1.Three weeks postpartum, a women reports that her period has returned and that it is very heavy; each times she changes her pad, it is soaked through. What postpartum complication might this woman be experiencing, and what instructions or information should the nurse provide?

2. The nurse records a blood loss of 500 ml from a woman who had a cesarean delivery less than 24 hours ago and notes she appears to be developing hypovolemic shock. What signs and symptoms of hypovolemic shock should the nurse recognize? What medical management is indicated?

1.   Provide three unique examples of specific sport tasks using (primarily) each of the three energy systems (9 examples total). For example: Phosphagen, 100m dash (don’t steal that one).

1. Phosphagen:

2. Lactic Acid System:

3. Aerobic System:

Brad presents with report of foreign object in right eye.Brad Pittman is a 35 year old welder.While at work welding , a metal splinter lodged in his eye.

Scenario:.The patient is afebrile and appears in moderate distress,clutching his face.Respirations increased .Heart rate elevated.Patient is slightly diaphoretic.No obvious debris lodged in the face,neck or hands.Nares clear.Ipsilateral lids normal.Sclera grossly inflamed .Upon examinatiuon with slit lamp,the metal splinter is embedded in the cornea but does not enter the anterior chamber.Splinter removed without complications .Contralateral eye is unaffected.Identify the Examinatio elements in this note by organ system,

A. Eye, Ears, Nose

B. Mouth, Throat

C. Skin

D. Cardiovascular and Respiratory

E. all of the above

Patient Name: Arthur Tapping
Patient Number: 2004-1756-0
Birth Date: 12/07/72
Date: 07/07/04

Chief Complaint/ Present illness:
Mr. Tapping is a 32-year-old obese African-American male who visited the hospital with a chief complaint of postprandial gastralgia. The patient was well two weeks ago when he noticed the gradual onset of intermittent epigastric pain, after eating. Initially each episode lasted for ½ hour, was mild, and located diffusely in the upper abdomen. Over time the episodes lengthened to 1-2 hours, became severe, and localized in the RUQ. As of yesterday, he has vomited three times, and is now anorexic. The patient denies any previous history of abdominal pain, hemorrhoids, recent weight gain or loss, illicit drug use and excessive alcohol consumption. There are no suggestions of prior postprandial symptoms, or jaundice.

Physical Examination:
General: alert, responsive, middle-aged man who is moderately obese, in obvious discomfort.
Vitals: BP 173/80; Temp 98.5F; HR 97bpm;
Skin: clear, no evidence of jaundice
Lymphatics: unremarkable
HEENT: Sclera was icteric, ears, nose, and throat are clear
Chest: unremarkable
Abdomen: Moderately obese with a very tender globular mass in the RUQ. No splenomegaly or hepatomegaly noted on palpation. Rebound tenderness was negative over the RLQ. No ascites noted, or other evidence or portal hypertension. Bowels sounds are normal and no bruits noted.
Pelvic/Rectal: within normal limits, Guaiac negative, significant steatorrhea noted
Extremities: All distal pulses are palpable, no edema noted

Lab tests:
Blood: Within normal limits except for hypercholesterolemia, and hyperbilirubinemia
Urine: Bilirubin 3+
Echo scan gallbladder: Gallbladder is approximately 13 cm in length with four to five spherical calculi visualized each approximately 1.5 cm at their greatest diameter.
Impression:

1. Acute cholecystitis, from cholelithiasis
2. Secondary jaundice
3. Hypertension
4. Exogenous obesity
5. Hypercholesterolemia

Treatment/Plan: Refer patient to a gastroenterologist for an open cholecystectomy surgery with operative cholangiography.

Thomas Nosbod, MD

What surgery is suggested for Mr. Tapping?

Question 1 options:

1. A 67-year-old male presents to the clinic along with his family with a chief complaint of having problems with his short-term memory. His family had dismissed these problems and attributed them to the aging process. Over time they have noticed changes in his behavior, along with increased confusion and difficulty completing basic tasks. He got lost driving home from the bowling alley and had to be brought home by the police department. He is worried that he may have Alzheimer’s Disease (AD). Past medical and social history positive for a minor cerebral vascular accident when he was 50 years old but without any residual motor or sensory defects. No history of alcohol or tobacco use. medications is clopidogrel 75 mg po qd. Neurological testing confirms the diagnosis of AD. Question: What is Alzheimer’s Disease and how does amyloid beta factor into the development and progression of the disease?

explain the differences between primary and secondary traumatic brain injuries (TBIs)?

How does atrial fibrillation contribute to the development of aCVA?

What are the underlying causes of fibromyalgia?

The patient had pain several weeks ago after his tennis team went to a regional competition. When he rests, the pain seems to go away. The pain is alleviated when he takes Naprosyn. No history of trauma or infection in the elbow. Past medical and social history non contributary. He's a junior at the local high school and just started taking tennis lessons 2 months ago and his coach is working with him on his backhand serve. Focused physical exam revealed point tenderness over the lateral epicondyle which increases with pronation and supination. The APRN diagnoses him with lateral epicondylitis and orders a wrist splint to prevent wrist flexion. Question: Why did the APRN feel a wrist splint would be helpful? What patient characteristics lead to this diagnosis.

why did the APRN order an HLA-B27 lab? How would that lab result assist in understanding what ankylosing spondylitis?

The patient is a 45-year-old man who presents to the clinic complaining of intermittent fevers, joint pain, myalgias, and generalized fatigue. He noticed a rash several days ago that seemed to appear and disappear on different parts of his abdomen. He noticed the lesion below this morning and decided to come in for evaluation. He denies recent international travel and the only difference in his usual routine was clearing some underbrush from his back yard about a week ago. Past medical history non-contributory with exception of severe allergy to penicillin resulting in hives and difficulty breathing. Physical exam: Temp 101.1 ˚F, BP 128/72, pulse 102 and regular, respirations 18. Skin inspection revealed a 4-inch diameter bull’s eye type red rash over the left flank area. The APRN, based on history and physical exam, diagnoses the patient with Lyme Disease. She ordered appropriate labs to confirm diagnosis but felt it urgent to begin antibiotic therapy to prevent secondary complications.  

What is Lyme disease and what patient factors may have increased his risk developing Lyme disease?

why a patient with gout is more likely to develop renal calculi.