Nr 603 Week 7 Case Study Discussion, Ra And Oa|Verified Solution 2022

NR 603 Week 7 Case Study Discussion, RA and OA Subjective: CC: Laura says, “I feel so bad, been this way for a few weeks. I thought it was the flu but it has lasted so long. I have not had a fever, but I have been nauseous. Now I noticed my skin color has a funny tinge to it.” HPI: Onset: 3 weeks ago Location: GI Duration: 3 weeks Characteristics: flu like symptoms, nauseous, skin color funny tinge, decreased appetite, lost 5 pounds, muscle aches and stomach cramps. Aggravating factors: no information given Relieving factors: ibuprofen helps for the muscle aches and stomach cramps Treatment: ibuprofen Severity: decreased appetite, nausea for about 3 weeks, lost 5 pounds and skin color has funny tinge. Extra information: Laura reports decreased appetite and nausea for about 3 weeks. She states she has lost 5 pounds. She reports some muscle aches and has stomach cramps. She has taken Ibuprofen for the aches and pains but no other OTC medications. PMHx: Reports general health as good. Was exercising regularly and very active until onset of these symptoms. Childhood/previous illnesses: chicken pox Chronic illnesses: None Surgeries: cholecystectomy, total abdominal hysterectomy Hospitalizations: childbirth x 2 Immunizations: Does not receive the flu shot. Allergies: Penicillin (rash) Blood transfusions: None ETOH, tobacco, illicit drugs. She drinks alcohol socially, does not smoke, denies illicit drug use. Sleeps 6 to 8 hours per night. Current medications: daily multivitamin, fish oil, and CoQ 10 Social Hx: Divorced for 2 years, dating for 1 year. She is sexually active with 2 partners in the last 6 months. Does not use condoms, had a BTL 10 years ago. Family Hx: Parents are alive in good health. She has 2 daughters in good health. What further questions do you have for Laura at this visit? ROS: Constitutional: Have you felt any fatigue, night sweats, any low grade temps, chills? If yes, when did it occur and what makes it better or worse and what did you do for it? (Hep A, C, pancreatic cancer and liver abscess) Cardiac: Have you felt your heart palpitate, race when your pain increases or chest pain? GI: You state you have felt nauseous for 3 weeks now, did you notice this happening after eating somewhere like a fast food restaurant? Did you eat raw oysters? Have you drunk water out of lake recently? Have you been exposed to eating foods where people might not wash their hands thoroughly? Are you able to go to rest room? If you have bowel movement? What color is your stool? (Hep A, C and liver abscess) Abdomen: Have you ever felt this type of abdominal pain before? When and what brought it upon and what did you do for it? What make it feel better or worse? (Hep A, C, pancreatic cancer and liver abscess) Does it hurt to touch your abdomen? What position makes your abdomen feel better? What is your pain level? Describe: shooting, tingling, stabbing, shooting pain? 0/10 10 being the worst pain ever? Skin: How long have you noticed your skin change? Has this ever happened to you before? (Hep A, C, pancreatic cancer and liver abscess) Immunity: Have you ever been vaccinated against hep A? If yes, when? If not why? (Hep A, C) Based on your differential diagnoses list, identify what body systems you’d examine along with pertinent positive/negatives in each system Objective: PE: Constitutional: PE: VS : Height 5 feet 9 inches. Weight 150 pounds BP 126/76. T 98.0, P 72, R 12 General: Caucasian female in no apparent distress, appears stated age. Alert, oriented and cooperative, appears fatigued. Skin: Skin warm, dry, and intact. Skin color is slightly jaundiced. No moles noted. No track marks noted. HEENT: Head normocephalic. Hair thick and distribution even throughout scalp Eyes: .Sclera clear. Conjunctiva: icteric, PERRLA, EOMs intact Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender Nose: Nares patent without exudate. Sinuses nontender to palpation Throat: Oropharynx moist, no lesions or exudate. Tonsils one fourth bilaterally. Teeth in good repair, no cavities noted. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small, and firm without palpable masses. Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Recent tattoo noted to lower back. CV: Heart S1 and S2 noted, RRR, no murmurs, noted. Peripheral pulses equally bilaterally. Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organomegaly noted. Mild tenderness noted in right upper quadrant. No CVAT. Labs: HbsAg- negative HbsAb - positive HbcAb - positive Amylase- normal Lipase- normal ALT- Normal AST- Normal What is your differential diagnosis list for this visit thus far with rationale? Assessment: 1. Hepatitis A without hepatic coma ICD 10 code: B15.9- is a single-stranded, positive- sense, linear RNA enterovirus of the Picornaviridae family. In humans, viral replication depends on hepatocyte uptake and synthesis, and assembly occurs exclusively in the liver cells (Matheny & Kinergy, 2012). S/S: Prodrome phase: patients may have mild flulike symptoms of anorexia, nausea and vomiting, fatigue, malaise, low-grade fever (usually 39.5°C), myalgia, and mild headache. In the icteric phase, dark urine appears first (bilirubinuria). Pale stool soon follows, although this is not universal. Arthralgia and rash may occur as well (Matheny & Kinergy, 2012). Rationale: decreased appetite and nausea for about 3 weeks. She states she has lost 5 pounds. She reports some muscle aches and has stomach cramps. She has taken Ibuprofen for the aches and pains but no other OTC medications. Funny tinge skin and flu like symptoms. 2. Abscess of liver ICD 10 code: K75.0 A bacterial, parasitic, or fungal abscess that develops in the liver. It is usually the result of an abdominal infection, trauma, or surgery in the right upper quadrant (Cartwright & Knudson, 2015). S/S: abdominal pain, nausea, vomiting, jaundice and fever may or may not be present (Cartwright & Knudson, 2015). Rationale: decreased appetite and nausea for about 3 weeks. She states she has lost 5 pounds. She reports some muscle aches and has stomach cramps. She has taken Ibuprofen for the aches and pains but no other OTC medications. Funny tinge skin and flu like symptoms. 3. Acute pancreatitis, unspecified ICD- 10 code: K85.9 An acute inflammatory process that leads to necrosis of the pancreatic parenchyma (Quinlan, 2014). S/S: weight loss, anorexia, malaise, nausea, fatigue, and midepigastric or back pain. Midepigastric pain is a common symptom of pancreatic cancer, with radiation of the pain to the midback or lower-back region sometimes occurring and jaundice (Quinlan, 2014). Rationale: decreased appetite and nausea for about 3 weeks. She states she has lost 5 pounds. She reports some muscle aches and has stomach cramps. She has taken Ibuprofen for the aches and pains but no other OTC medications. Funny tinge skin and flu like symptoms. 4. Unspecified viral hepatitis C without hepatic coma ICD-10 code: B19.20 (HCV) infection, a major cause of chronic liver disease and cirrhosis, is predominantly transmitted by exposure to blood or body fluids (Wilkins, Akhtar, Gititu, Jalluri & Ramirez, 2015). S/S: fever, fatigue, poor appetite, nausea, vomiting, stomach pain, joint or muscle pain, yellowing of skin and eyes (Wilkins, Akhtar, Gititu, Jalluri & Ramirez, 2015). Rationale: decreased appetite and nausea for about 3 weeks. She states she has lost 5 pounds. She reports some muscle aches and has stomach cramps. She has taken Ibuprofen for the aches and pains but no other OTC medications. Funny tinge skin and flu like symptoms. Sexually active with 2 partners. Diagnostic tests you would like to perform? Plan: * CT of abdomen: (liver abscess, abdominal pain s/s, acute pancreatitis) (Cartwright & Knudson, 2015). *serum immunoglobulin M (IgM) anti-HAV antibodies (Hep A) *anti-HCV antibody test is recommended to screen for HCV infection (Hep C) (Wilkins, Akhtar, Gititu, Jalluri & Ramirez, 2015). *complete blood count; a comprehensive metabolic panel including renal and hepatic function; urinalysis; and measurement of lipase, calcium, lactate dehydrogenase, and triglyceride levels (Pancreatitis) (Quinlan, 2014). References: Cartwright, S. L., & Knudson, M. P. (2015). Diagnostic imaging of acute abdominal pain in adults. American Family Physician, 91(7), 452-459. Retrieved from Matheny, S. C., & Kinergy, J. E. (2012). Hepatitis A. American Family Physician, 86(11), 1027. Retrieved from Wilkins, T., Akhtar, M., Gititu, E., Jalluri, C., & Ramirez, J. (2015). Diagnosis and Management of Hepatitis C. American Family Physician, . Retrieved from Quinlan, J. D. (2014). Acute pancreatitis. American Family Physician, 90(9), 632-639. Retrieved from