Watc Case Study

Pt's appearance is consistent with that stated by dispatch and pt appears to be in moderate distress due to abdominal pain. With assistance, pt is able to ambulate to gurney from the residence. Pt tracks EMS personnel as they move around him and pt is found to be alert and oriented to person, place, time, and event. Pt's airway is found to be open and pt and he is able to communicate with EMS personnel in full sentences. Pt answers all questions asked by EMS personnel appropriately. Pt's pupils are found to be PERL and no secretions are noted upon inspection of the pt's ears, nose, or mouth. Pt's trachea is found to be midline and no JVD is noted. Equal chest rise and fall are noted upon inspiration and expiration. All four abdominal quadrants are soft and tender upon palpation. A strong radial pulse is able to be palpated by EMS personnel and the pt's skin is found to be warm, pink, and dry. Pt is able to move and has sensations in all four

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.

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

0700 Pt in her room awake getting ready for breakfast. No sign of distress or discomfort this morning…………………………………………………………L.Gotora PNS2/WATC

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.

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

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.

WIC currently serves prenatal clients, infants from birth to 1 year, and children from 1 year to 5 years. They have various locations throughout the country with 15 locations in Miami-Dade. Currently their operators and staff provide English, Spanish, and Creole language at each site to accommodate their client’s needs. The central appointment line provide all three languages and additionally provides a translation service to contact for additional languages. There is currently no waiting list and no health insurance is

0700 Pt in his room awake getting ready for breakfast with the assistance of CNA. No sign of distress noted at this time………………………………...L.Gotora PNS2/WATC

Worcester’s public-access channel WCCA, was born out of the public access movement from the 1970s with the establishment of cable television. Through this an opportunity for people to present their stories, concerns, and their needs on cable in exchange for rights of way was created. Every city and town was given the right to ask the cable provider for public access and require the cable company to provide provision for public access. The City has become the condor for providing public access, allowing the municipalities a share of the funding. WCCA began in 1986 and the first along those years to do youth involvement and training, along with other residents. It was also first to offer hotspot for digital recording in the region along with

Patient “DD” is a 56-year-old woman who was admitted to a nearby hospital for respiratory failure. With the only previous medical history being chronic bronchitis, she was diagnosed upon admission with COPD, anemia, hypoxia, moderate anxiety, and dyspnea.

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

Though not ill appearing, his distended, almost tense, abdomen reminded me of a patient I had during medical school with abdominal compartment syndrome. Bladder pressures were measured and found to be elevated, and we deduced that the source of his dyspnea was increased intra-abdominal pressure transmitted through the diaphragm. Decompression and resolution of the constipation led to rapid relief of his symptoms. That was one of the first times I felt like I had truly applied my knowledge and it gave me a sense of pride and

The patient is a 50-year-old gentleman with a medical history of cerebral palsy, seizure disorder, and multiple admissions for fecal impaction who was brought to the emergency with severe abdominal pain. The patient is nonverbal and does not follow commands. The family and the chart reveals the patient has been pointing, grimacing and complaining of abdominal pain along the abdomen but no apparent vomiting. It is not known exactly how long. He has had poor intake over past 2-3 weeks. This is a recurrent problem for this gentleman with severe neurologic deficit. In the emergency room CAT scan found him to have been enterocolitis, severe fecal impaction in the center of the colon there were fluid levels. He therefore was admitted. The

He admits to a 25 pound weight gain over the last few months. The patient was