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Health history and Physical examination - Coggle Diagram
Health history and Physical examination
Admitting medical diagnosis with pathophysiology process
Lung cancer stage 4 mets to mediastinal lymph nodes
Etiology: Tobacco smoking, industrial hazard, air pollution, dietary factor (Vit A deficiency), chronic scarring
A single epithelial or gland cell of the tracheo-bronchial airways is damaged through binding of carcinogenic chemicals to the cell DNA
Cellular changes (mutation) occur and abnormal cell growth -> malignant cell
Damaged DNA is unstable and passes on changes to daughter cells
This is the start of invasive carcinoma
Stage 4 is the most advanced form of lung cancer and is metastatic. Cancer cells separate from the original tumor and move through the body via the blood or lymph system. The cancer has spread from the lung to mediastinal lymph nodes
Massive hemoptysis
Due to metastatic lung cancer to mediastinal lymph nodes
Mediastinal mass/tumor
Enlarged lymph nodes
Pressure put by the tumor onto surrounding structures, such as spinal cord, heart or pericardium
Massive hemoptysis
Coughing up blood or blood stained mucus with blood loss 100-600 ml over 24 h
1 more item...
Other current conditions
Papillary thyroid cancer
currently taking tablet Levothyroxine as prescribed by the doctor 100 mcg OD 1 hour prior to meal for thyroid hormone replacement therapy
++ ascites
Past history
Had a total thyroidectomy and anterior neck dissection on 27/11/17 due to thyroid cancer.
Diagnosed with right lung adenocarcinoma stage IIIA non-small cell lung cancer (NSCLC) in October 2017.
PET/CT done on 21/11/2017 showed FDG avid primary malignancy of thyroid and lung with regional nodal metastasis.
Unemployed, living with family
Ex-smoker, non-alcoholic.
Significant physical examination findings
Inspection:
Alert and conscious.
Rapid rate of breathing with wheezing sound heard sometimes.
Ineffective cough.
Patient has a distended abdomen with paraumbilical hernia.
Palpation:
Left leg swelling (+).
No tenderness felt in the abdominal area.
No palpable lymph nodes
Percussion: ++ ascites.
Auscultation: Coarse crept(crackles) are heard over the posterior lungs.
History of present illness
First episode of massive hemoptysis while at ETD with expectorated 100 ml of fresh blood,
managed by
-Neb Tranexemic acid 5 ml stat at 11.40 pm
-Neb adrenaline 4mg/4ml stat at 12 am.
Then, occasional incidents of epistaxis and hemoptysis at palliative care ward,
managed by anterior nasal packing with adrenaline and IV Tranexamic acid 500 mg tds respectively.
Ineffective cough
Breakthrough pain related to background pain. Aching pain is felt sometimes at the back and/or near the right shoulder. Controlled by oral medication tablet paracetamol 1g PRN.
Having ascites. Peritoneal tapping is done 23/08/2021 to drain ascites fluid
