What tests should we anticipate the physician to order on this patient?
A 73-year-old man presented to his primary care provider for evaluation of easy bruising. He
was in his
usual state of health until 10 days prior to presentation when he noticed bruising of his bilateral
upper extremities associated with mild swelling and discomfort. He initially attributed this to
musculoskeletal pain from doing yardwork, but the bruising and pain did not improve.
The patient denied any personal or family history of bleeding disorders. His medical history was
otherwise remarkable for osteoarthritis of the bilateral knees and obesity. He underwent a tooth
extraction and an inguinal hernia repair several years ago, which were not complicated by
bleeding. He reported taking ibuprofen sparingly in the 10 days prior for his upper extremity pain
but denied ay other new medications. He was not on any prescription medications, other overthe-counter medications, or herbal supplements. He otherwise denied fevers, chills, night sweats,
change in weight, shortness of breath, chest pain, abdominal pain, change in urination, new joint
pain, skin rashes, and other bleeding symptoms including epistaxis, mucosal bleeding,
hematemesis, hemoptysis, melena, hematochezia, and
hematuria.
Upon presentation, vital signs were normal. His physical examination was notable for scattered
large ecchymoses involving the right upper, left upper arm, left upper arm, chest, and abdomen.
What tests should we anticipate the physician to order on this patient?
What could be some potential medical diagnoses for this patient?
What are some potential education topics for this patient?
A 2-year-old girl with no significant medical history presented to the emergency department with
febrile seizure and a six-day history of fever above 102°F treated with amoxicillin and clavulanic
acid (Augmentin) without any improvement. No weight loss or unusual fatigue were reported.
She had been tracking along her growth curves and meeting her developmental milestones
appropriately. She was born full-term with no significant complications. There was no significant
family medical history. Her only recent medications included acetaminophen and ibuprofen.
Physical examination revealed prominent lymphadenopathy involving cervical and
supraclavicular lymph nodes. Diagnostic work-up includes an abdominal ultrasound and
abdominal CT, which revealed multiple enlarged abdominal lymph nodes and
hepatosplenomegaly. Blood work showed a WBC count of 1.77, hemoglobin of 10.1, and
platelets of 70. She developed pancytopenia in the days following admission. A viral serological
panel detected the presence of Epstein-Barr virus (EBV) anti-VCA IgM antibodies. Due to the
atypical presentation of the EBV infection with pancytopenia, an oncological work-up with
initiated to rule out malignancy.
What could be some potential medical diagnoses for this patient?
What are some nursing interventions for this patient?
How could you care change due to the patient’s age?
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