NR 546 Week 6 Case Study Questions And
ss ss ss ss ss ss ss ss
Detailed Answers All Question Upgraded
ss ss ss ss ss
/Newest Version[Grade A+]
ss ss ss
d
HISTORY ssOF ssPRESENT ssILLNESS:
A ss37-year-old ssmale sswas ssbrought ssto ssED ssby sshis sspartner. ssThe ssclient sshas ssbeen
ssexperiencing sschest sspain ssfor ss1 ssday, ssstarting ssat ss2:00 ssa.m. ssHe ssis sstriaged ssto ssthe
ssmedical ssemergency ssdepartment. ssA ssmedical sshistory ssis sstaken. ssThe ssclient sshas ssno
sshistory ssof ssmyocardial ssinfarctions(MI) ssor sshypertension. ssThe ssclient ssis ssirritable ssand
sshypervigilant. ssHe ssrepeatedly ssasks ssthe ssnurse ssif ss“you ssknow sswhat ssyou ssare ssdoing”
ssand ssbecomes ssincreasingly ssguarded ssas ssthe ssintern ssrequests ssmore ssdetails ssabout sshis
ssmedical sshistory, ssreplying sssuspiciously, ss“you ssdon’t ssneed sstosknow ssthat.” ssHe ssdenies
ssfeeling ssdepressed ss and ss says sshe ssis ss“just ssstressed ssout.” ssHe ssis sscooperative sswith ssECG
ssbut ssis ssrestless.
The ssman’s sspartner ssasks ssif ssshe sscan ssspeak ssto ssthe ssED ssprovider ssalone ssand sssays ssthat
ssthe ssclientts ypically ssleaves sshis sswork ss as ssan ssinvestment ssbanker sson ssFriday ssnight ssand
ssdoes ssnot ssreturn sshome ssuntil ssthe ssearly ssmorning sshours sson ssSaturday, ssstays ssout sslate
ssseveral ssnights ssa ssweek, ssandshas ssgreat ssdifficulty ss going ssto sswork sson sstime ssin ssthe
ssmorning. ssOn ssthe ssweekends, sshe ssoften ss sleeps ss12-18 sshrs. ssa ssday. ssShe ssalso ssnoticed
sssome ssweight ssloss ssover ssthe sspast ssfew ssmonths.
Sometimes ssafter ssa sslate-night ssworking ssor sssocializing sswith ssco-workers, sshe ssaccuses
ssher ssof sscheating sson sshim ssor sstalking ssabout sshim ssbehind sshis ssback. ssThe sspartner
ssdenies ssthe ssclient’s ssaccusations ssand ssappears ssextremely ssconcerned. ssShe
ssacknowledges ssthat sshe sshas ssbeen ssundersincreased sspressure ssat sswork ssto ssperform ssand
ssstay sslate; ssseveral ssfriends ssat sswork sshave ssbeen sslaid ssoff ssin ssthe sspast ssyear.
PAST ssPSYCHIATRIC ssHISTORY:
The ssclient ssdenies ssany sspast sspsychiatric sshistory; sshe sshas ssnever ssbeen sshospitalized
ssin ssa sspsychshospital ssor ssreceived sspsychiatric sstreatment. ssHe ssadmits ssthat sshe
ss“dabbled” ssin ssdrugs ssrecreationally ssbut ssit’s ssnot ssa ssproblem. ss“I ssam sshere ssfor sschest
sspain.”
PAST ssMEDICAL ssHISTORY:
The ssclient ssdenies ssany sspast ssor sscurrent ssmedical ssproblems.
MENTAL ssSTATUS ssEXAM:
The ssclient ssis ssalert ssand ssoriented ssand ssappears ssdisheveled, ssdressed ssin ssunkempt sswork
ssclothes. ssHis ssspeech ssis ssrapid ssand ssmildly ssincreased ssin ssvolume ssbut ssis ssnot sspressured.
ssHe ssis ssrestless ssandslooks ssaround ssthe ssroom ssfrequently, ssthough sshe ssdoes ssnot ssexhibit
sspsychomotor ssagitation.
Client ssdescribes sshis ssmood ssas ss“fine,” ss“just sshaving sschest sspain,” ssbut sshis ssaffect ssis
ssextremely ssanxious, ssirritable, ssand ssguarded. ssThought ssprocess ssis sslinear ss and ssgoal-
directed, ssbut ssthought sscontent ssshows sssome ssparanoid ssideation sstoward sshis sspartner ssand
ssER ssstaff. ssThe ssclient ssdeniesshallucinations ssand sssuicidal ssor sshomicidal ssideation. ssHis
sscognition ssis ssintact. ssInsight ss and ssjudgment ss are ssdeemed ssto ssbe sslimited.
, PHYSICAL ssEXAM:
VITAL ssSIGNS: ssHR=104/min.; ssB/P ss170/95; ssTemp= ss98.9F, ssresp.= ss18/min.
The ssclient ssis ssbreathing sscomfortably ssand ssappears ssrestless sswithout ssobvious sssigns ssof
ssdistress. sThe ssclient ssappears ss somewhat ssthin, ss and ssthere ssare sstraces ssof ssdried ssblood
ssnoted ssin sshis ssleft ssnostril. ssCardiac ss exam ssreveals ssno sssigns ssor ssmurmurs, ssrubs, ssor
ssgallops. ssThe ssremainder ssof ssthesexam sswas sslikewise ssunremarkable.
ss ss ss ss ss ss ss ss
Detailed Answers All Question Upgraded
ss ss ss ss ss
/Newest Version[Grade A+]
ss ss ss
d
HISTORY ssOF ssPRESENT ssILLNESS:
A ss37-year-old ssmale sswas ssbrought ssto ssED ssby sshis sspartner. ssThe ssclient sshas ssbeen
ssexperiencing sschest sspain ssfor ss1 ssday, ssstarting ssat ss2:00 ssa.m. ssHe ssis sstriaged ssto ssthe
ssmedical ssemergency ssdepartment. ssA ssmedical sshistory ssis sstaken. ssThe ssclient sshas ssno
sshistory ssof ssmyocardial ssinfarctions(MI) ssor sshypertension. ssThe ssclient ssis ssirritable ssand
sshypervigilant. ssHe ssrepeatedly ssasks ssthe ssnurse ssif ss“you ssknow sswhat ssyou ssare ssdoing”
ssand ssbecomes ssincreasingly ssguarded ssas ssthe ssintern ssrequests ssmore ssdetails ssabout sshis
ssmedical sshistory, ssreplying sssuspiciously, ss“you ssdon’t ssneed sstosknow ssthat.” ssHe ssdenies
ssfeeling ssdepressed ss and ss says sshe ssis ss“just ssstressed ssout.” ssHe ssis sscooperative sswith ssECG
ssbut ssis ssrestless.
The ssman’s sspartner ssasks ssif ssshe sscan ssspeak ssto ssthe ssED ssprovider ssalone ssand sssays ssthat
ssthe ssclientts ypically ssleaves sshis sswork ss as ssan ssinvestment ssbanker sson ssFriday ssnight ssand
ssdoes ssnot ssreturn sshome ssuntil ssthe ssearly ssmorning sshours sson ssSaturday, ssstays ssout sslate
ssseveral ssnights ssa ssweek, ssandshas ssgreat ssdifficulty ss going ssto sswork sson sstime ssin ssthe
ssmorning. ssOn ssthe ssweekends, sshe ssoften ss sleeps ss12-18 sshrs. ssa ssday. ssShe ssalso ssnoticed
sssome ssweight ssloss ssover ssthe sspast ssfew ssmonths.
Sometimes ssafter ssa sslate-night ssworking ssor sssocializing sswith ssco-workers, sshe ssaccuses
ssher ssof sscheating sson sshim ssor sstalking ssabout sshim ssbehind sshis ssback. ssThe sspartner
ssdenies ssthe ssclient’s ssaccusations ssand ssappears ssextremely ssconcerned. ssShe
ssacknowledges ssthat sshe sshas ssbeen ssundersincreased sspressure ssat sswork ssto ssperform ssand
ssstay sslate; ssseveral ssfriends ssat sswork sshave ssbeen sslaid ssoff ssin ssthe sspast ssyear.
PAST ssPSYCHIATRIC ssHISTORY:
The ssclient ssdenies ssany sspast sspsychiatric sshistory; sshe sshas ssnever ssbeen sshospitalized
ssin ssa sspsychshospital ssor ssreceived sspsychiatric sstreatment. ssHe ssadmits ssthat sshe
ss“dabbled” ssin ssdrugs ssrecreationally ssbut ssit’s ssnot ssa ssproblem. ss“I ssam sshere ssfor sschest
sspain.”
PAST ssMEDICAL ssHISTORY:
The ssclient ssdenies ssany sspast ssor sscurrent ssmedical ssproblems.
MENTAL ssSTATUS ssEXAM:
The ssclient ssis ssalert ssand ssoriented ssand ssappears ssdisheveled, ssdressed ssin ssunkempt sswork
ssclothes. ssHis ssspeech ssis ssrapid ssand ssmildly ssincreased ssin ssvolume ssbut ssis ssnot sspressured.
ssHe ssis ssrestless ssandslooks ssaround ssthe ssroom ssfrequently, ssthough sshe ssdoes ssnot ssexhibit
sspsychomotor ssagitation.
Client ssdescribes sshis ssmood ssas ss“fine,” ss“just sshaving sschest sspain,” ssbut sshis ssaffect ssis
ssextremely ssanxious, ssirritable, ssand ssguarded. ssThought ssprocess ssis sslinear ss and ssgoal-
directed, ssbut ssthought sscontent ssshows sssome ssparanoid ssideation sstoward sshis sspartner ssand
ssER ssstaff. ssThe ssclient ssdeniesshallucinations ssand sssuicidal ssor sshomicidal ssideation. ssHis
sscognition ssis ssintact. ssInsight ss and ssjudgment ss are ssdeemed ssto ssbe sslimited.
, PHYSICAL ssEXAM:
VITAL ssSIGNS: ssHR=104/min.; ssB/P ss170/95; ssTemp= ss98.9F, ssresp.= ss18/min.
The ssclient ssis ssbreathing sscomfortably ssand ssappears ssrestless sswithout ssobvious sssigns ssof
ssdistress. sThe ssclient ssappears ss somewhat ssthin, ss and ssthere ssare sstraces ssof ssdried ssblood
ssnoted ssin sshis ssleft ssnostril. ssCardiac ss exam ssreveals ssno sssigns ssor ssmurmurs, ssrubs, ssor
ssgallops. ssThe ssremainder ssof ssthesexam sswas sslikewise ssunremarkable.
