Mr. XYZ is a 57 year old Caucasian male who you recently saw in the clinic for the first time for ev
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Mr. XYZ is a 57 year old Caucasian male who you recently saw in the clinic for the first time for evaluation of generalized abdominal pain and fullness, urinary frequency, urgency, and nocturia for 2 months. Labs were completed and have partially resulted. You recall he has liver masses shown on CT which are consistent with metastatic disease of unknown primary.
Currently, he is complaining of shortness of breath which started 24 hours ago and increased lower extremity swelling. He has mild, intermittent, left sided substernal chest pain which does not radiate.
Review of symptoms is positive for: weight loss of 40lbs over the last 6 months, fatigue, malaise, general body aches, polydipsia, polyuria, chest pain, shortness of breath, abdominal fullness, lower extremity swelling.
Social History: Quit smoking 5 years ago but smoked 4 packs a day for 8 years. Denies ETOH and drug use
Mother: Had some type of cancer but does not know what kind, parkinson’s disease, pneumonia
Father: Diabetes, chronic kidney disease, hypertension
Vitals: 98.6-100-26-158/96, 92% on 2L NC
Constitutional: Alert and Oriented x 3. Obese. Is mildly dyspneic.
Head: Normocephalic and atraumatic
Eyes: pupils are equal, round, and reactive to light. No nystagmus. No scleral icterus.
Neck: Neck supple. 3 cm JVD present. No tracheal deviation present. No Thyromegaly or thyroid modules noted.
Cardiovascular: Normal rate, S1 Normal, S2 present, S3 is present, +2 edema in lower extremities bilaterally.
Pulses: Brachial, Radial, Dorsalis pedis, and posterior tibial pulses 2+/4+ bilaterally
Pulmonary/Chest: Dyspneic, not using accessory muscles. Respirations regular and even. Lungs with rales in the anterior and posterior lung fields bilaterally.
Abdominal: Obese, Soft. Bowel Sounds are active. Generalized tenderness. no masses 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.
Medications: None
AST 60 units/L
ALT 58 units/L
Cholesterol 250 mg/dL
LDL 180 mg/dL
HDL 15 mg/dL
Triglycerides 275 mg/dL
Troponin I 0.6 ng/ml
Chest xray: 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.
Explain Mr. XYZ’s diagnoses. Must integrate the answers to the questions below into your discussion.
Based on the current information available, what diagnoses do you believe Mr. XYZ has?
What labs and/or diagnostic tests do you believe are needed at this time?
Describe the pathogenesis which explains Mr. XYZ’s condition, his physical symtoms and diagnostic test results?
What education is important for Mr. XYZ to receive?
SCIENCE
HEALTH SCIENCE
NURSING
NURS 5315
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