A 35 year old man developed increasing pain in his left thigh and a marked limp, over 3 weeks. Five years he had undergone a nephrectomy for a renal carcinoma. An isotope showed metastasis in his right lateral ribs and left femur and he had been taking sunitinib. Assuming you are the attending physician, what is the most appropriate next step in his management?
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- 35 year old white male presents to the ER with low back pain for two weeks with increasing severity. He had a normal Lumbar spine X-ray and had a normal CBC and blood chemistry. A urinalyisis was done to look for signs of nephrolithiasis and showed no white cells or red blood cells but large protein and no bacteria. He had a slight fever and was in such pain that IV morphine did not even touch it. Examination was difficult as he could not even get into a comfortable position to lessen his pain. Internet searches on the local state pain medication abuse systems did not show him to be drug seeking but the ER doctor considers him drug seeking and wants him out of his ER. You are called as the nurse practitioner helping the nighttime hospitalist admit new patients to the hospital and you are paged to consult as your physician is busy with another admission on the floor with an MI. You question this young man and find him to be in terrible pain and barely able to answer your…Mr. Jones is a 69-year-old man who was admitted to the hospital 10 days earlier with a diagnosis of acute diverticulitis. He was given intravenous fluids and empiric antibiotic coverage with ceftriaxone and metronidazole. His antibiotics were stopped after 7 days, and he continued to do well until today, when he developed abdominal pain, fever, and diarrhea. A diagnosis of Clostridium difficile colitis was made, and antibiotic treatment was initiated. Discuss the following questions: What diagnostic test would confirm the diagnosis? What risk factors did Mr. Jones have to acquire a Clostridium difficile infection? Why is oral but not intravenous vancomycin a potential treatment option for this infection? One person from each group should respond to this discussion with a link to their group’s recording and a summary of the discussion that took place.Ms. Cornwall is admitted with pyelonephritis. She has chills, and her temperature is 101°F. She is complaining of flank pain, frequency, and dysuria. Her urine has white blood cell casts, and her urine culture is growing Escherichia coli. Why does she have bacteria and white blood cell casts in her urine?
- A 45-year-old man had a 10-day history of appetite loss, flu-like symptoms, and nausea. He noticed that upon urination, his urine had been dark in color over the past 4 days. On examination, he had tenderness in his upper right quadrant of his abdomen. Laboratory tests show: Total Bilirubin- 4.5 mg/dL Direct Bilirubin- 2.5 mg/dL Indirect Bilirubin- 2.0 mg/dL 1. What is the clinical importance of the result of: a. Total Bilirubin b. Direct Bilirubin c. Indirect Bilirubin 2. What does the dark-colored urine indicate? 3. What is the diagnosis of the patient? 4. What other tests are needed to be done to support your diagnosis?Charles Christian Baletbet is a 38-year-old woman who has breast cancer. She is receiving radiation and chemotherapy. Mr. Baletbet is experiencing significant nausea and vomiting. Her physician orders ondansetron 32 mg IV to be administered 30 minutes prior to her chemotherapy and 8 to 16 mg PO every 8 hours as needed. She also receives metoclopramide 10 mg PO four times a day: 30 minutes before meals and at bedtime. The physician orders Mr. Baletbet to also receive diphenhydramine with her metoclopramide. What is the rationale for giving these two medications together?11:11 Back CASE #3DISCUSSI... Case #1 Patient is an 89 year old male admitted with Hyperkalemia, ESRD, HTN, and Bladder Cancer. Patient's past medical history includes recurrent bladder carcinoma, CVA, hernia repair and hemodyalisis. Patient was admitted due to weakness and 2 weeks of diarrhea for which he had refused to be dialyzed for 7 days. Patient lives s at home with wife and daughter who are both his healthcare surrogates. Based on patient's poor prognosis, oncologist had recommended on previous admissions that patient be made Hospice Care with comfort measures. Case #1 Cont. Daughter and wife have refused Hospice care and want patient to be dialyzed and continue aggressive treatment to include full resuscitation if cardiopulmonary arrest. Daughter and wife have requested all physicians to refrain from speaking to patient about his prognosis. At t this time all physicians have followed daughter and wife's request not let patient know that his cancer has returned, except for the…
- An Independent Nurse Prescriber needs to prescribe treatment for an uncomplicated genital chlamydial infection, due to budget constraints she needs to prescribe the cheaper regime. The two treatment choices she has are between doxycycline or azithromycin. The respective dosages are: Doxycycline 100mg bd for seven days Or Azithromycin 1g stat The doxycycline costs £2.32 for a pack of 8 100mg capsules and the azithromycin costs £8.95 for a pack of 4 250mg capsules. What would be the exact saving the nurse would make if she prescribes the cheaper regime? units £ and penceAn alert and oriented 62 y/o cliente was diagnosed with colon cancer. Surgery was recommended , and she agreed to surgical excision of the tumor.Post Op she experienced serious complication and remained at the surgical intensive care unit for 2/12. During the time she experinced cardiad failure, renal failure, temporary respiratory failure, and requiers multiple surgical preocedure. Explain the deontogical view of this ethical dilemma.A female who is 36-year-old, experienced a recent weight loss. Her tongue was red and fissured. She also complained of chronic fatigue and shortness of breath upon exertion. Physical examination suggested signs of jaundice and increased numbness and a tingling sensation of fingers and toes. She was hospitalized with the general diagnosis of moderate anemia, jaundice, and neurological symptoms. Her admitting CBC demonstrated the following laboratory results: RBC: 2.5 X 1012/L WBC: 4.5 X 109/L Hb: 10.0 g/dL Hct: 31% MCV: 124.0 fL MCH: 40.5 pg/dL MCHC: 32.7 gm/dL RDW: 21.2 PLT: 155 X109/L WBC Differential Lymphs: % 36.0 Monos: % 3.8 Neutrophils: % 59.4 Eosinophils: % 1.0 Basophils: % 0.0 NRBCs/100WBCs: 5 The blood film shows anisocytosis and Poikilocytosis in which moderate hyper-segmented neutrophils and abnormal erythrocyte morphology was reported: Macrocytes, Ovalocytes with presence of basophilic stippling and occasional Howell-Jolly bodies. Also, 50 pg/mL (Low) Folate 10.3…
- A 63-year-ol woman presented with increasing darkening of the skin, dizziness, and easy fatigability, nausea with occasional vomiting and progressive weight loss over eight months prior to presentation. There were no headaches, blurred consciousness nor change in her bowel habit. The medical history and systemic review revealed no abnormality and were not significant as to the likely cause of her disease state. Physical examination revealed an elderly lady, pale, asthenic with generalized hyperpigmentation especially on the face, oral mucosa, palmar creases and knuckles. No features of malnutrition or hypovitaminosis. vision, and neither loss of There was no significant peripheral lymphadenopathy. Main findings in the systemic examination were a pulse of 106 bpm, regular and small; blood pressure 100/60 mmHg supine and 70/40mmHg sitting. She could not stand on account of severe postural dizziness. The apex beat was normal. Fundoscopy revealed a normal fundus. All other systems were…Charles Christian Baletbet is a 38-year-old woman who has breast cancer. She is receiving radiation and chemotherapy. Mr. Baletbet is experiencing significant nausea and vomiting. Her physician orders ondansetron 32 mg IV to be administered 30 minutes prior to her chemotherapy and 8 to 16 mg PO every 8 hours as needed. She also receives metoclopramide 10 mg PO four times a day: 30 minutes before meals and at bedtime. For what adverse effects would you assess Mr. Baletbet, in relation to ondansetron?A 63-year-old woman presented with increasing darkening of the skin, dizziness, and easy fatigability, nausea with occasional vomiting and progressive weight loss over eight months prior to presentation. There were no headaches, blurred vision, and neither loss of consciousness nor change in her bowel habit. The medical history and systemic review revealed no abnormality and were not significant as to the likely cause of her disease state. Physical examination revealed an elderly lady, pale, asthenic with generalized hyperpigmentation especially on the face, oral mucosa, palmar creases and knuckles. No features of malnutrition or hypovitaminosis. There was no significant peripheral lymphadenopathy. Main findings in the systemic examination were a pulse of 106 bpm, regular and small; blood pressure 100/60 mmHg supine and 70/40mmHg sitting. She could not stand on account of severe postural dizziness. The apex beat was normal. Fundoscopy revealed a normal fundus. All other systems were…