General Information: GY is a 70 years old White American male at the emergency department of NYP Medical
Center with multiple complications.
CC: “I feel weakness and difficulty of breathing”.
HPI: GY is a 70 years old male presents to the emergency department with multiple complications. He has not
felt well last couple of weeks and lost appetite and lost weight 15 lb in the last month. GY has diabetic
nephropathy which has progressed to ESRD for 10 years. He has renal failure and has been on hemodialysis
for 5 years (2 times/week). He has history of coronary heart disease for last 10 years, COPD for last 15 years
and abnormality in secretion of corticosteroid hormone from birth. He occasionally feels pain in his chest which
disappears after taking nitroglycerine sublingual tablet or rest. He complains shortness of breath and becomes
weak after walking several blocks.
PMH: Ischemic Heart Disease X 10 years and controlled by medication
Chronic Obstructive Pulmonary Disease X 15 years and uncontrolled
Adrenal insufficiency X from birth
FH: Mother died at the age of 90 from diabetes.
Father died of heart attach at the age of 75.
He has no siblings.
SH: Ethanol drinking with 2 beers x daily, he smokes 1 pack of cigarettes daily, he is single and live in
Meds: Nitroglycerine SL 0.4 mg prn for chest pain
Atenolol 50 mg po qd
Levalbuterol neb 0.63 mg tid every 6 hours
Ipratropium neb 500 mcg every 6 hours
Lipitor 10 mg po daily
Prednisone 5 mg po daily
Glyburide 10 mg po daily
Furosemide 40 mg po daily
PE: VS: BP 130/74 P 79 RR 18, T 98ºF, Wt 62 kg, Ht 5’8”
CHEST: RRR, no murmur, rales bilaterally chest wall NT.
CV: S1 S2 normal, no chest pain, no palpitation, no shortness of breath
Abd: No bruits tenderness, no masses.
Skin: Rash at lower extremities
HEENT: No history of headaches, dysphasia or odonyphasia
Mental status: Normal.
Labs: Na 135; K 4.3; Cl 102; CO2 24; BUN 27 (H); Scr 2.1 (H); Glu 170 (H); ALT 26; AST 21; total Chol 175;
LDL 120; HDL 39; TG 115; Albumin 4.8; Hgb 18; Hct 43% RBC 5.6; WBC 9; Plt 250, A1C 9.0, DST 450.
Problem List: 01. Coronary Heart Disease (CHD)
- Chronic Kidney Disease (CKD)
- Chronic Obstructive Pulmonary Disease (COPD)
- Adrenal Insufficiency
- Coronary Heart Disease (CHD)
S: GY is a 70 year old male who is suffering from coronary heart disease from last 10 years. He complains
weakness and difficulty of breathing. He occasionally feels pain in his chest which disappears after taking
nitroglycerine sublingual tablet or rest. He drinks beer and smokes regularly.
O: Age 70; BP 130/74 P 79 RR 18; ALT 26; AST 21; total Chol 175; LDL 120; HDL 39; TG 115; Hgb 18; Hct
43% RBC 5.6
Simone de Beauvoir's Insights Towards Gender and Status Is there any ponder that Simone de Beauvoir dismissed that sexual orientation has natural qualities from birth? As a lady savant living in a man's reality I trust she completely comprehended what she was discussing. The compositions in her widely acclaimed book 'The Second Sex' written in 1947 give us a recorded and social exercise of what ladies have needed to defeat to exist as ladies in a man's reality. People are both impacted by their molding the principle contrast is that man has been ascribed the main job. Times are changing and Simone de Beauvoir has assumed an essential job in our endeavor to fix the incorrect programming. The present driving women have demonstrated their abilities at filling the role. Simone de Beauvoir's case of what a lady that is clever can do in life by her clear, genuine methodology might be the venturing stones for other ladies to valiantly do likewise. As far back as the tenth century thoughts of antifeminism have frequented the ladies of the world. The bunch of ladies that were in the spotlight were generally wrecked for black magic as on account of Jeanne D'Arc or openly derided or at more awful martyred. Ladies as the lesser sex have been portrayed as flirts from Bible days which in the meantime undermined their insight. This double picture which has adapted ladies to consider themselves to be uninvolved creatures who lie in trust that men will spare, them or come and cherish them and their partners the eating up flirts who take what they need and abandon the rest including their insight is the thing that Simone de Beauvoir sees as our molding. This molding begins at an early age when there are no evident contrasts between child young ladies and infant young men. They are both at this early age absolutely needing supporting and physical contact which they flourish upon. This adoring consideration is actually the equivalent up until a specific minute when the infant is weaned. As indicated by Simone De Beauvoir starting there on young men are instructed to end up little men and they get less physical contact and fondness than their young lady partners; They are likewise a result of their molding similarly as we may be. This is something imperative to recollect all through this perusing. Young men and young ladies alike are a piece of their natural molding through family legacy, social conventions, religious convictions and authentic convictions. As kids we as a whole have similar dispositions of fits, sulking, beguiling our folks then we are in certainty the equivalent until the point that our condition gives us another viewpoint upon ourselves. Young ladies rapidly discover that they should be cautious. They have to act like little women not climbing trees and cleaning knees as their siblings are urged to do. This legend begins ahead of schedule with the family frame of mind about the physical contrasts between genders. Young men have an outward articulation of their manliness which transforms them quickly into having something to be glad for. This declaration of self that has, according to the guardians, an esteem progresses toward becoming what the kid estimates himself to different young men with. It's a material marker of their masculinity and gives them the intuition of quantifiability. To what extent their sex is and how far they can urinate. The unavoidable nearness of their augmentation gives them an intensity of question. Ladies are internal quality. The majority of their disclosures are internal and subsequently left inferred. You can't see a great part of the sex of a young lady so it isn't made an obsess about as kid's genders may be. Young ladies attempt to express their exchange towards a protest a doll for instance. This regarding a doll as herself gives her that the substance is the equivalent and along these lines she is somebody to spruce up to take into account, that has a presence since others make her exist. Later on in life she will in the end turn into that doll thing that sits home sitting tight for her better half and youngsters to lift her up and do however they see fit her. Similarly as she sat away her youth she sits away the hours of her parenthood, or wifehood at home fighting off weariness with no specific objectives or universes to prevail. Young men grow up with the possibility that they are going some place and have something to achieve and will accept obligations en route. They learn at around 13 yrs. old that the appropriate response may not turn out in words but rather through savagery. A young lady wills quell her own viciousness since young ladies don't do that kind of thing. This viciousness transforms into hypochondria which to some degree is brutality unexpressed which returns to oneself inevitably. Simone De Beauvoir was avant protect when she perceived the way that ladies have their own piece of savagery at that age yet we don't enable ourselves to express it. We are just not empowered socially, truly or socially to express it. Where advance has been made is that an ever increasing number of ladies are preparing in hand to hand fighting which are a positive method to express their internal brutality. What upset our moms, and relying upon what molding you were likewise given, was the pre-set up way decided for us regardless of what we might want to turn into. When the way was set at that point fear was rapidly to pursue. What way? The way that says regardless of what instruction you get you will wind up a spouse and mother then grandma. This is an alarming part of the developing young lady's situation. She won't just need to figure out how to end up a lady, a spouse, a mother and a grandma. She can ponder all that she might want however there is no genuine asking of her to do as such or to accept the obligations this suggests. She'll wed at that point quit attempting to have youngsters and her better half's profession will win and go up against the conventional job of provider. Maybe the present economy has obliged young ladies to be vocation decisive yet perhaps not for the correct reasons. Vocation disapproved in light of the fact that families are not withstanding without two great pay rates to help them. The external articulation of sexual pride may in any case be exposing the street. The way that a young lady can be a beneficial and essential individual from our general public and that she likewise has her commitment to make does not appear to urge young ladies as it does on young men. There are such a significant number of unnerving natural occasions in the life of a young lady who is turning into a lady that having her very own internal sexuality is a muddled errand. Young fellows can see theirs, be glad for it, and use it where as young ladies need to manage what organically is forced upon them. Their menstrual cycles which modify their characters for a few days multi month is in itself part of the riddle of womanhood. The adjustments in her body that may lead her to withdrawal since now she is turning into the protest so wanted by men. The doll has grown up and would now be able to be moved as needs be. This is a minute in time when numerous young ladies wind up anorexic keeping their bodies under control and ceasing the menstrual cycle as though time would stop. The beginning of an inevitable pregnancy, fetus removal chance, dangers amid pregnancy, menopause and every one of the decisions that infers has made being a lady most likely more entangled than taking care of business. What is exceptionally fascinating to comment as indicated by measurements there are a vast lion's share of ladies that would favor being men. Men in a little minority on the off chance that they had the decision would have favored being a lady. There is the lamentable, radical, women's activist perspective of consistently demonstrating that ladies can be more or superior to men by doing likewise things and acting a similar way.. I locate this grievous. On the off chance that we need equity, we ought to make progress toward equivalent regard and equivalent rights not prevalence and mastery which are what has influenced us to experience the ill effects of the ages. Ladies observing approaches to be decisive, all around adjusted, splendid, and successful is the thing that can give us our quality in this day and age. It was unthought-of at the season of French shape rice Camille Claudel that a lady could outperform the ace. Camille Claudel could never have gotten through the layers of men to get to where she did in expressions of the human experience whether she hadn't had the help of her dad initially and Rodin. When Rodin withdrew she lost all esteem and command over her life. There is the incomparable Mexican craftsman Frida Kahlo who additionally had the help of her dad strikingly enough and that of an incredible Mexican craftsman also. The two dads in these two models gave their help to their little girls which were likely what they would have gotten on the off chance that they were children rather than girls. Notwithstanding ability and virtuoso these men were steady and ready to perceive potential. What number of other Sunday morning painters got left by the roadside since they were not perceived in temperance of their gifts but rather as a result of their sexual orientation? What did the world wars show us ladies? It instructed us that without siblings, cousins, fathers, and spouses they were equipped for running a nation from industry to training the national wellbeing Women kept their families sustained, dressed, and shielded amid the war. We are not warriors are heart but rather have a similar potential. There are precedents in history like Amazons and Jeanne d'Arc of ladies fit for driving armed forces and warring. We could have been developed as war rulers likewise yet weren't. Ladies are providers of life and that is likely what gives us the motivation to advance harmony culture rather than war. No lady needs to see her children, girls, spouse, siblings or sisters head out to war and not return. The harmony development has a larger part of ladies supporters and that appears to run with the way that nurturing is as yet our domain. The political world has opened up it's ways to ladies inside the most recent twenty years. Prior to that time there was typically a lady behind an incredible man in the shadows and there to beautify the photos for the press more than for her suppositions. In France there were three lady priests chosen in the late 70's. This was a defining moment. The Catch 22 comes in when ladies battled in the French r>GET ANSWER