POWERPOINT

PLEASE I NEED SOMEONE WITH KNOWLEDGEMENT TO HEALTH OR NURSING

Criteria: 12 SLIDES IN POWERPOINT FORMAT, NO MORE THAN 12 OF CONTENT

APA STYLE

2-3 REFERENCES NO MORE THAN 5 YEARS OLD

NO PLAGIARISM

TOPIC: HEMATURIA

1)Presents the case including CC, HPI, Hx, ROS and PE findings concisely

2) List possible differential diagnosis with supporting/excluding criteria.

3)What labs or tests are typically ordered concerning this condition? What results should the
Does NP expect to see with this diagnosis?

4)What medications are typically prescribed for this condition? List specific drugs, starting doses, dose ranges, precautions to keep in mind when prescribing these drugs.

5) What are the outcomes expected or unexpected for this specific condition? Moreover, What patient outcomes will trigger a referral?

6)Provide patient teaching materials specific to their condition

IF SOMETHING IS NOT UNDERSTOOD YOU CAN CONTACT ME.

PLEASE I NEED YOU TO ANSWER IN THE PRESENTATION THE 6 QUESTIONS ABOVE, USE THE WORD DOCUMENT AS A GUIDE BUT NOT DO THE SAME, JUST ADD IN THE PRESENTATION WHAT I WROTE IN THE 6 QUESTIONS ABOVE PLEASEE

Patient name: N.L.

Sex: Female DOB: 02/04/1993 Age: 27 years old

Ethnicity: Hispanic

Language: Spanish

Religion: None

SUBJECTIVE:

Chief Complaint:

“I have a irregular vaginal bleed and I has been vomiting after overeating.”

History of Present Illness:

Patient is a 27-years-old female presents to the office reporting vaginal bleeding and vomiting

after overeating for the last 3 month on and off without relief. Patient report that she is been

acting different for the last 4 months, decreasing in sizes and body weigh not related with binge

eating, also an excessive diet and daily exercise. Patient report feeling very anxious and easily

get stressed with any minor issue.

Past Medical History:

Surgeries: Appendectomy 10 years ago.

Hospitalizations: 2010 as patient

chart.

Chronic Medical conditions: None.

Psychiatric Illnesses: None.

Injuries: None .

Childhood Illnesses: Chicken pox, Measles.

Preventive Care:

Pap smear: 2019 Without Abnormalities

Family History:

Mother: Alive with history of Cancer.

Father: Diabetic.

Sister: None.

Brother: None

Additional History:

Immunizations: Current vaccinations up to date.

Nutritional Status: Regular Diet, Poor Nutrition

BEHAVIOR/HABIT:

Caffeine: No

Smoke: No

Alcohol: No

Drug: No using illicit drugs

Exercises: Moderate exercise habit

Legal Document: Patient does not have a living will and livings will/advanced not directives on

records.

FUNCTIONAL STATUS:

Normal/ Independent ADL’s.

Allergies:Iodine as per chart and patient report.

Medications:

1. None.

HEALTH CARE MAINTENANCE: She has received her annual influenza vaccine. Annual

checkup with primary care provider. Review of physical health, well-being, and psychosocial

concerns, nutritional education and guidance, and health education, guidance annually by patient

chart.

Review of Systems: (ROS)

CONSTITUTIONAL: Significant loss weight and sizes, report fatigue lately, no fever, no chills,

no malaise, no night sweats, no exercise intolerance.

INTEGUMENTARY: SKIN: Skin dry and turgor, denies skin rash, no wound, no change in a

mole, no unusual growth, no jaundice, no lesions, no bruising, no bleeding.

HAIR: Abnormal hair distributions throughout the body.

NAILS: Discoloration, mild nail clubbing, scan cyanosis, no longitudinal ridges.

NEUROLOGIC: Denies changes in LOC, denies history of tremors, seizure, weakness,

numbness, dizziness, headaches, memory lapses or loss.

HEENT: HEAD: Denies head injuries, or change on Level Of Consciousness.

EYES: No vision changes, no diplopia, no blurred vision, no wears eyeglasses.

EARS: Denies loss of hearing, no ear pain, no drainage, no sensation of ears feeling full, no ear

ringing, no ear’s trauma.

NOSE/SINUSES: No nasal congestion or nasal drainage, no nosebleeds, normal smell sense.

THROAT/THROAT/MOUTH: Denies sore throat, no hoarseness, no difficulty swallowing, no

postnasal drip. No mouth or lips sore, no thrush, no bleeding gums.

NECK: Denies neck pain, no masses, no nodules, no history of thyroid abnormality.

PULMONARY: Denies hemoptysis, dyspnea, or pleuritic pains. No history of lung disease, toxin

or pollution exposure. 


CHEST/BREAST: Denies chest abnormalities, no breast lumps, no nodules, no nipple drainage,

no nipple retraction.

RESPIRATORY: No cough, no sputum, no wheezing, no recurrent URIs, no hemoptysis, no

bronchitis, no pneumonia, no TB history.

CARDIOVASCULAR: Denies chest pain, no palpitations, no orthopnea, no edema, no

claudication, no known murmurs, no history of cardiac disease.

GASTROINTESTINAL: Denies abdominal pain or discomfort, no bloating, no flatulence, no

nauseas, mother reported vomiting after overeating, no diarrhea, no constipation, no changes on

stools, no black tarry stools, no (melena) red or bright rectal bleeding after defecation, abnormal

appetite.

GENITOURINARY: Abnormal bleeding report, denies dysuria, frequency, urgency, hesitancy,

incontinence, nocturia, hematuria. Denies genital discharge, no history of Sexual Transmitted

Disease.

PERIPHERAL VASCULAR: Denies claudication, coldness, varicose veins, tingling, numbness,

leg cramps, ulcers, or discoloration of hands.

MUSCULOSKELETAL: No muscular aches, weakness and fatigue report, no arthralgia, denies

history of falls, no pain during ambulation, no loss of balance.

PSYCHIATRIC: Anxiety and irritability noted and report from the parents, no depression, no

mood swing, no sleep disturbances, no hallucinations.

ENDOCRINE: Cold intolerance, no excessive sweating, no hot flashes, no abnormal thirst/

hunger. Abnormal appetite report, normal urinary habits.

HEMATOLOGIC/LYMPHATIC: History of anemia report by her parents, no bruising, no

abnormal bleeding, no swollen glands.

OBJECTIVE: 


APPEARANCE: No well nourished noted, developed and dressed/groomed, anxiety demeanor,

speech clear. Appears to be without discomfort.

VITALS SIGNS:

-Blood Pressure: 99/59

-Pulse:100 bpm

-Regular Respiration: 19 rpm

-Temperature: 97.6 degrees Fahrenheit

-O2 saturation: 98% at room air.

-Weight: (136 lb 50th percentile in normal range 07/13/2019) / Today weight: 98 lb 8th

percentile underweight.

-Height: 5’7” BMI: 14.3 kg/m2

-Last Menstrual Periods: 08/10/2020-09/01/2020-09/22/2020-10/01/2020

-Pain level 0 of 10.

-General Appearance: Normal general appearance. Patient is awake, oriented, and alert. Well

developed , not well nourished. Patient keeps a normal position and posture without deformities.

Patient speaks clear and appropriate in native language. Excellent personal hygiene. No acute

distress.


NEUROLOGIC: Alert, oriented to time, place and person, Neurologic grossly intact. Memory to

recent and remote events preserved. Sensation intact and preserved strength to Bilateral Upper

Extremities/Bilateral Lower Extremities.

INTEGUMENTARY: SKIN: Skin dry and turgor noted with scars on the knuckles.

HEENT: HEAD: Normal cephalic with normal distribution of hair.

EYE:PERRLA, EOMs intact. No discharge, no pain noted. Sclera clear, Conjunctiva Pink. Lids

normal.

EARS: Without pain or tenderness.

-NOSE: External aspect is normal.

NECK: negative for masses. No thyromegaly. No JVJ distention.

THROAT/MOUTH: Dry mucosa, tooth erosion and swollen parotid glans noted, no dental

appliances, no missing teeth.

CARDIOVASCULAR: Pulse of Maximal Impulse not displaced, normal S1 and S2, no

murmurs, no rubs, no gallops, no bruit. No varicose veins, no edema, Peripheral Pulses Present

rapid palpable in all extremities.

RESPIRATORY: Unlabored respiration, lungs clear to auscultation. Breath sounds normal.

GASTROINTESTINAL: Abdomen soft, non-tender, non-distended, no masses, no scars, no

herniation, no guarding, no rebound tenderness, bowels sound presents all 4 quadrants, no

organomegally, no bruits.

GENITOURINARY: No mass visible, not enlarged kidneys noted by manual palpation, no pain

on the flanks during percussion exam.

REPRODUCTIVE: Irregular menstrual cycle.

MUSCULOSKELETAL: Iliac crest protruding, no joint effusion or swelling. No scoliosis or

kyphosis.

PSYCHIATRIC: Insight: Anxiety noted. Patient report and excessive interest in her weight,

exercise and diet.

Range of Motion: (ROM) 


Hips: Patient is able to perform ROM in abduction, adduction, internal/ external rotation,

symmetrical. 


Knees: Patient is able to perform ROM flexion, extension 


Feet/ankles: Patient is able to do , dorsiflex, plantar flexion, inversion, eversion Shoulder:

patient is able to do forward flexion, hyperextension, abduction/ adduction, internal/ external

rotation. 


Elbows: Patient is able to do flexion, extension, supination (palm up), pronation (palm down)

wrist: patient is able to do radial/ulnar, flexion, hyperextension. 


Hands: Patient is able to do metacarpophalangeal, thumb opposition, finger abduction/abbd,

hand grip 


Spine: Patient is able to do forward flexion, hyperextension, lateral bending, rotation, gait.

ASSESSMENT:

DIAGNOSIS:

Bulimia nervosa diagnosis due clinical presentation and physical exam.

1. Bulimia nervosa (ICD 10: F50.2).

Bulimia nervosa is characterized by recurrent episodes of binge eating followed by some form of

inappropriate compensatory behavior such as purging (self-induced vomiting, laxative or diuretic

abuse), fasting, or driven exercise; episodes must occur at least 1 time/wk for 3 mo. Diagnosis is

based on history and examination. Treatment is with psychologic therapy and antidepressants.

DIFFERENTIAL DIAGNOSTIC:

1. I ruled out patient is not Undernutrition what is another form of malnutrition.

Undernutrition can result from inadequate ingestion of nutrients, malabsorption, impaired

metabolism, loss of nutrients due to diarrhea, or increased nutritional requirements (as

occurs in cancer or infection). Undernutrition progresses in stages; it may develop slowly

when it is due to anorexia or very rapidly, as sometimes occurs when it is due to rapidly

progressive cancer-related cachexia.

2. I ruled out patient doesn’t present signs of Anorexia nervosa what is characterized by a

relentless pursuit of thinness, a morbid fear of obesity, a distorted body image, and

restriction of intake relative to requirements, leading to a significantly low body weight.

Diagnosis is clinical.

3. I ruled out patient doesn’t has Cachexia this one is wasting of both adipose tissue and

skeletal muscle. It occurs in many conditions and is common with many cancers when

remission or control fails. Some cancers, especially pancreatic and gastric cancers, cause

profound cachexia. Affected patients may lose 10 to 20% of body weight. Men tend to

experience worse cachexia as a result of cancer than do women.

Plan:

1. Lab test: CBC,

Pharmacologic treatment: 


1. Cognitive-behavioral therapy (CBT) or Interpersonal psychotherapy (IPT) therapy usually

involves 16 to 20 individual sessions over 4 to 5 months.

2. Nutrition supplementation begins by providing about 30 to 40 kcal/kg/day.

3. SSRIs Fluoxetine 60 mg po once/day or Second-generation antipsychotics (olanzapine

up to 10 mg po once/day).

Non Pharmacological Treatment:

-Decrease stressful stimulus or situations

-Take plenty fluids for avoid dehydration

Education Plans:

a. Increase intake of water. (2 liters/day).

b. High fiber diet (more than 30 g/day).

c. Counselor for Nutrition therapy for adolescents and family.

d. Patient and family educated on management of Bulimia nervosa in dietary measures and

preventions of further complications of her new medications treatment, also to contact the

provider if an abnormally or knew symptoms occurs.

Follow-ups/Referrals: 


Referrals to an Endocrinologist and Psychology for evaluation and further treatment.

Follow up in a weeks to evaluated patient’s laboratory testing results.