STUDY SHIA!!
Don’t neglect it
Scenario 1
Anesthesia
Nurse calling boy's mother
Anesthesiologist
Biopsy of the kidney
Tissue sample of the kidney
Send it to a pathologistq
Nephrectomy
Pre operative room
laparoscopic
TUbe camera
Surgeon
windpide
Lymph nodes
Family dz: sickle cell disease,cystic fibrosis, COPD, Down Synd, obs sleep apnea, clef pallat
wound, oozing, bleeding, Dad allergic reaction to benzocaine
Medications: Nasal spray
KNown dz: Seasonal allergies, pollen, citrizine
Several medications and dosages
allergies: latex, aspirin, penicillin
Metastasis
Foots: lean meat, fatty foods, whole grains
Scenario 2
All types Pain, dull pain,
Marcapasos
cateterismo
HZTC, lisinopril
Cardiovascular info
Smoking
Dental info
Lungs
Pneumonia, TB, ca, cv disease, STroke, dental infex, COPD
Dolor en pecho,
Congestive heart failure
EKG
CAT scan
Blood work
Nicotin patches
Scenario 1
Dr Smith: Welcome to the Pre-op, Dr Horowitz, the surgeon we be here briefly to explain the
surgery. I am Dr Smith, the anesthesiologist. I need to ask you: Is Javier allergic to aspirin,
penicillin, ibuprofen, latex, iodine or contras?
Mama: Si, Javier tiene alergias estacionales, al polen y a los ácaros.
Dr Smith: Ok, I’m going to prescribe him Zyrtec 10 mg two per day, fluticasone spray twice a day,
he will spray one in each nostril.
Dr Smith: Does Javier have any blood relatives with medical history of chronic disease such as
sickle cell disease, obstructive sleep apnea or hear murmur?
Mama: El papa tiene reacción alergia a benzocaína. Con respecto a enfermedades en la familia hay
fibrosis quística y síndrome de down. No hay ninguna otra enfermedad congénita aparte de esas.
Si tenemos sobrina que tiene paladar hendido, pero esa no cuenta porque no es pariente de
primer grado de consanguinidad.
Doctor: Ok mom, thank you. Dr Horowitz is here.
Dr Horowitz: Hello, I am Dr Horowitz. Let me walk you through the procedure: first the general
anesthesiologist will give Javier general anesthesia that will put him completely asleep. Once he’s
asleep, well do the laparoscopy.
Dr Horowitz: During the laparoscopy, we will use a camera and use small tools. Once he’s asleep,
I’ll make a small incision in his abdomen, put a camera in his body to obtain a sample of his kidney
tissue and send it to pathology.
Dr Horowitz: The pathologist will perform a biopsy on the tissue sample, well determine if it’s
benign, malignant, localized, or if it’s spread all over the body.
Mama: Si, el doctor me dijo que eso lo metástasis. Cuando el este en esa etapa, hay q estar
pendiente que no tenga sangre en orina, dolor en espalda baja o este bajando peso. De igual
manera, la enfermera nos enseno como cambiar las vendas y gasas.
Mama: ¿Entiendo Doctor, despues del procedimiento, de que debo estar pendiente en casa?
Dr Horowitz: You must look out for constipation, dry mouth and drowsiness. The site area of the
incision must be dry. Call us if you see peeling or bleeding.
Dr Horowitz: We’ll prescribe a special diet which include lentils, whole grains, low fat milk, lean
meat. He should stay away from greasy and spicy food.
Scenario2
DR: good morning Mrs Rojas, im Dr Jones and the nurse told me that you decided to come to the
emergency room since you felt fatigued, dizzy, you had a chest pain and a right leg pain.
PATIENT: Doctor estoy preocupada por mi dolor en el pecho y mareos la ultima vez que senti los
sintomas me hicieron un angiografia y me pusieron un marcapasos.
DR: I understand and does it pain stay there or does it move somewhere else? please describe if
the pain is sharp, throbbing , dull or feels like pressure.
PATIENT: Es un dolor insoportable (dijo acute) y a veces se traslada a mi brazo izquierdo, también
siento sibilancias cada vez que subo las escaleras, estoy preocupada porque mi abuelo tuvo
insuficiencia cardiaca congestiva.
DR: okay we will perform an EKG on you, are you still taking your Hydrochlorothiazide you were
taking 5 mg twice a day? and has it been increased to 12.5 mg correct?
PATIENT: sí doctor yo también estoy tomando 20 mg de lisinopril y me gustaría añadir a que hace
3 semanas me diagnosticaron neumonía, son todos estos síntomas están relacionados con mis
pulmones en lugar de mi corazón?
DR: that is a possibility, in order to rule out (continuar) that I'm going to order a lab work, a CT
scan of your Torax, hold on while I grab my stetoscope and gloves to perform a physical exam on
you, when was the last time you saw your cardiologist?
PATIENT: bueno diría que fue hace unos días pero ya se jubiló, se llamaba Dra García, estoy
pasando por depresión y me siento ansiosa no puedo dejar de fumar han pasado 20 años
DR: well it is very important you understand these are some serious issues to your health and can
develop COPD, vascular disease, dental problems and infections. It also puts a higher risk for
tuberculosis, Cancer and a stroke, your body sending you a warning
PATIENT: tiene razón doctor por favor ayúdeme a dejarlo, mi abuelo también tuvo un enfizema.
