Emily is a healthy 30-year-old woman, who has been experiencing pelvic pain, dysmenorrhea, and dyspareunia (painful intercourse) for the last 6 months. She has no medical problems and is not taking any medications. Emily scheduled an appointment with the nurse practitioner at her gynecologist’s office to discuss her signs and symptoms. She is sexually active and uses condoms for birth control.

What is endometriosis?
Is endometrial tissue outside the uterus similar to endometrial tissue inside the uterus?
What are the theories concerning the cause of endometriosis

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H.J., a 74-year-old African American male, is a retired army military officer. His wife of over 50 years passed away four years ago. He has four daughters and two sons who are all grown and married. He has fourteen grandchildren with a great-grandchild on the way. His son brought him to the health care provider today because he is concerned his father has been more forgetful and is losing weight. H.J. has a history of coronary artery disease that is being managed with metoprolol XL (Lopressor) and aspirin.

Subjective Data

Patient states, “I am doing fine. I just miss my wife and the fine meals she used to make.”
His son says he has noticed his dad has been tightening his belt up to two notches.
Patient states, “My children are worrying unnecessarily.”
What level of assessment do you need to perform?
How will your assessment be different from the assessment performed by the health care provider?


Patient Profile

A.J. is a 56-year-old man who goes to see the health care provider for chronic fatigue. He has a history of type 2 diabetes, obesity, and depression.

Subjective Data

States he is sleepy all of the time
Goes to bed at 10:00 p.m. and gets up at 7:00 a.m. but is tired when he gets up and never feels rested
Wife states he snores loudly
States he has frequent headaches, which are worse in the morning when he wakes up
Admits drinking “2-3” alcoholic beverages each evening

Objective Data

Physical Assessment

Temperature 98.4° F, pulse 88, respirations 18, blood pressure 146/86
Oxygen saturation 97% on room air
Height 5’8”, weight 210 lb, BMI 32 kg/m2

Diagnostic Studies

Hemoglobin A1C 8.8%
Hct 47%
Hgb 17 g/dL

Discussion Questions

1) What are A.J.’s risk factors for OSA? What are other risk factors for OSA?

2) A.J. asks how a diagnosis of OSA would be made. How would you respond?


R.B. is a 48-year-old female with an established history of rheumatoid arthritis. She is a horse trainer, which is her sole source of income to provide for her two daughters. She says the environment in which she works encourages social drinking as part of entertaining clients. R.B. states that symptoms had been kept under control until now. This latest flare-up has lasted three days and the pain is getting worse. Her current medications are:
• Methotrexate 20 mg PO every week
• Sulfasalazine 500 mg PO bid

Subjective Data
• Has had rheumatoid arthritis for 10 years
• Has been feeling tired, with a decreased appetite and overall joint and muscle aches
• Using heat and cold packs3-4 times a day to try to alleviate the pain with minimal success
• Smokes one pack of cigarettes per day
• Drinks two to five beers per day

Objective Data
• Blood pressure 144/84, pulse 88, temperature 98.9o F, respiratory rate 20
• Height 5’8″, weight 155 lb
• Increased discomfort with palpation of the shoulders, elbows, wrists, and knees

1. What type of pain is R.B. experiencing?

2. What risk factors does she have that could contribute to exacerbation of her rheumatoid arthritis?

3. She is prescribed prednisone (Deltasone) 10 mg orally every other day and ibuprofen (Motrin) 200 mg orally three times daily. What teaching regarding these medications would you provide R.B.?

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