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Theresia was admitted with an acute pelvic inflammatory disease Theresia was admitted to the Gynaecology ward at 2 a.m.

she had been feeling unwell and had experienced lower abdominal pain for several days, but on this day the pain had become gradually worse until by 11 p.m.. she was in severe pain and very frightened. Christ, her husband, persuaded her that they should telephone their G.P. and he came to see her at half past midnight. He took theresias temperature which was raised, and discussed her symptoms with her, and then thought she ought to go to hospital to be observed and examined. Theresia was upset, but as the pain was still severe and she was very worried, she agree to go. Christ quickly gathered together some of the things that she might need in hospital, while the G.P organized an ambulance and talked to the doctor on duty at the hospital. In the darkened quiet ward, the night nurse receives the message that a patient is coming in with severe lower abdominal pain. She goes quickly to a single empty room and prepares it, collecting equipment that may be needed so that there will be no delay or unnecessary noise when the patient arrives. The night nurse realized that the symptom of lower abdominal pain without any other information could mean a variety of conditions. The doctor arrives and Christ is asked to sit in the waiting room while his wife is examined When the doctor has completed taking a history and doing a physical examination he diagnoses theresias pain as the result of an acute pelvic inflammatory disease. The senior doctor on duty will be asked to confirm this diagnosis.

MRS. Lukmanto was admitted with an acute asthmatic attack

Mrs. Lukmanto is 37 years old, and has a 15-year-old son. She has had intermittent admission to hospital with acute attacks of asthma since she was 21. This time the asthmatic attack was due to bronchitis which mrs. Lukmanto had had for three days. After initial treatment in the casualty department mrs. Lukmanto was taken to the ward and helped into bed. The nurse assigned to her care welcomed her to the ward, gently told her that she would soon be feeling more comfortable, and ensured that she was well supported with four pillows. The oxygen theraphy commenced in casualty was continued.

How old mrs lukmanto ? How old is her son ? What is her chief complain ? How long mrs lukmanto suffering from her complaint? How many pillow that supported her ? What theraphy that given to her ?

Mr. Jansen has had a myocardial infarction Mr. Jansen was a 64-year-old psychologist who managed a clinic for mentally handicapped children. He was very active despite his age. He had had thrombophlebitis of his left leg, but since he was not incapacitated, he had been treated at home for it and was totally cured. Yesterday, whilst at work he suddenly developed a crushing, center chest pain which radiated up his throat and down his left arm. His assistant called an ambulance and he was brought into the casualty department where a diagnosis of myocardinal infarction was made. He was immediately transferred to the coronary care unit after being given diamorphin to relieve his severe pain. This was done because complications following a heart attack are likely to occur during this period of time. The staff in the coronary care unit are specially trained to look out for, and to treat, any abnormalities as they occur so that life threatening complications will not develop. On arrival at the CCU mr. jansen was pale, sleepy, but free from pain. He was accompanied by his wife. He was settled into bed and attached to a cardiac monitor. The doctor arranged for an ECG straight away.

Mr. Hendra had a peptic ulcer Mr. Hendra, a 47-year-old man, was known to have an ulcer in his duodenum. One evening while at home with his wife watching television, he suddenly felt dizzy and

sick, and vomited a large amount of blood (haematemesis). He felt cold and clammy, and then had a bowel movement. The stool was black and tarry (malaena). Both Mr. Mrs hendra were frightened by what had happened, and Mrs hendra rang for the doctor immediately. The doctor arrive quickly, examined mr hendra and arranged his admission to hospital right away. On arrival at the ward hendra was very cold and clammy, his blood pressure was 90/50 mmHg and his pulse was 136 beats per minutes, he was pale, restless and frightened. These symptoms all indicated shock resulting from a sudden loss of blood. The nurse responsible for mr. hendra/s care assured him that immediate action would be taken and that soon he should be feeling more comfortable. She helped the doctor prepare an intravenous infusion and mr hendra was given normal saline and then plasma umtil blood was available for blood transfusion. (blood from the blood service had to be matched with a specimen of blood from mr hendra) The nurse measured and recorded all urine, vomit and stool passed my mr. hendra, and was careful to describe the nature of the vomit and the stool in the nursing records and on the relevant observation charts. She also recorded all fluid given intravenously to mr. hendra. All this information would be used by the doctor when evaluating mr. hendras progress and treatment, therefore accuracy in record keeping is essential. In order to confirm the cause and site of the bleeding the doctor decided to perform a gastroscopy. The patient must be starved prior to the procedure. If an abnormality would be noted a biopsy might be taken. Pregnancy The average duration of pregnancy is forty week which is ten lunar months or two hundred and eighty days or approximately nine calendar months and one week. The date on which the baby is due to be born is called the expected date of delivery (EDD). This is calculated as being forty weeks after the first day of the last normal menstrual period. When the pregnant women reaches her EDC she is said to be at term, after conception, the fertilized ovum is implanted into the inner lining of the womb, and the site of implantation the afterbirth or placenta develops. The placenta is essential for the survival of the unborn baby because the baby is being incubated inside a sac of fluid within the mothers womb and therefore it can not breathe in the normal way, nor can it forage for food. The baby is isolated in the fluid contained in the bag of membranes. The babys blood flows along the umbilical cord from the baby to the placenta, and then back to the baby. Likewise the mothers blood flows through cavities in the wall of the womb next to the placenta. In this way oxygen and foodstuff pass from the mothers blood to the babys blood

through the placenta, and carbon dioxide and other excretory products pass from the babys blood to the mothers blood. The baby is entirely dependent upon the mother and the placenta for survival. The womb grows in size as pregnancy continues and at term, it is a large powerful, muscular organ, ready to expel the baby during labour. During the last twelve weeks of pregnancy the mother feel the womb contract from time to time, but these are not painful contractions. They are known as Braxton hicks contraction, and they indicate that the womb is toning itself up in preparation for the hard work it will have to do during labour. If the baby is born before the thirty-fifth week of pregnancy its chances of survival are rather poor. From the thirty-fifth week up to the thirty-eighth week there is a sharp improvement in the survival rate. Abortion or miscarriage is defined as the expulsion of the products of conception (I.e. the baby and the placenta) before the end of the twenty-eighth week of pregnancy. Abortion is the correct medical term for miscarriage. Premature labour is defined as expulsion of the products of conception after the end of twenty-eighth week of pregnancy and before term.