Serita Case Summary

Breasts: no masses, no nipple retraction, no discharge. Heart: S1 and S2, no gallops, rubs, or murmurs appreciated. Abdomen is scaphoid, soft and non-tender with positive bubble sounds. Pelvic/ Rectal: deferred as patient has recently visited her GYN for a routine Pap smear. Neurologic exam reveals normal motor strength in all muscle

treatment, her TSH values did not change and her Thyroxine levels increased by 778.62%. Explain the why TSH did not change and

On 11/13/2017 at about 0930 hours, Officer Blackwell (P#xxxx) and I were dispatched to 1811 Night Shadow Avenue in reference to a family disturbance.

In Deltona, FL there are angry squirrels attacking the elderly at the Sterling Court Retirement Community Center. The squirrels are biting the elderly in the arms, legs and back and they are also scratching. Not only are the squirrels attacking the residents in the community center but also the staff that tries to help with the angry squirrels. The squirrels are being tested and are getting trapped.

I called to make Juanita Buda, aware of my being back in Memphis and my intent to become permanently employed at the Memphis VA, she made the comments: The Memphis VA do not transfer from VA to VA, and perhaps I should seek employment at another VA facility in the surrounding area and the Private sector. I made her aware that the nearest VA was Little Rock and it was 324 miles round trip for me. She led me to believe they where no longer doing Transfers. Junita Buda said, “this VA don’t transfer for VA to VA”. I ask you Who would better know this than the administrators in nurse recruitment. She also stated that I was not a good fit for the Memphis VA.

A 30-year-old woman who has never been pregnant comes for her annual examination. She currently desires birth control, but plans to become pregnant 1 to 2 years from now. She has no history of significant medical illness. Her body mass index is 23 kg/m2, and she takes no medications.

She reported having a normal delivery, full term with no complications; developed normally. Major events: none. Nutrition history: fair. Social history: Currently lives with 2 children in her mother’s house, separated with ex-husband, who is in jail and plans to get a divorce.

Brittany is a 22yo, G2 P1001, who was seen for an ultrasound evaluation and FTS. The patient states that she has a history of hypothyroidism but believes that she was tested in this pregnancy and told that her values were normal. I do not have copies of that lab work but would recommend that this be followed as her pregnancy progresses. She also reportedly has some issues with anxiety and IBS but is stable not on medication. She has a previous cesarean delivery with her last delivery but is uncertain about a VBAC. Lastly, she states that her main issue in this pregnancy is that when she wakes up in the morning after sleeping her arms and hands are numb or asleep and this did not occur in her previous pregnancy.

At this stage she is experiencing swelling of the legs, along with iron deficiency and a possibility of gestational diabetes, in order to maintain a heathy full term pregnancy at twenty weeks with additional calorie requirement of protein, vitamins and minerals like iron, zinc, folate and vitamin D (Grosvenor & Smolin, 2015, p. 373). She will need to decrease her salt and sugar intake, eat more lean protein, drink water only three liters per day while eliminating sweet tea, In addition to incorporating

Physical assessment reveals intermittent heart palpitations with strong carotid and radial pulses, brisk deep tendon reflexes, 1+ non-pitting edema of bilateral ankles, hair thinning, onycholysis, orbital lid lag and an enlarged neck with positive audible bruit. Mrs. J.P. denies pain upon palpation of neck as slight thyroid enlargement is noted. Orders to perform complete blood count (CBC), complete metabolic panel (CMP), thyroid stimulating hormone (TSH), thyroxine index, free (T4), triiodothyroine (T3), and pregnancy test result in abnormal values including:

We also rediscussed the AMA issue. She is not interested in the invasive and again CVS and amniocentesis were declined but she was interested in the noninvasive prenatal testing (NIPT) and now that she is beyond 10 weeks gestation that bloodwork was drawn. We will forward the results to your office upon return. In addition, because she did have a 36 week and 22 week loss, she would be a candidate for 17-alpha hydroxyprogesterone starting at around 16 to 187 weeks gestation. She actually was on 17-OHP with her last loss that occurred at around 20 weeks gestation.

Eduardo Serpa is a business owner of a well-known printing service in Little Havana, Fl. He was born and raised in Cuba and came here for opportunity. He came with a high school diploma but no degree of any college. He now makes beautiful portraits and albums for people during special events like quinceañeras, weeding’s, parties, and more. Since little, he never wanted to work for anyone but himself. He started being an entrepenuer by selling jewelry and other accessories for women and men. He was all about making business and had done everything in his power to build a successful business. He realized what with the skills and knowledge he has with printers, pictures, and technology, he can make a printing service business. He uses

In this case pre-pregnancy counseling includes but not limited to evaluation of HTN control, discussion of increased risk of pre-eclampsia, and education about any drug alterations which would be needed to be made in the first trimester if she becomes pregnant. Research shows that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) need to be stopped in the first trimester since it can increase risk of congenital abnormalities if these drugs taken during pregnancy (National Institute for Health and Care Excellence, 2010). So in this case ACE inhibitor should be stopped if she becomes pregnant most preferably offer alternative treatment. It is necessary to find out J.M.’s detail PMH if she had poor outcomes with previous pregnancies because of HTN then she needs to be counselled

Shruti Saralaya et al (2013) study offers a insight into a generally unknown condition, the study was conducted with 100 participants, including 50 cases and 50 controls for equal representation, the study was based on what earlier scientist thought was a correlation for the condition, for example preterm labour with TTTS is high, but not effect on percentage with pregnancy induced hypertension as well as gestational diabetes. Saralaya didn’t work alone on this and worked with multiple other people on the study, suggesting that the results will be more reliable as there will be less researcher bias which is increased as this was an observational study.

I have based this case presentation on a 38year old lady with a fictitious name of Agnes. She is a married lady with no medical or surgical history. She is a non-smoker and non-drinker. This was her first pregnancy and was relatively uncomplicated until week 36 gestation. At 36 weeks gestation, Agnes complained of increased shortness of breath, ankle swelling and paroxysmal nocturnal dyspnoea which mimicked pregnancy related physiological changes. Agnes was referred to the Coronary Care Unit from the national maternity hospital, 12 hours post caesarean section of a healthy baby boy in view of deteriorating condition, tachycardia and increased shortness of breath and leg oedema.