4/5/16 1500 T98.6, BP 130/70, P115, RR 36. Pablo Rodriguez is 71 years old male admitted to Emergency Department complained of increased pain and nausea and vomiting for 3 days. The patient also complained of hard, small stools. Rodriguez is suffering from advanced non-small cell lung carcinoma diagnosed one year ago. Received chemotherapy. After 6 months he received irradiation treatment for 6 weeks with a total dose of 63Gy in 34 fractions. The patient developed multiple subcutaneous nodules all over his body for 2 months on the upper chest anteriorly and on the back, left flank, left subchondral region, left hip, and left calf. Malnutrition related to nausea and vomiting. Pneumonia X 3-2, 3 and 4 years ago. Occasional alcohol use; history
…show more content…
Breathing shallow and rapid; diminished breath sounds in upper left lobes, some crackles bilaterally A&P. Dyspneic with increased respiratory rate 22. Shortness of breath, hemoptosis with sputum. Head of bed 45 degree. GI: Dehydration. Vomiting. Poor appetite. Get nauseated if eat spicy foods, cheese, or refried beans. Patient states loss of 50 pounds in the past year. Has metallic taste sometimes and has decreased ability to tastes/enjoy foods. Hypoactive bowel sounds auscultated in all 4 quadrants. Abdomen is soft, with no palpable masses. Constipation. Last bowel movement was 3 days ago small hard stool reported with as passed with difficulty. GU: Voiding freely of clear amber urine sufficient quantities. Skin: Hair thick, dry, and coarse. Skin warm, dry, and intact except for a few subcutaneous nodules over left upper chest anteriorly and on the back, left flank, left subchondral region, left hip, and left calf. There is also erythema. All other lesions are not tender to touch. Some are painful. The lesion in the left lower back area has some scab formation and pustules. Nodules are mostly dry without redness or drainages. IV: Peripheral IV left forearm with fluids of D5.45 NS infusing at 150ml/hr. IV site clear without signs of
Breathing shallow and rapid; diminished breath sounds in upper left lobes, some crackles bilaterally A&P. Dyspneic with increased respiratory rate 22. Shortness of breath, hemoptosis with sputum. Head of bed 45 degree. GI: Dehydration. Vomiting. Poor appetite. Get nauseated if eat spicy foods, cheese, or refried beans. Patient states loss of 50 pounds in the past year. Has metallic taste sometimes and has decreased ability to tastes/enjoy foods. Hypoactive bowel sounds auscultated in all 4 quadrants. Abdomen is soft, with no palpable masses. Constipation. Last bowel movement was 3 days ago small hard stool reported with as passed with difficulty. GU: Voiding freely of clear amber urine sufficient quantities. Skin: Hair thick, dry, and coarse. Skin warm, dry, and intact except for a few subcutaneous nodules over left upper chest anteriorly and on the back, left flank, left subchondral region, left hip, and left calf. There is also erythema. All other lesions are not tender to touch. Some are painful. The lesion in the left lower back area has some scab formation and pustules. Nodules are mostly dry without redness or drainages. IV: Peripheral IV left forearm with fluids of D5.45 NS infusing at 150ml/hr. IV site clear without signs of