Subjective:
Chief Complaint: N.G., a 33 year old Hispanic female who appears reliable presents today with complaints of “something is in my left eye”.
HPI: This patient claims that a piece of plastic off of a milk crate broke and flew directly into her left eye when she was attempting to set it down yesterday evening. She claims that the pain started immediately and was a “10/10”. The pain has only improved slightly overnight to a “8/10” this morning. She describes this pain as a sharp, burning and stabbing type of pain. She has obtained some relief from rinsing her left eye out repeatedly and then applying cool compresses and ice packs. She claims that opening her eye makes the pain worse and causes her “eye to water”. She denies any radiation of
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Plan of Care: No laboratory work ordered at this time. Patient prescribed Tobramycin ophthalmic ointment 1/4 to 1/2 inch ribbon to lower conjunctiva every four hours while awake (Medscape, 2014). Patient instructed to keep eye clean using a dilute baby shampoo solution twice daily. The patient is instructed to seek immediate medical intervention for visual changes, fever greater than 100.0, or increasing ocular pain. Return for follow-up appointment in two days (Goolsby & Grubs, 2011). Continue current medication regime as previously prescribed.
Evaluation: I was provided the opportunity to observe and participate in fluorescein staining of the eye to assess for scleral abrasions. Bailey, Buttaro, Sandberg-Cook, and Trybulski (2013) claim that the degree of injury is determined by the size of the object and the amount of mechanical energy the foreign object obtained prior to reaching the surface of the eye. This patient was in severe pain, yet received only a minor trauma to conjunctival aspect of the upper eyelid. It is imperative for her to keep her follow-up appointment as infection and ulcers are common after ocular injuries (Bailey et al., 2013).
The patient is a 74-year-old female who tells me she did see Dr.[____] and she did get a shot into her hip. She states symptoms are "1000 times better". She does tell me he was done ultrasound and thought she might have a [____] tear, which at this point, if this does not work, she will need likely to have a hip replacement, as he did not think this is fixable at her age.
The start-up of any new business can be challenging on many different levels. For instance, the regulatory guidelines, policies, and procedures, as well as ethical standards, must be implemented at the start of any business to ensure that everyone abides by the same practices and principles. Seeing as Tri-County already has services in place for patients, Pat could use some of the regulatory and ethical guidelines such as the diversity and compliance rules as a blueprint. However, some anticipated concerns that Pat may encounter upfront is first the perception of the community of a new business in town. Pat would need to set a precedence that the new psychotherapy clinic values and respects their patients and the community. Second, Pat would
Following epithelial debridement, Riboflavin 0.1%, suspended in a dextran T500 20% solution, is applied every 3–5 min for at least 20 min to allow sufficient stromal absorption prior to UVA exposure (Wollensak et al., 2003a). Intra-operative pachymetry is advocated by many surgeons to monitor corneal thickness prior to UVA exposure and apply hypotonic Riboflavin drops if it thins excessively during Riboflavin administration. The central 8–9 mm of the cornea is then irradiated with UVA, at 3 mW/cm2 for 30 min.
IOP was ound to be increased in two eyes (8%), both in the same patient with rapid control by beta blocker only and shif rom steroid to non-steroidal anti-inflammatory drops which suggesting it was steroid sensitive patient.In one eye one year later the iris tissue between one o haptics show atrophy with impending dislocation o the IOL and another surgery under local anaesthesia was done with refixation o the IOL. Glare and halos were observed in 2 eyes (8%) o. Glare and halos were explained by poor centration o the phakic IOL in one eye and a large scotopic pupil size in the other eye however adaptation with clinical improvement in ew post-operative months. One eye (4%) show postoperative iritis rapidly reserved in ew days however another attack o iritis within three months occurred affecting the vision however resolution occurred with requent steroids but non pigmented precipitate persist decreasing the vision. pigmented deposits were ound in our eyes (16%). Tese eyes were treated with topical corticosteroid agents, but pigment precipitates persisted in these eyes. Tese eyes, however, did not have a loss o visual acuity. Complications are summarized
Clindamycin could be used for patient A as it is effective against penicillin-resistant staphylococci, organism A was found to be resistant to penicillin in this experiment. Clindamycin is recommended for skin and soft tissue infections and can be prescribed to young children. The dosage recommended for patient A is 3-6mg/kg per dose 4 times a day, orally.
The patient was prepped and draped in the usual sterile manner. The lid speculum was placed in the right eye. A conjunctival peritomy was made and the 4 recti muscles were hooked and anchored with 2-0 black silk bridle sutures. The sclera was detached from 8 to 12 with macula-off. Cryotherapy was performed to 1 or 2 tiny retinal breaks. A #240 band was placed under the 4 recti muscles with a sleeve deep in the inferonasal quadrant. The band was anchored 12 mm from the limbus with a 4-0 Mersilene mattress suture in each quadrant. Drainage of a large amount of viscous subretinal fluid was achieved via 75S blade into the subretinal space of the inferotemporal quadrant, and intraocular air was injected to tamponade the retina and normalize the
Wounds that involve the eyelids or the soft tissue around the eye must be handled
In the ophthalmic clinic the doctors are prone to all kinds of ocular emergencies, that demands quick reaction, this case was one of them. A two years old girl came to the clinic falling from bed at 4:30 a.m. last night she was landed on a glass nightstand which shattered on impact. Her Mom checked her and found no bruises or bleeding. This morning mom noticed her rubbing the right eye constantly, assuming that her doughter feeling pain, redness and constant tearing. She also can’t open it and squinting all the time.
Michael was excused from the meeting at the request of the physiatrist. The physiatrist wanted to know concerns and questions regarding Mike’s medications, well-being, blood work and activities outside and inside the community. Ellen the therapist wanted to talked about briefly about Mike’s interpersonal skills due to his friendships. The team talked about the transitioning to independent living within the next year. The STAR program feels that Mike is not ready to leave NEW Foundations or live independently on his own. Ellen reported that Mike is having sexual urges with teenagers. The team came together and decided Mike would not be a good candidate to visit the zoo with the
Examination of the wound shows approximately 1.5 inch laceration adjacent to the left eye. There is no involvement of the upper or lower lid. No indication of orbital fracture. Pupils are equal, normal eye movements. The
Hypnosis has been in use for a very long time, but we tend to think about its use for
Present-day modern psychodynamic theory has also been viewed as a model that explains mental phenomena as the outgrowth of conflict (Gabbard, 2014). Wherein, the conflict is derived from powerful unconscious forces that seek expression and require constant monitoring from those opposing forces, to prevent their expression (Gabbard, 2014). With consideration to Steven’s case, we know that this model proves pertinent. Insofar, Steven has a weakened or absent cognitive structure, evidenced by his ruminative thoughts that he is a facade and “people will find out who I really am.” Thus, preventing him from feeling whole and secure about himself.
The first patient is MMH, a 67 year old retired Caucasian married female. The patient visit was conducted in the home, which was a uncluttered trailer located in Greenwood, IN. Her husband was present during the exam. The purpose of the well visit was to determine medication compliance, evaluate functional and mental status and perform a complete physical evaluation. The past medical history (PMH) was positive for insulin dependent diabetes, cataracts, hyperlipidemia, hypertension and Dupuytrens contracture of her right ring finger. She was being followed by her family physician, a dialectologist and an orthopedic surgeon. All immunizations were current and she had a colonoscopy in 2016. She had not had a dilated eye exam for two years, however.
This information could confuse the parents of the child in not thinking about an infection, therefore, not providing sufficient importance in the antibiotic regimen, causing the infection to reoccur or the organism to become resistance to the antibiotic. This website also said that the first line of treatment is Broad-spectrum antibiotic. This information is inappropriate because the first approach should be to monitor the infection to resolve without the use of antibiotic, helping the body to build immunity and also prevent too much used of antibiotic putting the child at risk of opportunist infections. (WebMD, LLC,
The patient has 44 years and completed the electronic screening by herself. The results were negative for suicide ideation (C-SSRS), normal for moderate depression (CAD-MDD, CAT-DI: 17.7), normal for anxiety (CAT-ANX: 10), normal for mania/hypo mania (CAT-M/HM), positive for prescription drugs in the past year (NIDA assist). The outcome for mania /hypomania was elevated, however during the interview explored the criteria for the diagnostic and the patient does meet the criteria. The patient explained that she is active and organized in the family agenda, which includes games of her sons, her daughter and grandson. Moreover, she is manager also. The patient was oriented about the criteria for mental health. No follow is necessary at this moment.