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By R. Konrad. Pennsylvania State University at Altoona.

His sources of support are his wife buy proventil 100 mcg without a prescription chronic asthmatic bronchitis icd 10, minister proventil 100mcg otc asthma treatment in qatar, and a sister who lives near the patient. Has worn reading glasses since 1995; notes blurred vision for 1 year; last eye ap- pointment 1996. Resp 16, HR 88 and regular, BP 110/70 left arm supine Skin: Tattoo left arm, otherwise no lesions Node: 1 × 1 left axillary node, nontender and mobile. Funduscopic examination disks sharp bilaterally, moderate arteriolar narrowing and A-V nicking. Internal jugular vein visible 2 cm above the sternal angle, pa- tient at 30 degrees. Breath sounds normal except end-inspiratory crackles heard at both bases that do not clear with coughing. Apical impulse palpable at the sixth intercostal space 2 cm lateral to the midclavicular line. No inguinal lymphadenopathy Genital: Normal circumcised male, both testes descended without masses or tenderness Rectal: Normal sphincter tone. Stool present, stool for occult blood negative Musculoskeletal: Lumbar spine decreased flexion to 75 degrees, extension to 5 degrees, decreased rotary and lateral movement. No clubbing cyanosis or edema Peripheral Vascular: Radial, ulnar, brachial, femoral, dorsalis pedis, and posterior tibial pulses +2/4 bilaterally. Intact finger-to-nose and heel-to-shin bilaterally; gait normal—normal heel-and-heel, toe-and-toe, and heel-to-toe gaits. Rapid alter- nating movements intact upper and lower extremities bilaterally DATABASE ECG. HR 80, NSR inverted T waves V1 through V5 1 History and Physical Examination 31 1 CXR. The ST depression without evolving Q waves was consistent with a nontransmural MI. Jones is at risk for further MI since it was a nontransmural MI, and he will require further evaluation before discharge. Signature: ______________________________ Title: __________________________________ Date Date of Date Entered Onset Problem Active Inactive Inactive 7-10-01 4-01 1 Coronary artery disease 7-10-01 7-7-01 1a Subendocardial MI—anterior 7-10-01 1998 2 Hypertension 7-10-01 1997 3 Bronchitis 7-10-01 1999 4 Heartburn/reflux esophagitis 7-10-01 1990 5 Back injury 7-10-01 7-10-01 6 Eosinophilia 7-10-01 2000 7 Blurred vision 7-10-01 1970 8 Appendicitis 1970 This page intentionally left blank. VAAN DIML,” which stands for Admit/Attending, Diagno- sis,Condition,Vitals,Activity,Allergies,Nursing procedures,Diet,Ins and outs,Medications, and Labs. Condition: Stable, critical, etc Vitals: Determine frequency of vital signs (temperature, pulse, blood pressure, central ve- nous pressure, pulmonary capillary wedge pressure, weight, etc) Activity: Specify bedrest, up ad lib, ambulate qid, bathroom privileges, etc Allergies: Note any drug reactions or food or environmental allergies. Temperature >101°F, BP <90 mm Hg, etc Diet: NPO, clear liquid, regular, etc Ins and Outs: Refers to all “tubes” a patient may have. NG to low wall suction, Foley to gravity, etc 33 Copyright 2002 The McGraw-Hill Companies, Inc. List each medical, surgical, psychiatric problem separately: pneumonia, pancreatitis, congestive heart failure, etc. When the problem is resolved, mark it as such and delete it from the daily progress note. Or, you may do a separate assessment and plan for each problem Soap Subjective • How the patient feels, any complaints Objective • How the patient looks • Vital signs • Physical examination • Laboratory data, etc Assessment: (for each problem) • Evaluation of the data and any conclusions that can be drawn Plan: (for each problem) • Any new lab tests or medications • Changes or additions to orders • Discharge or transfer plans DISCHARGE SUMMARY/NOTE A formal discharge note is usually required for any admission that is longer than 24 h at most hospitals. This note provides a framework for the complete dictated note as well as providing a reference, if needed, before the dictated note is transcribed and filed. The fol- lowing skeleton includes most of the information needed for a discharge note. Date of Admission: Date of Discharge: Admitting Diagnosis: Discharge Diagnosis: Attending Physician and Service Caring for Patient: Referring Physician: Provide address if available. Procedures: Include surgery and any invasive diagnostic procedures, eg, lumbar punctures, arteriograms. Hospital Course: Briefly summarize the evaluation, treatment, and progress of the patient during the hospitalization. Disposition: Where was the patient discharged to (eg, home, another hospital, nursing home)?

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The result can be dam- GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1189 Lead in water Airborne lead Lead-glazed pottery Peeling lead paint Lead crystal Peeling lead paint Lead soldered cans Lead from soil Lead painted toy Continuous exposure to lead can damage nearly every system in the human body and is particularly harmful to the develop- ing brain of fetuses and young children order proventil 100mcg on line asthma treatment prednisone. Common sources of lead exposure include lead-based paint proventil 100 mcg online asthma 68, dust and soil, drinking water, food from cans, and eating utensils, such as plates and drinking glasses, that are lead-based. Acute lead poisoning, which is somewhat rare, oc- 200 deaths from lead poisoning in the United States be- curs when a relatively large amount of lead is taken into tween 1979 and 1998. Chronic lead poi- males (74%), African Americans (67%), adults over the soning — a common problem in children — occurs when age of 45 (76%), and Southerners (70%). The Centers for Disease Control and Prevention (CDC) About one out of every six children in the United defines childhood lead poisoning as a whole-blood lead States has a high level of lead in the blood, according to concentration equal to or greater than 10 micrograms/dL. Many of these children are exposed to lead through peel- ing paint in older homes. Others are exposed through Description dust or soil that has been contaminated by old paint or Lead can damage almost every system in the human past emissions of leaded gasoline. Since children be- body, and it can also cause high blood pressure (hyper- tween the ages of 12–36 months are apt to put objects in tension). It is particularly harmful to the developing their mouths, they are more likely than older children to brain of fetuses and young children. Over the long term, lead poisoning in a child can lead to learning Over 80% of American homes built before 1978 disabilities, behavioral problems, and even mental retar- have lead-based paint in them, according to the Centers dation. At very high levels, lead poisoning can cause for Disease Control and Prevention (CDC). According to the Nation- home, the more likely it is to contain lead paint, and the 1190 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 SOURCES OF LEAD POISONING Source Description Paint Lead-based paint can be a hazard in older homes. Children eat peeling paint, chew on painted surfaces, or come in contact with it during remodeling projects. Dust and soil Contamination of soil is usually caused by paint, leaded gasoline, pollution from industrial sites, and smelters. Foods Lead can be found in imported canned foods, leaded crystal, and some ceramic dishware. Activities Activities such as pottery, stained glassmaking, and furniture refinishing can heighten exposure to lead. Lead around their homes or in their drinking water without may also be found in leaded crystal glassware and knowing it, since lead cannot be seen, smelled, or tasted. In addition, food Before scientists knew how harmful it could be, lead may be contaminated by lead in the water or soil. Today, house paint is almost lead-free, alarcon, alkohl, azarcon, bali goli, coral, ghasard, greta, gasoline is unleaded, and household plumbing is no longer liga, pay-loo-ah, and rueda) and traditional cosmetics made with lead materials. Still, remnants of the old hazards (kohl, for example) contain large amounts of lead. Following are some sources of lead exposure: Also, certain Chinese and Tibetan herbal remedies and • Lead-based paint. This is the most common source of techniques are contaminated with lead, and other heavy exposure to large amounts of lead among preschoolers. They may also chew on legally distilled liquor is still a cause of death among painted surfaces, such as windowsills. These can be contaminated with lead sorbed from bullets or bullet fragments that remain in from old paint or past emissions of leaded gasoline. Exposure may come from lead water children even at low levels that were once thought to be pipes, found in many homes built before 1930. Even safe, and the risk of damage rises as blood levels of lead newer copper pipes may have lead solder. The symptoms of chronic lead poisoning take new homes have brass faucets and fittings that can time to develop, however. A number of activities can expose time, though, problems such as the following may arise: participants to lead. These include making pottery or • learning disabilities stained glass, refinishing furniture, doing home re- • hyperactivity pairs, and using indoor firing ranges.

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