct all93errors.Number 1-93, write what is incorrect… Find and correct all 93 errors. Number 1-93, write what is incorrect and how you would correct it. (Words of wisdom . . . print this test – or copy and paste it into Word, highlight what you know is wrong, read and reread for content. Does it make sense? Highlight as many as you can. Many times students find things that aren’t actually wrong, so more than 93 answers would be better than 93. Submit your 1-93 errors in order.) HISTORY AND PHISICAL CHEIF COMPLAINT: Shortness of breath for one to two days, worst this morning. HISTORY OF PRESENT ILLNESS: This is a 41-year-old morbidly obese male with a passed medical history of MI approximately two weeks ago. He was admitted to St. Mary’s and given blood thinners as per the patient and then later discharged in stable condition. He was also intubated for one day at that time. He also has a history of diabetes and hypertension. The patient was admitted from the emergency room today with complaints of progressively worsening episodes of shortness of breathe for the last one to two days at rest. It is relieved on its own. Orthopnia is also present. Earlier this morning around 2:00 a.m. while watching television, he again suddenly felt short of breath at rest. It did not get better and that is why he came to the hospital. Records show the patient does not usually sleep at night and this is normal for him. The patient denies any chest pain, palpitations or any leg swelling. He also gives a history of productive cough for the last one week with off and on brownish sputem but he denies any fever. PAST MEDICAL HISTORY: 1. MI two weeks ago and was intubated for one day. 2. Hypertension for two years. 3. Diabetes for two years. 4. Morbid obesity. PAST SURGICAL HISTORY: Surgery for infected left knee and hand joint. MEDICATIONS: Some of these medications were started after he was discharged from St. Mary’s one week ago:1. Ecotrin 325 mg p.o. daily. 2. Prinivil 2.5 mg p.o. daily. 3. Toprol XL 25 mg p.o. daily.4. Advair Diskus p.o. b.i.d.5. Glucophage 850 mg p.o. daily.6. Glyburide 5 mg p.o. daily. 7. Zantac 150 mg p.o. b.i.d.8. Lantus 60 units q. p.m.9. Ibuprofen 800 mg t.i.d.10. Ultram p.r.n. The patient is not taking the Lantus or Zantac because, as per the patient, he was not given a prescription for them and he did not know that he has to take them. ALERGIES: No known drug allergies. FAMILY HISTORY: Mother, Grandmother and Aunt are diabetic. His aunt had a stroke. Grandmother had heart problems. SOCIAL HISTORY: He quite smoking two weeks ago. Before that he used to smoke 1 to 1 ½ pacs per day for the last 20 years. He denies elicit drug use. He lives at home with his girlfriend. REVIEW OF SYSTEMS: CONSTITUTIONAL: No fever or chills. ENT: No earache or soar throat. CVA: No chest pain. Shortness of breath is present at rest.RESPIRATORY: Productive cough is present. GU: No diarrhea, constipation or abdominal pain. GI: Some decreased output for the past one day. SKIN: Denies any rash. PHYSICAL EXAMINATION: GENERAL: The patient is morbidly obese and is on oxygen. He does not seem to be in any acute distress. VITALS: Pulse in the ER was 111 and now is 101. Blood pressure in the ER was 159/92 and is now 112/6, O2 saturations in the ER were 88% on room air and are now 94% on two liters of oxygen via nasal canula. HEENT: Mucus membranes are moist and pink. Pupils are equal and reactive to lite. LUNGS: Supple. No masses or thyromegaly. NECK: Bilateral few scattered basilar crackles. No wheezing heard. HAERT: S1, S2 normal. Regular rate and rhythm. ABDOMEN: Obese. Ecchymotic areas on anterior abdominal wall on the right and left side of the umbilicus. (as per patient these are secondary to the subcutaneous injection that were given to him at St. Mary’s when he had the MI). The abdomen is nontender. It is very difficult to apreciated any fluid in the abdomen because he is very obese. EXTREMITIES: Pedal edema bilaterally. LABORATORY: 1. The CBC showed a hemoglobin of 13.9, white count 13.5, hematocrit 42.2. 2. The BNP showed a sodium of 139, potassium 5.2, chloride 104, bicarb 28, BUN 13, creatinine 0.6, glucose 162. 3. The first set of cardiac enzymes are negative. 4. The chest x-ray showed cardiomegaly with CHF and right pleural fusion. 5. The EKG showed a pH of 7.41, PO2 of 55, PCO2 of 40 and bicarb of 26. 6. The ABG done in the ER and they will fax the EKG to us, otherwise, we will order an EKG for him now. ASSESSMENT: 1. Chongestive heart failure and pulmonary edema, status post myocardial infarction two weeks ago. 2. Hypertension.3. Diabetes. 4. Morbid obesity. 5. Productive cough. PLAN: 1. Start the patient on a cardiac and diabetic dite. 2. We will monitor his I&Os and daily wait. 3. For diabetes we will start him on an insulin sliding scale, low dose and restart him on his home medications. We will put the Glucophage and Lantus on hold for now. Accu-Cheks q. ac and hs. 4. For his blood pressure will restart the Prinivil and Toprol. 5. We will also restart his aspirin and Zantac. 6. Hold the Advair for now and give him albuterol nebulizers p.r.n.7. We will follow the other lab work and other two sets of cardiac inzymes. 8. Chest x-ray in the morning. 9. HbA1c and fasting lipid panel in the morning. 10. Sputum colture now. 11. We will do an echocardiogram. 12. Will do a D-dimer.13. Cardiology consultation. 14. The assessment and plan has been discussed with Dr. Bradley. 15. We will follow the patient. CONSULTATION REASON FOR CONSULTATION: Hypoximia and obstructive sleep apnea. HISTORY OF PRESENT ILLNESS: This is a 41-year-old male who recently had respiratory arrest at St. Mary’s with lateral wall myocardial infarction. Regarding his morbid obesity, they could not do catheterization because the patient would not fit in the cardiac catheterization equipment. He optimized medically and was discharged on 02/28/2007. He was fine until a couple of days ago, when he started having some shortness of breath with exertion, worsening with orthopnea and also adema. At the time of admission, the patient denied any chest pain. The patient was admited for further evaluation. His EKG showed sinis rhythm with lateral ST elevation, no change from his previous EKG. Laboratory studies showed eleviation of cardiac BNP. So far, cardiac enzymes is negative. Chest x-ray showed cardiomegaly with congestive heart failure and right plural fusion, and we consulted for further evaluation. The patient is morbidly obese, and with his obstructive sleep apnea, he had a sleep study 1½ years ago. At the time of consultation, the patient denied any constitutional symptoms, any sputum, or any cough, shortness of breath, chest pain, difficulty breathing, GI, or genitourinary symptoms. PASSED MEDICAL HISTORY: Significant for morbid obesity, hypertension, diabedes, hyperlipidimia, smoking, ubstructive sleep apnea, coronary artery disease, and congestive heart failure. Recently, the patient had a myocardial infarction around 2 weeks ago, and at that time injection fraction was 25% with lateral hypokinesia, and his injection fraction improved to 45%. PAST SURGICAL HISTORY: Significant for left hand and left knee surgery for ceptic arthritis. CURRENT MEDICATION: Aspirin 325 mg daily, Advair 50/500 b.i.d., lisinopril 5 mg daily, Toprol XL 25 mg b.i.d., Glucophage 850 mg daily, Glyburide 5 mg daily, Zantac 150 mg b.i.d., Lantus 60 units q h.s. ALLERGIES: None. FAMILY HISTORY: His father has a history of myocardial infarction in her 40s. SOCIAL HISTORY: Smoker, 1½ packs for 21 years. Denied alcohol or ellicit drugs. REVIEW OF SYSTEMS: CONSTITUTIONAL: No fever, no chills.HEAD/NECK: No symptoms. CARDIAC: Negitive for chest pain or palpitations.RESPIRATORY: Positive for shortness of breath and dyspnea in exertion and orthopnea. No cough, no hemoptysis.GI: Denied heartburn, loss of appetite, or melana. No nausea, no vomiting. Vowel movements okay.GENITOURINARY: No frequency, no urgency or dysuria.NEUROLOGIC: Negative for back pain or joint pain.MUSKULOSKELETAL: Negative for dizziness, lightheadedness, numbness, tingling, or weakness. PHYSICAL EXAMINATION: GENERAL: Morbidly obese, no distress. VITAL SIGNS: Stable. Temperature 197, pulse 104, respiratory rate 22, blood pressure 115/46, O2 saturation 92% with 5 liters oxygen. HEAD/NECK: Head atramatic, normal cephalic. Sclera anicteric, conjunctiva not injected, extraocular movements intact, PERRLA. Oral and nasal mucosa moiste and pink. Neck supple, no lymphadenopathy. LUNGS: Positive for bibasillar crackles. Good air movement. ABDOMEN: Morbidly obese, benign, no tenderness, not distended, no organomegaly. Ball sounds positive. EXTREMITIES: No clubbing or cyanosis, +3 edema bilaterally in the lower extremities. SKIN: Intact. LABS: Chest x-ray showed improving consolidation and effusion in the right lower lung laterally and also improving atelectagia in the right midlung with cardiamegaly. Lipid panel – tryglycerides 159, cholesterol 165, HDL 24.6, LDL 109. TSH is normal. CBC – WBC 17.1, hemoglobin 13.6, hematocrit 41.7 with 84% segmentation. ASSESSMENT/RECOMMENDATIONS: 41-year-old with recent history of respiratory arrest and myocardial infarction and congestive heart failure status post MI with extremely obstructive sleep apnea. Chest x-ray also was positive for congestive heart failure, his hypoxia contributing with +/- mild cor pulmonal. We recommend continuing diurisis, and also definitely the patient will benefit from losing weight. We are treating his sleep apnea at night with SEEPAP. Thank you very much for the consultation. We will follow the patient clinicaly. DISCHARGE SUMMARY FINAL DIAGNOSIS:1. New onset of congestive heart failure. 2. Coronary artery disease. 3. Two weeks ago, the patient had a lateral wall myocardial infarction.4. Hypertension.5. Diabetis melitus.6. Severe obstructive sleep apnea. 7. Morbid obesity.8. Dyslipidemia. DISCHARGE MEDICATIONS: Lasix 40 mg 1 p.o. daily, Lisinopril 5 mg p.o. daily, Toprol XL 25 mg p.o. daily, Glucophage 850 mg p.o. b.i.d., Glyburide 5 mg p.o. daily, Zantac 150 mg p.o. twice a day, nitroglycerin 0.4 mg p.o. sublingal chest pain, Zocor 40 mg p.o. q h.s., potassium 10 mEq p.o. daily. The patient is a 41-year-old morbidly obese male with a past medical history of hypertension, dyslipidemia, diabetes mellitus, and myocardial infarction two weeks ago who presented to Decatur Memorial Hospital Emergency Department with a compliant of progressively decreasing shortness of breath. According to the patient, he started having shortness of breath two days ago which got worse over the night and he couldn’t breathe. The patient came to Decatur Memorial Hospital. Two weeks ago at St. Mary’s, the patient was admitted for chest pain. The patient’s cardiac enzymes were elevated and on electrocardiogram, he had a lateral wall myocardial infarction. A cardiac cathaterization was not done because of the patient’s body habitus. The patient was treated medically. This patient was intubated for one day at St. Mary’s. In the emergency room, the patient’s initial lab work was ordered. Complete blood count showed a hemaglobin of 11.3, hemacrit 14.2, white blood cells 13.5. BMP – sodium 139, potassium 5.2, chloride 104, bicarb 28, BUN 13, creatinine 0.7, glucose 162. First set of cardiac enzymes were negative. Chest x-ray showed cardiomegaly with congestive heart failure and right-sided plural fusion. ABGs were done and showed a pH of 7.41, oxygen 55, carbon dioxide 40, bicarb 26. Electrocardiogram was unchanged from prior study. The patient was admitted to the entensive care unit and was started on a strick cardiac diet. Lasix was given. Cardiac enzymes were ordered. Hemoglobin A1C and lipid profile was ordered. Cardiology was consultated. He was treated with intravenous Lasix. Two-dimensional echocardiogram was ordered which showed a poor acustic window, mildly dilated left atrium, possible left bentricular dilatation, paradoxical ceptal motion noted with mildly reduced systolic function, estimated ejection fraction of 45%, trace of mitral regurgitation and trace of tricupsid regurgitation, and mild pulmonary hypertension. Repeat electrocardiogram showed normal sinus rhythm. Normal electrocardiogram. Pulmonary was also consulted and they think the patient’s hypoxia is due to congestive heart failure. They also recommend diuresis. At home, the patient was on CPAP, so they continued his CEPAP with a pressure of 70. On the following day, the patient started getting better. Repeat B&P came down as the patient started feeling better. At the time of discharge, the patient’s condition was stable. The patient was discharged home on the above medications. Follow-up with Dr. Arain in one week. See cardiologist in one month. Follow-up with pulmonology in one month. Hemoglobin A1C in three months. B&P in one week. Okay to discharge home. Diet – diabetic and cardiac. Activity as tolerated. Health Science Science Nursing Hit 244 Share QuestionEmailCopy link Comments (0)