Question

1. What Would You Do? What would you not do?

Case Study: Alex Jacoby is 18 years old and a senior in high school. He comes to the office complaining of severe pain in his left shoulder. Alex is an outstanding competitive swimmer and is currently ranked first in the state in the 100-yard butterfly. Alex has a big meet coming up and must do well because he has a chance of getting an athletic scholarship to the University of Florida. He says he thinks he can take 2 seconds off his best time at this meet and he doesn't want anything to interfere with that. Alex wants the physician to do whatever he can to make his shoulder better and thinks that a steroid injection and OxyContin might be the answer. His vital signs are as follows: temperature 98.5°F, pulse 48 beats per minute, respirations 12 breaths per minute, and blood pressure 108/68 mm Hg. Alex asks why his pulse is so slow and wants to know if there is any medication that he can take to make it faster.

2. What would you do? What would you not do?

Case Study: Tyrone Jackson, 45 years old, is at the medical office to have his blood pressure checked. Three months ago, Mr. Jackson started taking a diuretic and an antihypertensive prescribed by the phy sician to reduce his blood pressure. The last documentation in his chart indicates that Mr. Jackson's blood pressure decreased from 168/112 mm Hg to 118/78 mm Hg: however, his blood pressure at this visit is 138/98 mm Hg. Mr. Jackson says that he has not been very good at taking his medication lately. He says it is really hard to remember to take all those pills every day. He also says that he felt just fine before being put on blood pressure pills, but when he started taking them, he felt awful. He had to urinate more often; when he got up fast, he felt dizzy; and he had some problems with headaches. Mr. Jackson says that he decided to cut back on his pills to see if these problems got better, and sure enough, they went away altogether. Mr. Jackson wants to know if there's anything he can do to lower his blood pressure other than taking pills.

3. What Would You Do? What Would You Not Do?

Case Study: Marcela Mason comes in with Olivia, her 5-year-old daughter. Olivia has had a fever and sore throat for the past 2 days. Olivia's aural temperature is taken in her left ear, and it measures 103.3°F. Mrs. Mason says that she has an ear thermometer at home, but when she took Olivia's temperature with it, the readings were always below 97° F. She knew that could not be right because Olivia felt so warm. Mrs. Mason would like to be able to use her ear thermometer, but she thinks that it might be broken because of the low readings. Mrs. Mason says that she is thinking of switching back to a mercury glass thermometer, but she has heard that it isn't a good idea to use this type of thermometer anymore and wants to know why.

Answer 1

1.What to do?

- take an ECG

- do an echo

- if normal just reassure him

And make him understand that there are drugs to increase heart rate and used only on emergency situations.

What not to do

- no steroid injection to be administered EPIDURALLY as it may lead to arrythmia and bradycardia

2.What to do

- take one more BP reading also

- advise him of lifestyle modifications like diet change and do compulsory exercises regularly.

- since raised bp is due to changes in blood vessels which can't be reverted but can retard progression, by these medicines, so it is necessary to take drug, once BP becomes normal we can stop the medication.

- have periodical BP monitoring

-take less water

- check serum electrolytes

What not to do?

- not to discontinue drug

- reduce physical activities

3.will do

-yes encourage to discard Mercury thermometer, if broken can lead to mercury spilling

- checking of the thermometer at home

-

Not to do

-don't touch spilled out mercury fluid

- not to use aural thermometer it may leads to damage of EAR DRUM