Name 3 differential diagnoses based on this patient presenting symptoms?
Name 3 differential diagnoses based on this patient presenting symptoms?
For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. You will work on case study # 1
| Case 1 | Case 2 | Case 3 | |
| Chief Complaint (CC) |
“I am here today due to frequent and watery bowel movements” | “I have pain in my belly” | “neck swelling” |
| History of Present Illness (HPI) | A 37-year-old European American female presents to your practice with “loose stools” for about three days. One event about every three hours | A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex | A 42-year-old African American female who refers that she has been noticing slow and progressive swelling on her neck for about a year. Also she stated she has lost weight without any food restriction |
| PMH | No contributory | Patient denies | Patient denies |
| PSH | Appendectomy at the age of 14 | Surgical removal of benign left breast nodule 2 years ago | |
| Drug Hx | No meds | Birth control | No medication at the time |
| Allergies | Penicillin | NKA | NKA |
| Subjective | Fever and chills, Lost appetite Flatulence No mucus or blood on stools | Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urination | Mild difficult to shallow, Neck feels tight, Pt states she feels Palpitations |
| Objective Data | |||
| PE | B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8 | B/P 138/90; temperature 99°F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10 | B/P 158/90; Pulse 102; RR 20; Temp 99.2; Ht 5,4; wt 114; BMI 19.6 |
| General | well-developed female in no acute distress, appears slightly fatigued | acute distress and severe pain | 42-year-old female appears thin. She is anxious – pacing in the room and fidgeting, but in no acute distress. |
| HEENT | Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous. | Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip. | Bulging eyes |
| Neck | Supple | Diffuse enlargement of the thyroid gland | |
| Lungs | CTA AP&L | CTA AP&L | CTA AP&L |
| Card | S1S2 without rub or gallop | S1S2 without rub or gallop | S1S2 without rub, Tachycardia |
| Abd | positive bowel sounds (BS) in all four quadrants; no masses; no organomegaly noted; diffuse, mild, bilateral lower quadrant pain noted Mild diffuse tenderness. | · INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round • AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted • PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable • PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area |
benign, normoactive bowel sounds x 4 |
| GU | Non contributory | • EXTERNAL: mature hair distribution; no external lesions on labia • INTROITUS: slight green-gray discharge, no lesions • VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls • CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT) • UTERUS: ante-flexed, normal size, shape, and position • ADNEXA: bilateral tenderness with fullness; both ovaries without masses • RECTAL: deferred • VAGINAL DISCHARGE: green in color |
Non contributory |
| Ext | no cyanosis, clubbing or edema | no cyanosis, clubbing or edema | no cyanosis, clubbing or edema |
| Integument | good skin turgor noted, moist mucous membranes | intact without lesions masses or rashes | Thin skin, Increase moisture |
| Neuro | No obvious deformities, CN grossly intact II-XII | No obvious deficits and CN grossly intact II-XII | No obvious deficits and CN grossly intact II-XII |
Once you received your case number, answer the following questions:
- What other subjective data would you obtain?
- What other objective findings would you look for?
- What diagnostic exams do you want to order?
- Name 3 differential diagnoses based on this patient presenting symptoms?
- Give rationales for your each differential diagnosis.
Submission Instructions:
- Your initial post should be at least 750 words, formatted and cited in current APA style with support from at least 3 academic sources.
Requirements: At least 750 words | .doc file
Subject: Masters Nursing
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