Pulmonary Diseases

 

 

 

 

 

 

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
government shelter.
ROS: None
All: NKA
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)
02. Chronic Kidney Disease (CKD)
03. Chronic Obstructive Pulmonary Disease (COPD)
04. Adrenal Insufficiency
01. 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

 

 

Sample Solution

John Wayne Gacy’s set of experiences of sexual and psychological mistreatment was instrumental in provoking examiner’s curiosity of him as a suspect. John Wayne Gacy was brought into the world on March 17, 1942, in Chicago, Illinois. Being the solitary child out of three kids, Gacy had a stressed relationship with his dad, who drank intensely and was regularly oppressive towards the whole family (Sullivan and Maiken 48). In 1949, a temporary worker, who was a family companion, would pet Gacy during rides in his truck; be that as it may, Gacy never uncovered these experiences to his folks because of a paranoid fear of reprisal from his dad (Foreman 54). His dad’s mental maltreatment proceeded into his young grown-up years, and Gacy moved to Las Vegas where he worked quickly in the rescue vehicle administration prior to turning into a morgue orderly (Sullivan and Maiken 50). As a morgue chaperon, Gacy was vigorously associated with the treating cycle and conceded that one night, he moved into the casket of an expired adolescent kid and touched the body (Cahill and Ewing 46). Stunned at himself, Gacy re-visitations of Chicago to live with his family and graduates from Northwestern Business College in 1963, and acknowledges an administration learner position with Nunn-Bush Shoe Company. In 1964, Gacy is moved to Springfield and meets his future spouse, Marlynn Myers. In Springfield, Gacy has his subsequent gay experience when a collaborator shakily performed oral sex on him (London 11:7). Gacy moves to Waterloo, Iowa, and starts a family with Myers. In any case, after consistently undermining his better half with whores, Gacy submits his originally known rape in 1967 upon Donald Vorhees. In the coming months, Gacy explicitly mishandles a few different young people and is captured and accused of oral homosexuality (Sullivan and Maiken 60). On December 3, 1968, Gacy is indicted and condemned to ten years at the Anamosa State Penitentiary. Gacy turns into a model detainee at Anamosa and is conceded parole in June of 1970, an only a brief time after his condemning. He had to migrate to Chicago and live with his mom and notice a 10:00PM time limitation. Not exactly a year later, Gacy is accused again of explicitly attacking an adolescent kid however the young didn’t show up in court, so the charges were dropped.

Gacy was known by numerous individuals in his locale to be an enthusiastic volunteer and being dynamic in network governmental issues. His function as “Pogo the Clown” the jokester started in 1975 when Gacy joined a neighborhood “Chipper Joker” comedian club that consistently performed at raising support occasions.

On January 3, 1972, Gacy submits his first homicide of Timothy McCoy, a 16-year old kid making a trip from Michigan to Omaha. Guaranteeing that McCoy went into his room employing a kitchen blade, Gacy gets into an actual fight with McCoy prior to wounding him consistently in the chest. In the wake of understanding that McCoy had absentmindedly strolled into the stay with the blade while attempting to get ready breakfast, Gacy covers the body in his unfinished plumbing space. Gacy conceded in the meetings following his capture that slaughtering McCoy gave him a “mind-desensitizing climax”, expressing that this homicide was the point at which he “understood passing was a definitive rush” (Cahill and Ewing 349). Very nearly 2 years after the fact, Gacy submits his second homicide of a unidentified young person. Gacy choked the kid prior to stuffing the body in his wardrobe prior to covering him (Cahill 349).

In 1975, Gacy’s business was developing rapidly and his craving for youngsters developed with it. Gacy regularly baited youngsters under his work to his home, persuading them to place themselves in cuffs, and assaulting and tormenting them prior to choking them (Cahill 169-170). A large portion of Gacy’s killings occurred somewhere in the range of 1976 and 1978, the first of this time occurring in April 1976. Huge numbers of the young people that were killed during this time were covered in an unfinished plumbing space under Gacy’s home. For the rest of the homicides, Gacy confessed to losing five bodies the I-55 extension into the Des Plaines River; notwithstanding, just four of the bodies were ever recuperated (Linedecker 152).

In December 1978, Gacy meets Robert Jerome Piest, a 15-year old kid working at a drug store and offers him an employment at Gacy’s firm. Piest advises his mom regarding this and neglects to restore that night. The Piest family records a missing individual’s report and the drug specialist advises police that Gacy would undoubtedly be the man that Jerome addressed about a work. When addressed by the police, Gacy denied any contribution in Piest’s vanishing. Be that as it may, the police were not persuaded, and Gacy’s set of experiences of sexual maltreatment and battery incited the police to look through his home. Among the things found at Gacy’s home were a 1975 secondary school class ring with the initials J.A.S., numerous driver’s licenses, cuffs, apparel that was excessively little for Gacy, and a receipt for the drug store that Piest had worked at. Throughout the following not many days, specialists got different calls and tips about Gacy’s rapes and the secretive vanishings of Gacy’s workers. The class ring was ultimately followed back to John A. Szyc, one of Gacy’s casualties in 1977. Futhermore, after inspecting Gacy’s vehicle, specialists found a little bunch of strands looking like human hair, which were shipped off the labs for additional investigation. That very night, search canines were utilized to recognize any hint of Piest in Gacy’s vehicle, and one of the canines demonstrated that Piest had, truth be told, been available in the vehicle.

On December 20, 1977, under the pressure of steady police observation and examination, Gacy admits to more than 30 homicides and advises his attorney and companion where the bodies were covered, both in the unfinished plumbing space and the waterway. 26 casualties were found in the unfinished plumbing space and 4 in the stream. Gacy is captured, indicted for 33 homicides, and condemned to death by deadly infusion. He endeavored a madness request however was denied, and was executed on May 10, 1994.

There were a few measurable pointers that examiners used to attach Gacy to the killings. A portion of these include fiber examination, dental and radiology records, utilizing the decay cycle of the human body, and facial remaking in recognizing the people in question. Specialists discovered strands that took after human hair in both Gacy’s vehicle and close to the unfinished plumbing space where the bodies were covered. Notwithstanding these hair tests, examiners additionally discovered strands that contained hints of Gacy’s blood and semen in a similar region. Blood having a place with the casualties was found on a portion of the strands, which would later straightforwardly attach Gacy to the violations. The filaments in Gacy’s vehicle were investigated by criminological researchers and coordinated Piest’s hair tests. Moreover, the hunt canines that established that Piest had been in Gacy’s vehicle showed this by a “demise response”, which told agents that Piest’s dead body had been within Gacy’s vehicle.

Out of Gacy’s 33 known casualties, just 25 were ever definitively distinguished. A large number of Gacy’s casualties had comparative actual portrayals and were consequently difficult to recognize by absolutely asking the general population. To recognize the people in question, agents went to Betty Pat Gatliff, a pioneer in criminological science and facial reproduction. Facial remaking is the way toward reproducing the facial highlights of a person by utilizing their remaining parts. Certain facial highlights, for example, facial structures, nasal structure, and generally speaking face shape can be valuable in distinguishing a casualty even long in the afterlife. By utilizing these highlights, and with the assistance of program, scientific examiners can make a picture of an individual’s face, which is instrumental in recognizing casualties after their bodies have rotted. Facial recreation should be possible in a few measurements.

Two-dimensional facial reproductions is utilized with skull radiographs and depend on pre-demise photos and data. Nonetheless, this isn’t really ideal on the grounds that cranial highlights are not generally obvious or at the correct scale (Downing). To get a reasonable and more precise portrayal of the casualty’s face, a craftsman and a scientific anthropologist are generally vital (Downing).

Three-dimensional facial reproduction is finished by models or high goal, three-dimensional pictures. PC programs can make facial reproductions by controlling filtered photos of the remaining parts and use approximations to reproduce facial highlights. These will in general create results that don’t look fake (Reichs and Craig 491).

Some of the time, specialists will utilize a strategy called superimposition as a procedure for facial reproduction. Sadly, it’s anything but a regularly utilized strategy, as it expects specialists to have some information about the character of the remaining parts they are managing. By superimposing a photo of a person over the skeletal remaining parts, agents can check whether the facial highlights line up with the anatomical highlights, permitting them to distinguish a casualty.

On account of John Wayne Gacy’s casualties, specialists had the option to utilize facial reproduction to recognize nine of the bodies found in the unfinished plumbing space. The accompanying realistic shows the facial reproductions of these nine casualties:

Since facial recreation was insufficient to recognize the entirety of the people in question, specialists acquired DNA profiles from every one of the unidentified casualties and effectively searched out DNA tests from guys across the United States who had been accounted for missing somewhere in the range of 1970 and 1979 (Cook County Sheriff’s Office 3).

The leftover casualties were distinguished utilizing dental and radiology records.

Since dental polish is harder than bone, teeth outlive tissue and once in a while bone when the body deteriorates. Teeth are entirely solid in distinguishing casualties, as they will in general uncover propensities about the individual, for example, nail gnawing, pounding and weight propensities, lip gnawing, and holding (Ryan 254). Besides, the top of the mouth, which frames a curve, is one of a kind to every person fit as a fiddle, size, and shape. Teeth likewise have singular attributes that are novel

Humbert Humbert’s sexualised puns on place names represents the imposition of sex onto setting; it is an aesthetic renaming, separate from the plot of the novel. Nabokov uses sexualised setting in order to further emphasise Humbert’s personal transgression; perhaps on a first reading it only seeps into the reader’s sub-conscious, creating an atmosphere of all consuming sexuality. On a closer analysis of almost every single place which is mentioned, it becomes more apparent the depraved lens with which Humbert views the world. Obviously the world is not as sexualised as Humbert views it, but by virtue of the fact that he acknowledges changing names and place settings in order to preserve anonymity, it conveys to the reader the inner machinations of his psyche. This emphasis on sexualised setting does not replace the plot but simply draws the focus of the reader to be more holistic in order to view the character of Humbert as not solely the product of his actions. Perhaps more importantly, his well chosen selection of nominative sexualisation is an art form within the novel; a creative process concerning the aesthetic, not the descriptive.

Linguistics
Humbert Humbert again alludes to the aesthetic nature of the novel when he acknowledges that he has ‘only words to play with’. This becomes dominant through Lolita: wordplay taunts the reader, the jury, even the degraded memory of the deceased Lolita. ‘Lolita’ entered the Oxford English Dictionary after the publication of the eponymous novel and has come to be synonymous with the type of ‘precocious schoolgirl’ of Nabokov’s creation. Were he a real figure, perhaps he would be gratified that not only the memory of Dolores Haze, but specifically his version of Dolly—Lolita—pervad

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