Mr. XYZ is a 57 years old Caucasian male who presents to clinic for the first time for evaluation of

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Mr. XYZ is a 57 years old Caucasian male who presents to clinic for the first time for evaluation of  generalized abdominal pain and fullness, urinary uregency, frequency and nocturia for 2 months. Lab were completed and have partially resulted. He has liver masses shown on CT which are consistent with metastatic disease of unknown origin. 
currently he is complaining SOB which started 24 hours ago and increase lower extermyty swelling. He has mild, intermittent left sided sub sternal chest pain.
Review of the symptoms is positive for weight loss of 40 lbs over the last 6 months, fatigue, malaise, general body aches, polydipsia, Polyuria, chest pain, SOB, abominal fullness, lower extremity swelling.

No past medical and surgical studies.
Social history: Quit smoking 5 years ago but smoked 4 pack a day for 8 years. Denies ETOH and drug use.
Family History:
Mother: has some type of cancer but doesnot know what kind. Parkinson’s disease, pneumonia
Father: Diabetes, CKD, HTN
Physical exam:
Vitals: 98.6-100-26-158/96, 92% on 2L NC 
Alert and oriented x3. Obese. Is mildly dyspneic 
Head: Normocephalic and atraumatic
Eyes: Puplis equal, round and recative to light. No Nystagmus. No scleral icterus
Neck: Neck supple. 3 cm of  JVD present bilterally  No tracheal deviation present. No Thyromegaly or thyroid modules noted.
Cardiovascular: Normal rates, S1 Normal, S2 present,  S3 present .+2 edema in BLE
Pulses: Brachial, Radial, Dorsalis pedis, and posterior tibial pulses 2+/4+ bilaterally 
Pulmonary/Chest: Dyspneic, not using accessory muscles. Respirations regular and even. Lung sounds rales on auscultation.
Abdominal: Obese, Soft. Bowel Sounds are active. Generalized tenderness. no mass noted. No CVA tenderness. Unable to palpate liver due to body habitus. There is no rigidity, rebound or guarding.
Lymph: No cervical lymphadenopathy
Neurological: CN II-XII intact
Skin: Skin warm, dry and intact. No rashes, Lesions and abrasions.
Psychiatric: Mood and affect normal. Calm and cooperative behavior. Judgment intact.
Mediactions: None
CT abdomen/pelvis: Hypovascular liver masses consistent with metastatic disease of unknown primary.
LABS                                       Results
AST                               60 units/L
ALT                       58 units/L
Total chiolesterol           250 mg/dL         
LDL                                   180 ml/dL
HDL                            15mg/dL
Triglycerids                275 mg/dL
Troponin  I                0.6 ng/ml
Chest X-ray: Shows Cardiomegaly and Kerley lines
Echocardiogram: Left ventricle ejection fraction of 35%, impaired left ventricular relaxation, left and right atrial hypertrophy, right ventricular hypertrophy and pulmonary Hypertension.

Discussion questions:
1. Based on current information, What  diagnosis do you beleive Mr.  XYZ  has?
2. What additional labs or diagnostic test is needed at this time?
3. Describe the pathogenesis which explains Mr XYZ’s condition, his physical symptoms and diagnostic test results?
4. What education is important for Mr. XYZ to receive?

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HEALTH SCIENCE
NURSING
NURS 5315

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