The Medical Surgical Floor Recovering From His Transverse Colostomy Five Days

31 y/o AA male patient seen today for psychiatric-mental health assessment. He is awake, alert and oriented x4. He is calm, cooperative and follows commands during assessment. The patient reports he is depressed, difficulty sleeping and nightmares at night. The patient explained his depression is as a result of deep thinking from a news he received two days ago from his elder brother that his mother is ill. Stressors identified by the patient include losing his job a week ago before the news about his mother; his wife is 6-months pregnant with their first child, who currently works part-time at her present job; patient relates difficulty paying monthly bills and inability to provide adequately for his family as a man. The patient denies mood swings, suicidal/homicidal thoughts and ideation. Patient reports his spouse is at work at the moment and he does not want to put stress on his wife due to her current condition. Patient denies been hospitalized for depression or psychiatric illness; and denies family history of mental illness. Patient reports he is seeking help because he does not like feeling this way using terms of “helpless and loss of worth from his spouse”. Patient reports he needs help with his depression and nightmares before his current condition get out of hands and ruined his marriage.

RO realized illness is a part of life, she knows this is a serious illness. She also is aware; with the proper treatment, she will live a long life with a few medical adjustments. Her acceptance, of the disease and the process will take a toll on the family as a unit, and finically. Her religious belief will also play a major role in the healing process. RO family has seen devastation; she believes there is no ritual that will cure her. She will continue to pray and ask for favor with this

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.

I spoke with the family and arranged for him to have video call his son so that he can see and talk to his granddaughter. This helped the patient’s willingness to participate in activities of daily living and reenergized him.

Deborah F. is a 53-year-old female who had been admitted to the Chemical Dependency Rehabilitation Program at Sharp Mesa Vista for the treatment of alcohol dependence and pain disorder. Her history includes several disorders that are a cause of her pain including lupus, fibromyalgia, spinal arthritis, interstitial cystitis, shoulder pain, and multiple foot surgeries. According to her chart, she had been drinking two bottles of wine daily for almost two weeks in attempt to forget about her increasing pain. She is currently on voluntary detoxification and is considered a high fall risk. Her plan of care includes a series of medications that are prescribed for her pain and medical problems. Along with her treatment, Sharp Mesa Vista Hospital implements a treatment plan for all patients in the CDRP, which is referred to the 12-step treatment. One of the main activities that are included in this treatment is regular participation at group meetings that are conducted each day. The concern with Deborah is that she has been continuously refusing to attend the groups during her three-day stay at the hospital. She believed that attendance would not help her with her drinking issues and believed that even groups such as Alcoholics Anonymous would not benefit her. Based on the nurses ' report, it seems that she will not be discharged in the near future. One way that she will be able to progress in her recovery

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

After extubation, the patient endured acute delirium. The attempt to control agitation using ativan, haldol, and thorazine was not successful. Consequentially, dexmedetomidine was used to sedate the patient. Seroquel was started and dexmedetomidine was in the process of weaning off when he developed a fever to 102.7 degree Fahrenheit (°F), worsening acute kidney injury (AKI), leukosytosis, hypotension on post-operative day (POD) five. He underwent CTA chest and Computed tomography (CT) of the abdomen and pelvis with and without contrast which revealed cecal and ascending colon pneumatosis. IC was suspected. Since Mr. S was sedated, assessing for symptoms of IC were not possible. However, he had three bowel movements (BM) on POD four and one BM on POD five without melena or hematochezia.

On examination, the patient was hot to the touch, and right upper quadrant was tender on palpation and abdomen was soft. The patient had dressings on her abdomen from the site of the surgery, but the appeared to be clean and did not have puss coming from

A 62-year-old white male presented to the hospital for a scheduled ventriculoperitoneal shunt removal. The patient had developed cysts in the brain seventeen years ago in 1998 leading to increased intracranial pressures from accumulation of cerebrospinal fluid. After discovering the brain cysts, the patient underwent a ventriculoperitoneal shunt placement. Two years after the shunt was placed, the patient underwent another procedure for shunt revisions due to complications with infection. Now, the patient is presenting for removal of the shunt. In the pre-op holding area, the patient’s vital signs were taken. The patient’s blood pressure was 153/75, heart rate 80, respirations 18, oxygen saturation 93% on room air, and temperature was 36.5 degrees Celsius. Prior to the patient’s surgery, lab work was performed consisting of a CBC and CMP. The patient’s white blood cell count was 11.7, platelets 379, hemoglobin was 10.8 and hematocrit was 33. The patient’s potassium level was 3.7, calcium 9.1, sodium 145, BUN 35, and creatinine 2.21.

is the middle child of two other sisters. Both have a history of hypertension, with the oldest having severe allergies. Their father passed away from cirrhosis of the liver at the age of 72; while their mother alive and has a history of colitis, migraines, and asthma. Currently, R.P. husband is 78 and is healthy, with the same for their children age 38 and 41 years old. She is an active mother and wife. While spending majority of her time traveling and attending golf tournaments with her spouse. When she is not doing so, she is out spending time with her friends and family. R.P. involves her husband in every aspect of her care and decision making. She does not partake in any drugs or tobacco, with some occasional alcohol. She is very family

My client is Margie M, a 69-year-old widower with chronic venous stasis ulcers. PMH: Asthma, Cataracts, Arthritis, Tremors, Narcolepsy, Congestive Heart Failure, Diabetes Mellitus, Peripheral Vascular Disease, Hyperlipidemia, Hypothyroidism, Gastric Ulcers, Irritable Bowel Syndrome, Micro colitis, Restless Leg Syndrome, Hypertension, Atrial Fibrillation, Anxiety, Depression, Cardiac Stents, and Cerebral Aneurysm. She lives in a two bed, one bathroom house with her daughter Becky, Becky’s husband Jim, and her twenty-five year old grandson Jason. Margie’s daughter, Terri, Jason’s mother is deceased. Jason has mild developmental delays. Margie has one son, Buster, who is not involved in her care. We met for lunch at McDonald’s

The patient relates that he has been depressed over the last several months as he fears that the dementia stages of Alzheimer's will set in. The patient is active and plays golf three times weekly. Mr. Smith eats most of his meals out rather than preparing them himself. Mr. Smith does not smoke or drink. Mr. Smith has several close friends that he talks to on a daily basis and that he spends time with.

Mr Brown is a 76 year old male, which presented to the emergency department via ambulance with thoracic back pain, which commenced two days prior to the presentation. The triage assessment stated the patient is alert, orientated, distressed, chest clear and equal, neurovascular intact with equal strength in all extremities and good strong regular pulses. The nil injury stated patient said he ‘just woke up with it’. The patient’s observation displayed a temperature of 36.9°C, blood pressure of 169/105, pulse rate of 99 beats per minute, respiratory rate of 20 breaths per minute, Glasgow coma score of 15, and a blood glucose level of 5.4. Mr Brown’s has a past medical history of atrial fibrillation, asthma, emphysema, hypertension, chronic back pain, lumbar fusion (L1), total

O): BLS assessment reveals a 35 y/o/f Pt sitting in a w/c. AOx4/GCS:15. Pupils PEARRL, HEENT clear, -JVD/TD, -CP/SOB, BBS not evaluated, Respiratory rate 16 breaths per minute, SPO2 100% on room air, BP 150/100, HR 96 beats per minute, Skin w/d. Moves extremities sluggishly. Pt claims to have a history nausea, vomiting, hypertension and received a total gastrectomy approximately 5 years ago. Pt states that she vomited twice before arrival and complains of abdominal pain that only subsides when not moving.

Adam Rudd is a 78-years-old retired mechanic who lives alone in a small village located 30 miles outside of town. He was married for 54 years and has been a widower for 3 years. Rudd has two sons Mathew and Douglas, who live in different states and come to visit him once a year. Rudd has a friend, Jennifer, who lives close by and visits him twice a week. Rudd has been diagnosed with hypertension 15 years ago and has been taking Tenormin, Norvasc, and aspirin daily. Rudd takes care of himself alone and lately he has been feeling very weak and tired. He was not able to refill his medication for the past month because he was feeling very weak and could not drive to the pharmacy. He does not like to depend on other`s for getting help and