Fugitive

Could I please get your thoughts on this case study? I'm having problems with figuring out what more (possibly) could be going on given the information. Thank you! ---------------------------------- Mr. H. is a 64 yo male with H/O COPD, HTN, Type II DM. He just arrived this am from the EC with the diagnosis of uncontrolled HTN, (Admitting BP was 220/110), and Chest Pain. The symptoms that brought him into the EC were severe morning H/A with occasional vomiting X 3 days, SOB and C.P. When you examine him you notice a large bruise on his right elbow and hip. He relays a H/O a fall recently. He complains of dysphagia which he attributes to a sore throat from vomiting. He ia slightly disorientated and drowsy, but received a dose of Zofran for vomiting before he was brought up to your unit.His HA has returned but he feels he can not take anything po because of his earlier vomiting. Labs: Na: 145, K: 3.7, Cl:110, C02: 28, BUN: 22, CRT: 1.5, BS 210 Hgb 12.7, WBC: 10.3, PLTS: 110. CK enymes neg Chest X-Ray: No effusions, pnemonia but emysematous changes noted. Current BP: 156/98 HR:78 reg., RR: 24 on 4L O2 What could be happening to Mr. H.? Hint: Is all his symptoms related to HTN? ---------------------------------- My impressions: The symptoms that he's exhibiting seems related to his HTN and COPD. His uncontrolled HTN is probably what is causing his severe HA which in turn is causing his N/V. The SOB and RR: 24 is due to the COPD w/ emphysematous changes. His bruising is from the fall and was also contributed to by a PLT: 110. Besides medication, I don't know what else could be causing his low platelets. He doesn't have a history of a blood disorder. I would check his medications to see if something could be causing it. His Cl and Cre are elevated. Possible renal insufficiency related to HTN and DM? But his BUN is normal. I think CBC and ABG should be drawn to better assess.

We just finished our unknowns this past Friday. It's funny. From looking at the streak plate, then confirming with a gram stain, I knew that my unknown bacteria was Escherichia coli. After doing the other tests it turned out I was right. Well... actually the only test that messed up was the API. Stupid API... --------------------------------------------------- For help with finding unknown: http://bio.classes.ucsc.edu/bio119l/9characterization.pdf Actually that link provided by Malia is perfect. Look under biochemical tests. Do all those. At the end do the API.

I got an A in both my chemistry classes and it really wasn't too hard. Though I have to say that these weren't the typical chem classes. They were for nursing. CHM 1020 was general inorganic chemistry and CHM 1030 was organic and biochemistry. Anyways... It was definitely the easiest of all the prerequisites. My favorite class though was Anatomy & Physiology. Good luck in chemistry!

So really dummied down... In glycolysis glucose is converted into 2 molecules of pyruvate. ATP (net 2) and NADH are also formed. The following is within the mitochondria: Through anaerobic respiration, pyruvate is either converted into lactate or ethanol. Through aerobic respiration, pyruvate in converted into acetyl-Coenzyme A. Acetyl-CoA enters the Krebs Cycle (the citric acid cycle). It goes through a series of 9 reactions. The first reaction combines acetyl-CoA with oxaloacetate. After the nineth reaction, the end product is oxaloacetate. This will then combine with acetyl-CoA to start the cycle over again. NADH and FADH2 are formed at different points in the cycle. NADH and FADH2 are electron carriers. They deposit their electrons (the hydrogen) into the electron transport chain. The electrons travel through the chain carried by cytochrome and quinone which are electron carriers. The electrons, while travelling through the chain, lend their energy to a series of proton pumps. The proton pumps take H+ (proton) out of the matrix and into the intermembrane space creating a gradient. H+ wants to diffuse (high to low) back into the matrix. Chemiosmosis takes place when an ATPase pumps H+ back into the matrix while simultaneously combining ADP with a phosphate to create ATP. The low energy electrons exit the chain and combine with oxygen to form water. The theoretical yield of the electron transport chain in 36 ATP. The is very basic. I hope you understand it. You'll have to use your textbook to fill in the details. You should find out what reactions occur. Also know what products are formed and how much is formed. Here's something even more simple: Glycolysis: Glucose -> Pyruvate Anaerobic Respiration: Pyruvate -> Lactate or Ethanol Aerobic Respiration: Pyruvate -> Acetyl-CoA -> Kreb's Cycle -> Electron Transport Chain Good luck!

Like many said, if I don't get in, then I'll just work wherever, probably take some more classes or repeat ones to get a better grade, and I'll keep applying to schools. At this point of my life there is no way I am gonna change my career plans/ goals.

Has anyone done a slide-mold culture yet? I cultured Rhizopus stolonifer, but forgot to draw a picture of it. Here is a great website that has pictures of several molds/fungus. http://www.dehs.umn.edu/iaq/fungus/pictures.html Good luck in lab and class! Here's another website I just found. It's great for photos in general. http://www.microscopyu.com/index.html

I think you have to redo the lab experiment. Acid-fast staining is used for detecting the presense of all Mycobacterium. Here's a quote from my lab book: "The acid-fast stain is an important differential stain for identifying bacteria in the genus Mycobacterium, some of which are pathogens (e.g., M. leprae and M. tuberculosis, causative agents of leprosy and tuberculosis, respectively)." I don't know how you got the Staphylococcus epidermidis to show (+) for acid-fast. What technique did you use? When my class did this lab we used the Ziehl-Neelsen method. The counterstain used was methylene blue. Anything that was negative for acid-fast staining was the color blue. Just like you, we did M. smegmatis and S. epidermidis. The Mycobacterium was pinkish red and the Staphylococcus was stained blue. That means the S. epidermidis is negative for acid-fast. The other method of staining is the Kinyoun. If you used that method, then your S. epidermidis should have stained green by the brilliant green counterstain. I guess after reading my post you won't have to redo the lab. Haha! Just remember what I wrote if you have a quiz or have to write a lab report. Good luck in lab!

It's definitely Gram(+). It's (-) for acid-fast. If you want to comfirm my answers, just do a web search. You'll find ample information.

There are several universities that allow you to finish your prerequisites BY May 2006 and then start the program IN May 2006. Sure that leaves you a week to get settled into the fact that you're starting an accelerated program. I'm writing this spur of the moment so I can't remember exactly what universities. I think University of Miami in Florida has an accelerated BSN program that starts in May and allows you to finish your prereqs by May. Basically you're just gonna have to check. What schools were you interested in in the first place? Have you thought about and researched schools yet?

I guess I should clarify my position. I've already graduated and have my BA. The schools I'm applying for have accerelated nursing programs. I foolishly made the assupstion that people were in the same position that I'm in or similar because from what I've noticed, most people on here are not in their 20s (or maybe upper 20s). It makes sense that if you're a regular undergrad, that you would most likely only apply to one school. That school being where you are taking your prereq classes. But I guess if that's not the case, then that is where my previous question would come into play. Well, I'm pushing this thread off topic so just ignore me. Haha!

I plan on applying to Spring 2006 and Fall 2006 start dates. May applications are due anywhere from November through March. Most or all of my prereqs will be done this semester. I might have to take an ethics class, a math class, or some nursing classes. It depends on the school I'm applying to. I'm curious... from skimming through most of the responses, it reads like people are concentrating on applying to one school. Possibly the school they are taking the prereqs at. I've noticed people say that if they don't get into nursing school this coming term, they won't know what to do. What I'm wondering is why don't you apply to more than one nursing program? The more you apply to the better chances of getting into one. I'm applying to several places. In Michigan and the surrounding midwest states. I realize that some people have obligations to stay in their location so you need to go to that particular school in your area. That's fine, but is that the case for eveyone? Also I could be misinterpretting what is being written so I just think it seems that most people are applying to one school. I was just curious.

MSU definitely has a BSN program, but that seems irrelevent because it seems like you want to stay close to home. As others have said, UM and WCC have degree programs for becoming an RN. Also it your area is EMU. They have a BSN program as well. Not sure if you have a bachelors, but if so, UM has an accelerated RN program. That way you won't have to do 4 years of undergrad with a bunch of 18 year olds. I think there are private colleges in your area as well. They'll probably be more expensive though. If you do an online search for nursing school in Michigan, there's a website that has a list of them all. Good luck!

Thanks for the links! I had seen those previously when trying to find the answers doing a web search. I had to resort to asking my lab TA what the answer was. Now she knows I didn't create a S. epiderimis slide for the capsule stain and I have to write that in my lab report. I was trying to avoid that, but oh well...

Has anyone done the capsule stain of bacteria? In my lab we did the capsule stain and I was only able to create a capsule stain slide for Klebsiellla pneumoniae. I did not have time to create a slide for Staphylococcus epidermidis. Does anyone know if S. epidermidis show a sign of having a capsule after under going capsule staining? If it doesn't, how does the slide look for it? Is it just a pink background and a dark redish stained bacteria with no sign of a capsule? Thank you for any help!!

Does anyone know if Staphylococcus epidermidis shows a capsule after under going a capsule stain? If it doesn't, what does the slide look like? A red background with purple cocci bacteria? I already know that Klebsiella pneumoniae exhibits a capsule. Thanks for any help!