Case Study: 69-Year-Old Patient

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.

Hi, Karen, I attempted to send the invite again for patient 326270. I checked our email server to see if it was delivered and it shows an immediate block on her side as rejecting this our invitation email. I understand that her coworker is using the same domain but each email setting(s) can be individual. The message we are getting back on our email servers when trying to send her an invite to this email address is:

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

The patient is a 74-year-old gentleman who was in elective surgical case on 10/10/2016 preoperative diagnosis spinal stenosis L4-L5 with facet cyst of the left side. The postoperative diagnosis was the same, however the patient underwent a decompressive lumbar laminectomy L4-L5 with repair of an incidental duratoma. The patient is known to have coronary artery disease, hypertension, diabetes mellitus, and dyslipidemia. The patient has undergone significant conservative care including epidurals but has been disabled by the pain. The fact that had an incidental duratoma the patient required acute inpatient admission to be placed on complete bedrest and to be observed for a spinal fluid leak. The patient was complete bedrest, flattened bed

Patient S is a seventy-eight-year-old male who presented to the ED in Rushville on October 25th with signs and symptoms of a stroke. These symptoms were leaning to the left side, a left facial droop, weakness in the left arm, and ataxia. The patient has no history of stroke. Patient S was admitted to 4-G in Memorial for a right-sided ischemic stroke. The patient has a history of atrial fibrillation (A-Fib), hyperlipidemia, bleeding problems, hypertension, sleep apnea, and a pacemaker. Patient S lives at home with his wife. Patient S was independent before the stroke. On October 13th, the patient had surgery of lumbar stenosis on L3, L4, and L5. The patient and wife reported increased serosanguinous drainage that soaked the dressing. Patient denied fever or pain at incision site. The doctor decreased Warfarin from 5 milligrams (mg) to 2.5 mg and prescribed a full dose of aspirin.

Northwest Medical Center follows Health Insurance Portability and Accountability Act(HIPAA) Privacy rule and a federal privacy law which provides all the guidelines for protecting the privacy of individual health information. It is mandatory for all the staff of the company to follow these protocols and enforce the use of best practices which will be provided to them as a training to keep them updated. We make sure that we provide the staff with regular training to keep them updated with the latest security measures. It is very important to refresh the staff with the guidelines because over the time they get to be very lenient in following the protocol which will result in the violation of the policy. Few of the top violations are that,

A elderly patient by the name of Mr. Nathan was hospitalized for Prostatic surgery. He woke up in the middle of the night and tried to leave. A registered nurse approached him and tried to hold him down. He pushed her into a wall and hit her in the face. As a result, she developed an concussion. There after, the unit clerk that was on duty called for security. Mr. Nathan tried escaping by running to the exit, but he was stopped by two orderlies and a security guard. During this time, Mr. Nathan was making accusations of false imprisonment. A doctor ordered restraining for him to be checked in an hour and ordered the patient to be sedated. Mr. Nathan was bruised in the struggle. In addition, the registered nurse was taken to the emergency room and couldn't go back to work for two weeks. Mr. Nathan said he will be suing the hospital for assault and false imprisonment.

Mr. Ahlee Muhammad was seen on June 6, 2013 at St. Mary’s Medical Practice for examination fever and a sore. He was examined by myself, Doctor Miguelita Neason with the assistance of Elaine Johnson RN. We treated the patient and performed a minor surgery on his leg in the office on his second visit. We also sent the patient home with instructions on how to care for his lesion.

Case 1: a 57-year-old female patient presented with a pinkish small nodule 3 x 3 mm in diameter on right palatal area near teeth 14. Overall clinical examination revealed benign epithelial lesion with the similar nodule in the right index finger of the patient. The final diagnosis was papilloma. High intensity diode laser (810 nm, 3 w and 1.5 w) was used to ablate lesion and stop bleeding. Post irradiated area was healed normally and no recurrence was observed.

This exemplar will discuss the situation of patient who presented with a retained IUD during her first trimester. A detailed explanation of the initial encounter as well as that of the patient’s additional appointments will precede a discussion of the associated risks of the situation. Various fetal and maternal outcomes are investigated through multiple journal articles and other sources. Among the references cited are results of recent experiments and specific rates of incidence for adverse outcomes.

A 55 years patient has entered the hospital and needs urgent attention. The doctors and nurses rush to him and soon realise he is partially sighted and struggles with English and depression. The doctor notices that he has cancer of the bowel and advice him to have an operation to remove the part. He eventually had the operation. A couple of days, a nurse came to check the wound and put a clean dressing. Talking in a low voice, the nurse explain what she is about to do and asked him if he has any question, the nurse draw the curtains around the bed and uncovered only the part that needed attention.

In the case study of the 75 year old woman these are some of the questions that could be added in the assessment process. The relation to the fatigue I would ask more question to get a better understanding in clarifying the direction. Like how long does it lasts when it occurs? Can you rate the level of your fatigue on a scale of 0-10 ten being the worst? Is it accompanied with a type of activity? Have you had any lifestyle changes? It is a gradual or sudden onset? Do you have any sleep disorders i.e. dyspnea? Do you sleep flat or reclined? This helps pinpoint the fatigue from different types. The types of fatigue are tiredness, exercise, depression, stress, medically like anemia, heart disease, emphysema. (Wilson & Giddens 2009)

Mrs. J. arrives at the emergency department with her 6 year old son, PJ, who has a history of Cystic Fibrosis (CF). He is febrile (101.7° F orally), BP 98/66, HR 122, RR 32 with the use of accessory muscles. Mother states PJ has, for the last five days, exhibited signs and symptoms of upper respiratory infection, runny nose, low grade fever, cough, and fatigue. He has lost 2 pounds over the past 5 days due to anorexia though he has not had vomiting. He weighs 36 pounds and height is 3’2”. Today, PJ became more lethargic and his fever was difficult to control with pyretics.

The following is a case study of a female patient; she is 50 years old, married with 2 older children that no longer live at home. She has a 2 bedroom home, a car, her husband works at night and she always has a smile on her face. I met the patient in February 2016. We received a referral to our program because of the patient’s high emergency department utilization. According to her chart, she had 13 emergency room visits in the 6 months prior to joining the Outpatient Care Management program. During my initial visit with the patient I asked her what her greatest need was. The patient answered by telling me that she didn’t want to die.