P.M., a 24-year-old house painter, has been too ill to work for the past 3 days. When he arrives at your outpatient clinic with his girlfriend, he seems alert but acutely ill, with an average build and a deep tan over the exposed areas of skin

P.M., a 24-year-old house painter, has been too ill to work for the past 3 days. When he arrives at your outpatient clinic with his girlfriend, he seems alert but acutely ill, with an average build and a deep tan over the exposed areas of skin. He reports headaches, joint pain, a low-grade fever, cough, anorexia, nausea, and vomiting (N/V), especially after eating any fatty food.P.M. describes vague abdominal pain that started about the same time as the other problems. He states that he has been using “a lot of Tylenol” for his pain. His past medical history reveals he has no health problems, is a nonsmoker, and drinks “a few” beers each evening to relax. Vital signs are

128/84,88,26,100.6 

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 F(38.1 

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 C)

; awake, alert, and oriented

×3

; moves all extremities well with complaints of aching pain in his muscles; very slight scleral jaundice present; heart and breath sound clear and without adventitious sounds; bowel sounds clear throughout abdomen and pelvis; and abdomen soft and palpable without distinct masses. You note moderate hepatomegaly measured at the midclavicular line; liver edge is easily palpated and tender to palpation. P.M. mentions that his urine has been getting darker over the past 2 days. Skeleton Diagram Reason for seeking help: Analyze and Categorize the Data Reason for seeking healthcare: Priority assessment: Problem/Nursing #1: Goal/Qutcome: Interventions: Patient Responses: Evaluation: Problem: Nursing Diagnosis H2: Goal/Outcome: Nursing Interventions: Patient Responses: Evaluation: Problem/Nursing Diagnosis# 3: Goal/Outcome: Nursing interventions: Patient Responses: Evaluation: T.H., a 57-year-old stockbroker, has come to the gastroenterologist for treatment of recurrent mild to severe cramping in his abdomen and blood-streaked stool. You are the registered nurse doing his initial workup. Your findings include a mildly obese man who demonstrates moderate guarding of his abdomen with both direct and rebound tenderness, especially in the left lower quadrant (LLQ). His vital signs are 168/98, 110, 24, 100.4 F

(38 

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C); he is slightly diaphoretic. T.H. reports that he has periodic constipation. He has had previous episodes of abdominal cramping, but this time the pain is getting worse. Past medical history reveals that T.H. has a “sedentary job with lots of emotional moments,” he has smoked a pack of cigarettes a day for 30 years, and he had “two or three mixed drinks in the evening” until 2 months ago. He states, “T haven’t had anything to drink in 2 months.” He denies having regular exercise: “just no time.” His diet consists mostly of “white bread, meat, potatoes, and ice cream with fruit and nuts over it,” He denies having a history of cardiac or pulmonary problems and has no personal history of cancer, although his father and older brother died of colon cancer. He takes no medications and denies the use of any other drugs or herbal products.