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Chief Complaint
• Chest pain.
• 68 year old female patient presents with complaints of chest pain that awoke her from sleep last night. Patient describes the pain as midsternal “tight, squeezing” and pressure in the epigastric region. Patient reports that the pain was accompanied by diaphoresis and lasted approximately 5-10 minutes before spontaneously resolving. Patient states she tried sitting up, walking, and taking some liquid antacid but experienced no relief with these measures. Denies change in diet, or any unusual foods yesterday.
• She also reported experiencing some intermittent attacks of chest pain and tightness approximately 2- 3 times over the last six months, that previous episodes were shorter in duration with less severe pain, and usually occurred when she was “emotional” or “tired”. Pain with prior episodes was relieved by rest.
• Recent widowed status – husband died seven months ago; states increasing anxiety and difficulty sleeping.
• Medical history significant for hypertension and hyperlipidemia. Negative for stroke, myocardial infarction, bleeding disorders, GERD, anxiety, and depression.
• Social history: Nonsmoker, occasional social drinking, denies illicit drug use. She only engages in sedentary activities at this time.
• Family history: Father died of heart attack at age 50, mother is 95 years old and in good health, two siblings both in good health, otherwise negative family history.
• Influenza and pneumococcal immunizations up to date. No known allergies.

Journal Week 5 Asthma: Write a journal of a patient with Asthma

A 28-year-old female with a history of asthma is being seen by the ER physician. She complains of acute shortness of breath and has audible wheezing. The patient has been taking her prescribed medications of Ventolin inhaler and Cromolyn Sodium at home, but has had no relief of her symptoms. A physical exam reveals a HR of 110, RR of 40, with signs of accessory muscle use. Chest auscultation reveals decreased breath sounds bilaterally, with inspiratory and expiratory wheezes. The patient is coughing up small amounts of thin, clear sputum.

Journal Week 6 Abdominal Pain: Write a journal of a patient with Abdominal pain

Mrs. S., a 46-year-old woman from Azerbaijan who had lived in Germany for the past eight years, had always been healthy and had never been under the care of a general practitioner. In November she visited a general practitioner complaining of right upper abdominal pain with no radiation. The pain, which was described as pressing in character, had been present for about three months and was intermittent. There was no nausea, vomiting, weight loss, melaena, change in bowel habit, urinary symptoms, or fever. The patient denied alcohol abuse and said that she was a nonsmoker and took no regular medication.
Blood pressure 140/80 mmHg, weight 75 kg, height 170 cm. Heart and lungs normal to percussion and auscultation. No lymph node enlargement. Abdomen slightly obese and soft. Tenderness present in the right upper abdomen. Bowel sounds normal. Renal angles clear

Journal Week 7 urinary frequency and nocturia: Write a journal of a patient with urinary frequency and nocturia

Urinary frequency is a genitourinary disorder that presents problems for adults across the lifespan. It can be the result of various systemic disorders such as diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate cancer. Many of these disorders have very serious implications requiring thorough patient evaluations. When evaluating patients, it is essential to carefully assess the patient’s personal, medical, and family history prior to recommending certain physical exams and diagnostic testing, as sometimes the benefits of these exams do not outweigh the risks. In this Discussion, you examine a case study of a patient presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient?
Consider the following case study:
A 52-year-old African American male presents to an urgent care center complaining of urinary frequency and nocturia. The symptoms have been present for several months and have increased in frequency over the past week. He has been unable to sleep because of the need to urinate at least hourly all day and night. He does not have a primary care provider and has not seen a doctor in more than 10 years. His father died when he was a child in an automobile accident, and his mother is 79 years old and has hypertension. The patient has no siblings. His social history includes the following: banker by profession, divorced father of two grown children, non-smoker, and occasionally consumes alcohol on weekends only.
To prepare:
• Review Part 13 of the Buttaro et al. text in this week’s Learning Resources.
• Review the case study and reflect on the information provided about the patient.
• Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
• Consider types of physical exams and diagnostics that might be appropriate for the evaluation of the patient in the study.
• Reflect on a possible diagnosis for the patient.
• Review the Marroquin article in this week’s Learning Resources. If you suspect prostate cancer, consider whether or not you would recommend a biopsy.
• Think about potential treatment options for the patient.

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