18 Oct A 56 year old man is thought to be in hypovolemic shock. What physical assessment findings would you expect to find to confirm this type of shock?

A 56 year old man is thought to be in hypovolemic shock. What physical assessment findings would you expect to find to confirm this type of shock?                                      

 

Question 2          A 56 year old Caucasian man is seen in the office as a new patient. He complains of headaches occurring with increasing frequency and attributes them to increased stress at work. He denies any chest pain, shortness of breath, or dyspnea. He smokes one pack cigarettes per day and has two glasses of wine with dinner. Physical exam – obese main (BMI 30) in no apparent distress. BP R arm 168/98 L arm 170/94. HR 64 regular. No thryomegly or lymphadenopathy. Fundascopic exam reveals narrowing of the arteries and arteriovenous nicking. Cardiac exam reveals that his point of maximal impulse (PMI) if displaced 2 cm to the left of the midclavicular line (MCL). No murmurs noted. Lung and abdomen examinations are normal.

 

What tests should be ordered for this patient ?                                

 

Question 3          A 44 year old man is thought to be in cardiogenic shock. What are the initial interventions needed for a patient in cardiogenic shock?                                     

 

Question 4          What is the mechanism of action and common side effects of dobutamine, norepinephrine, labetalol, and amiodarone?                                    

 

Question 5          What is the difference between dopamine and dobutamine?                                   

 

Question 6          A 56 year old Caucasian man is seen in the office as a new patient. He complains of headaches occurring with increasing frequency and attributes them to increased stress at work. He denies any chest pain, shortness of breath, or dyspnea. He smokes one pack cigarettes per day and has two glasses of wine with dinner. Physical exam – obese main (BMI 30) in no apparent distress. BP R arm 168/98 L arm 170/94. HR 64 regular. No thryomegly or lymphadenopathy. Funduscopic exam reveals narrowing of the arteries and arteriovenous nicking. Cardiac exam reveals that his point of maximal impulse (PMI) if displaced 2 cm to the left of the midclavicular line (MCL). No murmurs noted. Lung and abdomen examinations are normal.

 

How would you explain PMI being displaced 2 cm to the left of the MCL?                                             

 

Question 7          A 56 year old Caucasian man is seen in the office as a new patient. He complains of headaches occurring with increasing frequency and attributes them to increased stress at work.He denies any chest pain, shortness of breath, or dyspnea. He smokes one pack cigarettes per day and has two glasses of wine with dinner. Physical exam – obese main (BMI 30) in no apparent distress. BP R arm 168/98 L arm 170/94. HR 64 regular. No thryomegly or lymphadenopathy. Fundascopic exam reveals narrowing of the arteries and arteriovenous nicking. Cardiac exam reveals that his point of maximal impulse (PMI) if displaced 2 cm to the left of the midclavicular line (MCL). No murmurs noted. Lung and abdomen examinations are normal.

 

Considering all labs are within normal limits, what medication should the AGACNP prescribe for this patient?

 

If this patient were African-American, what medication should be prescribed?                                  

 

Question 8          A 47 year old male admitted with an infected elbow wound. On his second day in the hospital you find him in his room confused and agitated.

 

Vital signs are as follows:

 

Temperature – 96.2 °F

 

Pulse -140 beats per minute

 

Respirations – 40 breaths per minute

 

Blood Pressure – 90/40 mmHg

 

Labs include a WBC count of 3,000

 

Pt weighs 185 pounds

 

Further assessment of him includes:

 

o             Urine output of 100cc for the last 8 hours

 

o             Pulse oximetry of 88% on room air

 

o             Pallor

 

What initial treatment should be ordered for this patient?                                          

 

Question 9          How can a WCB with differential help you differentiate a bacterial infection from a viral infection?

 

Question 10        A 47 year old male admitted with an infected elbow wound. On his second day in the hospital you find him in his room confused and agitated.

 

Vital signs are as follows:

 

Temperature – 96.2 °F

 

Pulse -140 beats per minute

 

Respirations – 40 breaths per minute

 

Blood Pressure – 90/40 mmHg

 

Labs include a WBC count of 3,000

 

Pt weighs 185 pounds

 

Further assessment of him includes:

 

o             Urine output of 100cc for the last 8 hours

 

o             Pulse oximetry of 88% on room air

 

o             Pallor

 

What is your working diagnosis?