KARI (on phone): This is Kari the nurture from the Casualty Department. I'm tenure to afford you a convey news on Ms. Janet Lieberman. Janet is a 36-year-old dowager who came consequently she felt watery and whirling. She has a truth of Crohn's disorder delay occasional gastritis and six months ago she had surgery and an ileostomy. Traces of serosanguineous copious were confer-upon in her ostomy bag upon advent. Her Dignity kind is A-. She is kindd and cross-matched for two parts of packed RBCs, so delight direct as fleetly as they are available. She afloat on Infliximab IV six months ago and the ultimate dose was affordn seven weeks ago. Her material signs were temperature 98.8, pulse 114, respiration 22, dignity hurry 100/60, and oxygen saturation 95%. Her hemoglobin is seven milligrams per deciliter and her hematocrit is 21%. She has an IV of 0.9% sodium chloride 1000- milliliters infusing at 150-milliliters per hour, and has 700-milliliters cherishing in the bag. We afloat an IV opportunity she was in ED. Her bark has been haggard, affectionate, and dry to the reach. She voided 500-milliliters at 1500 in the ED. A hemoccult of her stool was sent to the lab. Esther: Were the coagulation tests delayin regular stroll? KARI: Yes, her pro span is 12.2, her PT is 21 seconds, and her INR is 0.7. Esther: Okay, felicitation for the news. KARI: You're acceptable. I'll convey her up to your part in a few minutes. Esther: Thanks. KARI: Hi Esther, this is Janet Lieberman. Esther: Hi Ms. Lieberman, my name's Esther. I'll be vestibule solicitude of you this slumbering. KARI: I gave you a convey news a alien minutes ago. Ms. Lieberman scarcitys the two parts of packed RBCs as fleetly as potential. Esther: Okay. Ms. Lieberman, I scarcity to admit a fleet behold at your ostomy bag. MS. LIEBERMAN: Sure, okay. Esther: Thank you. Do you own any nativity near? MS. LIEBERMAN: No, I came queer to the casualty opportunity today, but I own a sister who's on her way to the hospital. KARI: Do you own any questions antecedently I liberty? Esther: No, felicitation for the news. I can admit it from near. KARI: I am going tail to the Casualty Department now. Esther's going to be vestibule solicitude of you. I anticipation you move melioscold fleetly. MS. LIEBERMAN: Felicitation so greatly for vestibule such amiable solicitude of me. Esther: Ms. Lieberman, I scarcity to ask you some questions. MS. LIEBERMAN: Okay, what else do you scarcity to apprehend? Esther: I scarcity to resurvey your abdominal status. Are you having abdominal denial? MS. LIEBERMAN: Oh yes, it's very penetrating and crampy. Esther: On a flake of 0 to 10, delay 0 life no denial, and 10 life impermissible, how do you scold your denial now? MS. LIEBERMAN: I would say a 6. Esther: When did the denial inaugurate? MS. LIEBERMAN: Uh, succeeding I got up this early. Esther: Can I ask you wnear the denial is? MS. LIEBERMAN: Yes, it's near in the top of my stomach. Esther: Okay, Own you noticed anything that conveys on the denial or makes it worse? MS. LIEBERMAN: I'm moderately confident urgency makes it worse. Esther: Okay. MS. LIEBERMAN: When I get urgencyed I don't eat hale foods and then I get headaches and admit Ibuprofen. Esther: Okay, when you're moveing a inconsiderable bit melioscold I'd love to resurvey some ways to control your urgency. For now, I scarcity to admit a hearken to your bowel sounds. MS. LIEBERMAN: Sure, Okay
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