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External exam

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1. Summarize the history.
 
 
2. How would you characterize the severity of the patient’s diabetes?
 
 
3. What are the main, underlying medical problems of the patient?
 
 
4. Why might this patient have an elevated ammonia? What other part(s) of the history might support your answer?
 
 
5. What could cause a fall, such as this patient had?
 
 
6. When a patient dies after a fall, what might explain this?
 
 
7. What concerns might families have about an unwitnessed fall in a rehab setting?
 
 
8. What constitutes “appropriate monitoring” in a nursing home? In rehab? On a general medical floor? In the ICU?
 
 
9. How is trust built between providers and patients/families?
 
 
10. The family was concerned about bruising after the fall. In the setting of an unwitnessed fall, one family might attribute bruising to the fall. Another family might suspect foul play. How would you account for this difference in views? What can you do, as a provider, to build trust with a family?
 
 
11. Complete the external exam and inventory the physical findings.
 
 
12. What surgeries has the patient had? Are they old or new?
 
 
13. What is the name of the lower leg condition? What causes it?
 
 
14. Based on the physical exam, what’s reasonable to infer about the patient’s mobility?
 
 
15. Is there any evidence to suggest the patient might have been diabetic? What physical findings might suggest it?
 
 
16. Based on the physical exam, what general medical conditions might you predict here? What specific internal findings would you anticipate of check for based on each finding in the external exam?
 
 
17. You are a nurse: What nursing care plans would you implement for a patient with these physical findings.
 
 
18. You are a physician: What admission orders would you consider based on the exam so far?
 
 
19. You are an emergency service provider: What are the indications for inserting an intraosseous needle.
 
 
20. You are an emergency service provider: You are called to the scene and find a patient with these physical findings. In what way, if any, will your plan alter.
 
 
18. Do you think the bed sore is infected? Was there a debridement?
 
 
19. Is there any evidence to suggest the patient might have been septic?
 
 
20. Identify the livor mortis. Explain why the center of the back is pale.