A Study On Clinical Picture

Pt is a 84 year old Cascasion female living with her husband in their home. Husband reported the Pts Alzhemers has be pergresing for the last 8-9 years. Pt had open heart surgery in 2012, which contributed to the memory loss decline and increasing level of Alzhemer symtoms, husband verbalized. Husband reports they have been married for 19 years. Pt has a sister living Florda, two daughters living in Texas and Wyoming and one son in New York. The children stay in contact with them every other day. Pt reports she worked as a RN at the VA Hospital in New Mexico. Pt is not independent in the home without the husbands assistance. Pt does ambulate well in the home, but does have a walker in needed. Husband assists the Pt all her ADL's in the home and drives her to the store and for MD appointments. Husband currently suffers from Hemochromatosis (too much iron in one's body). Husband reports he manages well with his illness while taking care of Pt at the sametime. Husband reports the Pt's Alzehmers level appears to be stable at this time, but is quite forgetful at times and needs his assistance. Husband said they are managing

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Few days back, the patient had a CABG surgery and was send home under stable conditions. Family member noticed SOB and weakness from the patient and was directed to attend the ED. As they got to the ED, the emergency department nursing staff noticed SOB with pericardial hematoma and immediate drainage was necessary. A chest tube was placed as a treatment option.

He wants to become independent in ADLs such as bathing, toileting, dressing, transfers and IADLs such as caring for his grandchildren and home management. CP is successful in communication, feeding, grooming, hygiene, and bowel/bladder management. He is contact guard for transfers, mobility and bathing. CP currently struggles to shower and dress his lower body, transfer from bed to wheel chair and wheelchair to toilet/shower bench.

“The occupational therapy provided by Niagara Therapy LLC from 7/29 to 09/15/15 was not supported by records as medically necessary/standard of care. The medical necessity of ongoing therapy depends upon making measureable progress in functional goals. The documentation does not support that this patient meets this criteria. The patient received 12 visits through 7/27/15 and improvement in function was not documented. Also, there is a lack of literature support for long term OT for this patient’s condition. The patient could have continued a home program after 7/27/15. Occupational therapy after 9/15/15 would not be supported as medically necessary due to the lack of documented progress and lack of support for the efficacy of long term therapy over practicing skills with a home program.”

States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.

He will also have visits to the pyso-thearpy to be able to help him with his mobility. He could also adapt the requirement to be able to help with his mobility. His wife Alysha will also benefit from this, roger can also get help with his emotional needs with a social worker this will benefit him and his wife this is because they will understand and know how to help him more and give him the best treatment that both will know it will benefit them more. This will benefit his wife this is because not only does she have to care for him but she has four children that needs

This includes, practice ROM exercise and taking walks to see how their endurance and strength is. I shadowed one of the RA's that performed daily walks with each patient to see how far they are able to get and if they are able to move from a wheelchair to walker. In the afternoon, the RA's did ROM exercises and also instructed a work out class for anyone who would like to participate. An OTA would help patients with daily tasks such as being able to put on pants with the right movements (practice bending up and down) or how to put on a sweater with one weak

no problems with mobility noted, patient ambulates w/o assistance, ROM of joints intact, patient pt able to rotate feet,

On Tuesday August 30, 2016 a Male 63 years of age came into Christus Spohn South Heath Center with a diagnostic order for chest and rib x-rays. He was being seen because of chest pain on his right side due to a fall. He had an extensive patient history of x-rays that went as far back as 2014. For the year of 2016 he received approximately 12 different x-ray series. For example, on January 12, 2016 he received a chest 1 view image and cardiac catheterization. On May 21, 2016 he received a chest 1 view and a complete 4 view foot. On May 30, 2016 he received a cardiac catheterization. On June 1, 2016 and again on June 2, 2016 he received a chest 1 view. On June 10, 2016 he received a catheterization. On August 25, 2016 he received a chest 2 view. On August 26, 2006 an upper extremity without contrast. The patient also has a history of open heart surgery and receives dialysis treatments and is on oxygen.

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.

Resident maintained normal ROM and strength in bilateral UE/LE. Resident transfers with one person assist. He uses 4WW during ambulation and transfers. His Tinetti score maintained at 22/28, He is at moderate fall risk. Resident able to walk more than >200 feet. Walks 7days/week RCA staff. Resident continue to use the wheelchair for long distance mobility. Resident needs to be encouraged to walk to the dining room for meals and back to improve his walking tolerance, endurance and his general well-being.

PTA patient was able to ambulate on level surfaces with FWW and with one person assist.Patient has been dependent for all basic ADL and IADL activities.Patients mother is the primary caregiver.Mother states

While shadowing occupational therapy professionals at Montgomery General Hospital, I gained much insight into the profession and the day-to-day duties and responsibilities of a COTA. The entire facility caseload consisted of geriatric patients, and many of the diagnoses were due to cognitive deficits or recent falls due to weak lower extremities. Diagnoses observed were dementia, CVA, a hip fracture, a total knee replacement, osteoarthritis of the shoulder, bilateral upper extremity/lower extremity weakness, and total blindness.

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right