Mrs. Jones, a 42-year-old, G3P3, presents with a history of…

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Question Answered step-by-step Mrs. Jones, a 42-year-old, G3P3, presents with a history of… Mrs. Jones, a 42-year-old, G3P3, presents with a history of abnormal bleeding and pelvic pain. She was well until approximately age 35, when she began developing dysmenorrhea and progressive menorrhagia. The dysmenorrhea was not fully relieved by NSAIDs. Over the next several years, the dysmenorrhea and menorrhagia became more severe. She then developed intermenstrual bleeding and spotting as well as pelvic pain, which she describes as a constant feeling of pressure. She also complains of urinary frequency. Her past GYN history is negative. Her surgical history includes 3 C-sections and a bilateral tubal ligation at age 30. Her past medical history is unremarkable. Her physical exam reveals a well-developed, well-nourished woman in no distress. Vital signs and general physical exam are unremarkable. Her abdominal exam reveals an irregular-sized mass extending halfway between the symphysis pubis and umbilicus deviated to the right of the midline. The vagina and cervix appear normal on inspection. However, the cervix palpates firm. The uterus is markedly enlarged and irregular, especially on the right side. The adnexae are not palpable. Labs drawn: Hgb. 10.3 Hct. 31.2%. Indices are hypochromic, microcytic. Serum ferritin confirms mild iron deficiency anemia. Pap test is negative and an ultrasound reveals multiple large intramural fibroids, filling the pelvis and extending into the lower abdomen. The ovaries are not visualized. 1. What are the likely causes for the mass? 2. What are your differential diagnoses? What is your final diagnosis? 3. What is the prevalence of leiomyoma in different populations of women?4. Discuss the appropriate management of women with fibroids. 5. What are the indications for hysterectomy in women with fibroids? 6. What are nonsurgical treatment options for women with fibroids? Health Science Science Nursing NURS 664B Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step HPI: 25-year-old G2P1 with gestational diabetes presents to the... HPI: 25-year-old G2P1 with gestational diabetes presents to the hospital at 39 weeks forevaluation. Her diabetes, diagnosed at 25 weeks gestation, was initially controlled with diet, but she has required insulin since 32 weeks. Checks blood sugars four times a day.Past Medical History: Home insulin regimen.Physical Exam: Patient weighs 75 kgs, height is 5'0 ft. Vital signs are as follows (BP: 130/90 mmHg, T: 36.7 C, PR: 86 bpm, RR: 15 cpm) ; fetal heart tracings are good. Blood sugar is 200mg/dl. Fundus measurements appropriate. Urinalysis negative. No edema.Assessment and Plan: Gestational diabetes. Continue current care.FDAR CHARTING Time & Date   Focus  Data   Action   Response    Health Science Science Nursing BSN 122 Share QuestionEmailCopy link Comments (0)
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Question Scenario Mr. Henry, a 70-year-old man, admitted for elective right...  ScenarioMr. Henry, a 70-year-old man, admitted for elective right inguinal hernia repair. He had a right groin swelling for three-months duration. He was diagnosed with Hypertension and Type II Diabetes mellitus 20 years ago. No past surgical history. On assessment, Mr. Henry has a 4 cm by 5 cm right inguinal swelling that is reducible and non-tender on palpation and a positive cough impulse. He states that the swelling sometimes extends down into his scrotum. On admission: Temperature 37.1 0C, Pulse 80 beats/minute, Respiration 20 breaths/minute, Blood Pressure 150/92 mmHg, Oxygen saturation 99%, RBS 128 mg/dL, Height 156 cm, Weight 137.5 lbs. Mr. Henry has repeated doubts regarding surgery, and he is fearful of contracting COVID-19 while in hospital as he is yet to be vaccinated. He is also concerned about the risks involved with having surgery and his recovery period as he is a farmer. He denies any known drug or food allergies. Consent form has been signed. Patient had COVID-19 testing prior to surgery and had negative result.  Pre-Operative Plan of Care:- Admit to ward- Allow HTN and DM diet as tolerated- Supervised ambulation- Vital signs q6hrly with blood sugar monitoring- IVA, CBC, RFT's, GXM, PT, PTT, INR- CXR, ECG- Panadol 1g TDS/PRN- Nifedipine 20mg po bd- Insulin sliding scaleRBS (mg/dL)Insulin R (units)< 1500151 - 2002201 - 2504251 - 3006 301 - 350 8351 - 40010> 40012 and inform SOD - Keep NPO from midnight for surgery in the morning- IVF 2L/24hrs NS/RL once NPO- Allow patient to dry swallow of anti-hypertensive medications on morning of surgery- Informed consent signed SENARIO PROGRESSION:Mr. Henry has successfully undergone open right inguinal hernia repair with mesh under General Anesthesia. He returns to the ward drowsy but arousable and complains of feeling cold. His last vital signs from the Post Anesthesia Care Unit (PACU) are B/P 105/76, P 102, R 18 bpm and T 35.5 C.  SpO2 97% on room air, Blood Glucose 180mg/dl. His hemovac drain contains 60 ml serosanguinous fluid. Dressing to operative site is intact but a 2cm blood stain is apparent.  He has an IV in right arm infusing Lactated Ringer's at 40 gtt/min.  Mr. Henry moans softly and while transferring from the theatre trolley to his bed; he verbalizes pain 6/10 on a Pain Scale of 0-10.      Following surgery, the post-operative plan is as follows:- Keep NPO until fully awake then allow sips of clear fluids and graduate diet as tolerated- Routine post-op vital signs, then q4hrly once stable- Continue Blood glucose monitoring per routine with sliding scale insulin coverage as needed- IVF Lactated Ringer's alternate with Normal Saline 3000mls in 24 hours - Amoxicillin 1.2g IV TDS- Metronidazole 500 mg q6h- Tramadol 100 mg IV/IM and Gravol 50 mg IV/IM BD- Sterile dressing change upon discharge with normal saline- Chest physiotherapy and incentive spirometer- TED stockings- Repeat bloods -Patient to sit out in chair as soon as possible once stable QUESTION: Using the following five (5) body systems (CNS, CVS, GI, Respiratory, & Skin) explain the immediate post-operative assessment and interventions to be carried out on Mr. Henry. Give rationales for your interventions.  Health Science Science Nursing NURS 3014 Share QuestionEmailCopy link Comments (0)
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