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Notes - Entering the hospital after a 12-hr shift the day...

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Entering the hospital after a 12-hr. shift the day before, Dr. Smith is disgruntled to find a full waiting room again. Luckily he only has three patients so far and Nurse Jackie has been a tremendous help getting all the documents ready for him to review. Now it is time to get started – see the patients, follow the steps in SOAP and hope beyond hope that he does not lose anyone today. What Dr. Smith did not want to reveal to Mr. Jackson just yet is that he believed the patient’s liver was failing. It was odd though, Jackson was not a drinker, and there was no mention of hepatitis on his medical record. When Dr. Smith stepped into exam room 2, he was sure this would be an open and shut case – one of the easy ones. After an examination he found out just how wrong he was. This little boy was showing every sign of a very common infection; but this was no ordinary flu diagnosis. While listening with his stethoscope, Dr. Smith could hear the difficulty in the young boys breathing, could feel the labored respiration. The patient’s oxygen levels were well below normal, and his exocrine glands appeared to be working double time. His fingers – not yet showing signs of cyanosis but the nail plate was. Dr. Smith was sure what this was but had learned from experience that you ALWAYS wait for the results before explaining things to family, especially when it involves such a young child. The labs were sent in and Dr. Smith moved on to the next room while waiting for the results of his first two patients. Cystic Fibrosis can cause mucus to be quite viscous which blocks the alveoli and the bronchioles; it also causes cysts in the pancreas (that is how it got its name). People with this condition eventually need daily drainage of mucus in their chest. The life expectancy of someone with cystic fibrosis is not long; this is a hard blow to have to deal with, and telling the parent is never easy. The young boy was not Dr. Smith’s only patient and he had to get moving one. Dr. Smith has always dreaded walking in to an exam room with a woman ready to pop waiting inside; they are not usually the most predictable of patients. However, this woman seemed calm and completely under control – her only real complaint was the swelling of her feet which as Dr.
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