1. Mr. Shaggy comes in to see his health care provider for his yearly checkup. As...

1. Mr. Shaggy comes in to see his health care provider for his yearly checkup. As you are taking

his blood pressure, he says “I don’t need that rectal examination do I ? I had prostate surgery

last year.” How do you respond?

2. Mrs. Butterworth has just returned from an endoscopic examination. She says, “Something

went wrong, I just know it. Look at my belly. I look like I am 9 months pregnant”. How do you

respond?

Expert Solution

1. Explain the patient why it is important to examine the rectum to rule out abnormal prostate. The health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete. The patient may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate. The patient may go on with his normal activities. Your doctor will discuss the test results with you. If he or she detects a suspicious lump or area during the exam, further testing will be the next step. If the patient asks for avoiding rectal examination, test PSA (Prostate Specific Antigen). PSA is such a sensitive marker of prostate cancer that if the PSA is undetectable, men don't need a digital rectal examination or further imaging studies at that time. The patient needs careful follow-up with a PSA test every year.

2. First of all reassure the patient.

Inform the patient that excess gas is one of the most common side-effects of upper endoscopy due to the introduction of air into the stomach during the exam.

Adopting dietary and lifestyle changes are two main ways to alleviate symptoms. Watching the foods you eat and how you eat certain foods can help manage gassiness after an endoscopy. Using over-the-counter gas relief medication is also a great solution to excess gas.

The nurse should also be aware of a condition called tension pneumoperitoneum which is a rare complication of endoscopy.

Tension pneumoperitoneum is defined as the massive accumulation of air in the peritoneal cavity, which results in a sudden increase in intraabdominal pressure.

TPP should be suspected when gastrointestinal endoscopy is followed by sudden distention of the abdomen, which becomes barrel-shaped, although this finding can be overlooked in obese patients. Percussion on all areas of the abdomen reveals tympanicity, and bowel sounds are usually present but distant. Abdominal tenderness can also be found when inflammation of peritoneal cavity is present.

Nightingale answered 1 year ago

The health care provider tells Mr. J that she would like to biopsy the “knot” in...

The health care provider tells Mr. J that she would like to biopsy the “knot” in his neck to rule out Hodgkin lymphoma. After the HCP leaves the room, Mr. J immediately starts wringing his hands and says, “Oh my goodness. I know I am going to die. My friend had something like this, and he was dead in 6 months. Who will take care of my family?” 3. How will the nurse respond to Mr. J’s concerns? 4. What...

M.K. is a 22-year-old male who comes to the health care provider for complaints of frequent...

M.K. is a 22-year-old male who comes to the health care provider for complaints of frequent diarrhea and abdominal pain. He had appendicitis with appendectomy at age 9. He currently takes no medications. Subjective Data Frequently has abdominal pain and diarrhea Objective Data Physical Examination Temperature 99.9° F, pulse 78, respirations 16, blood pressure 114/62 Height 5’3”, weight 100 lb, BMI 17.7 kg/m2 Diagnostic Studies Lab values WBC 11,600/µL RBC 3.4 million/µL Hematocrit 33% Hemoglobin 10 g/dL Platelets ...

Mr. DeVito is a 48 old male who presents to his Primary Care Provider with left...

Mr. DeVito is a 48 old male who presents to his Primary Care Provider with left upper abdominal pain and complain of weakness and fatigue. The nurse immediately notes how pale his skin. A full set of vitals reveals the following: HR 82bpm, BP 142/90 mmhg, RR 16bpm, Spo2 94 on room air, Temp 101.0 F What further Nursing Assessment would you perform at this time? Upon further assessment, the nurse notes a palpable mass in the left upper quadrant,...

James is a 52-year-old black male who comes to the clinic for a checkup for his...

James is a 52-year-old black male who comes to the clinic for a checkup for his diabetes. He tells the doctor that he has noticed that his feet have been getting numb and cold, causing him annoyance and irritation. The pulses in James’ feet are faint and they are pale in color. James is diagnosed with vascular insufficiency secondary to consequences of his diabetes What is the most likely cellular stressor and injury type that may result from vascular insufficiency?

Mr. Green is 75 years old and in the doctor's office for his first checkup after...

Mr. Green is 75 years old and in the doctor's office for his first checkup after being prescribed digoxin (Lanoxin) once daily and chlorothiazide (Diuril) two times a day (BID) for congestive heart failure. He still has some signs of heart failure and has admitted that he sometimes forgets to take his pills. He also has trouble reading the labels and isn't sure which pill he is supposed to take again at night. What instructions would provide that might help...

E.G. is a 73-year-old woman whose daughter brings her to see the health care provider because...

E.G. is a 73-year-old woman whose daughter brings her to see the health care provider because she has had a case of the “stomach flu,” with vomiting and diarrhea for the past three to four days and is now experiencing occasional light-headedness and dizziness. Her past medical history includes hypertension, hypercholesterolemia, and mild heart failure. She is taking: Digoxin 0.125 mg po daily. Captopril 25 mg po BID. Furosemide 40 mg po daily. Potassium chloride 20 mEq po daily. Atorvastatin...

Charlie Berger, a 58-year-old obese man, comes to his primary care provider because he has difficulty...

Charlie Berger, a 58-year-old obese man, comes to his primary care provider because he has difficulty swallowing, has heartburn, and experiences occasional regurgitation. Answering his provider’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol. Today, endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of the proximal stomach into the thorax. The provider diagnoses gastroesophageal reflux disease (GERD). What...

.) Is the type of health care provider related to the patient’s satisfaction with care? Data...

.) Is the type of health care provider related to the patient’s satisfaction with care? Data are from a study of 10 patients who were seen for health care at an HMO. Each patient had three different urgent care visits. On one visit, the patient was seen by a physician (MD), at another visit by a nurse practitioner (NP), and at the third visit by a physician’s assistant (PA). After each visit, the patient completed a patient satisfaction survey. Satisfaction...

A 40-year-old man reports to his health care provider complaining of heartburn that occurs after eating...

A 40-year-old man reports to his health care provider complaining of heartburn that occurs after eating and also wakes him up at night. He is overweight and admits to enjoying fatty foods and lying down on the sofa and watching TV in the evening. He also complains that lately he has been having a cough and some wheezing. He is negative for peptic ulcerations. What is causing this man’s heartburn? Why does it get worse at night or after he...

The health care IT industry faces new challenges based on new health care insurance provider requirements,...

The health care IT industry faces new challenges based on new health care insurance provider requirements, including evolving guidance for the Center of Medicare and Medicaid Services (CMS). Describe a recent change to CMS regulatory reporting requirements and the role of a health information management (HIM) professional in ensuring an organization is in compliance.

Question