A Case Study Of The Diagnosis Of Managed Care

The patient that I have chosen for my diagnostic reasoning paper is a 47-year-ol-Hispanic female. The presenting problem that I have chosen to use as my patient’s chief complaint is back pain. The only other clues that I have to use in order to help narrow my focus is that she is a female, she is 47-years-old, and she is Hispanic. I do not know how long she has been experiencing pain or how severe her pain is. Given these parameters, I will “cast a wide net” as I evaluate my patient and create my list of differential diagnoses.

She continues to take the following medications: GABAPENTIN 400MG , ASPIRIN 81MG, Oxaprozin 600mg and

There are many methods in which providers are reimbursed for services. Some of these methods are:

10/30/15 Medical Evaluation reported neck, low back, and left sacroiliac pain. Physical examination of the lumbar spine revealed decreased ROM on

Diagnoses include failed back surgery, lumbar; degenerative disc disease, lumbar spine; back pain; lumbar radiculopathy; spondylosis without myelopathy or radiculopathy, lumbar region; impingement syndrome of bilateral shoulders; myalgia; xerostomia; erectile dysfunction; testicular hypofunction; chronic anxiety; chronic depression; and chronic insomnia.

Per the medical report dated 08/12/16 by Dr. Gunderson, the patient had neck pain, as well as headaches, dizziness and blurred vision. The neck pain radiated into both shoulders, but more so on the right, and occasionally she had tingling in her upper extremities. She described the neck pain as severe and intermittent, and not related to any specific activity, and relieved with massage. The pain in her lower back was in the beltline and radiated into both lower extremities, more so on the left. She described the pain as moderately severe and constant, and not related to any activity, and only relieved with nerve medicines. On examination, the patient had tenderness in the lower cervical region about C5 to C7. Range of motion of her neck was 75% of normal. Motor, sensory, and reflex examinations in the upper extremities were normal. On examination of the lumbar spine, the patient could dress and undress without difficulty. She had a bent forward posture and gait. She had reduced lumbar motion and with maximum forward flexion, her fingertips were 12 inches from the floor. Lateral flexion was 50% of normal, and she had no active extension in the lumbar spine. Motor, sensory, and reflex examinations in the lower extremities were normal. There was paravertebral tenderness about L4-5 bilaterally, as well as in both sacroiliac and sciatic notch regions. Straight leg caused hip and thigh pain at 50 degrees bilaterally. Of note, X-rays of the cervical spine demonstrated disc degeneration at C5-6. X-rays of the lumbar spine were normal. Patient sustained

Fundamental changes, one of which is managed care, have been introduced to the healthcare system to improve people’s health and deal with challenges of increased healthcare cost and uncontrolled healthcare utilizations (Steele & Merrick and 2013Shi & Singh, 2015).

Even with active assistance, the patient can only achieve approximately 140 degrees of forward elevation, 60 degrees of external rotation, and internal rotation barely to his upper sacrurn. He has 4/5 supraspinatus weakness and pain. Internal and external rotation strength seems to be normal. He has a nonspecifically painful Neer’s, Hawkins, and O’Brien’s test. His proximal biceps and acromioclavicular (AC) joint are both very tender to palpation.

DIAGNOSIS: Impingement syndrome, right shoulder; full-thickness rotator cuff tear with retraction, right shoulder; adhesive capsulites, right shoulder; post-op pain, right shoulder; Right elbow strain/sprain; Right wrist strain/sprain; Right upper extremity overuse syndrome.

1. Managed care plans (PPO/HMO) have had different successes in medicine and dentistry. Explain those differences and why you think they have occurred.

Examination revealed restricted range of motion with flexion and extension in the neck, upper back and upper trapezius area followed by pain. Tenderness in the paraspinous muculature and discomfort with right lateral flexion was noted. Muscle spasms were noted in the following areas upon palpitation: cervical paraspinals, suboccipitals, upper trapezius, levator scapulae, medial scapular, thoracic parasinals, lumbar paraspinals and gluteus. He was tender to palpation of the right dorsal wrist at

However the patient was brought back in to the ED after the fall at home. The patient stated that he was siting on the edge of his bed attempting to change his Foley bag when he slid off and landed on the floor. He was found on the floor approximately three hours after and taken to the hospital. As a result of the fall the patient also has skin tear on his left upper arm. Mr. J.S. lives at home with his wife who is on hospice care for pancreatic cancer. Patient ambulates with a cane and walker. Mr. J.S has a history of GERD, HTN, MRSA-NARES, hyperlipidemia, abdominal surgery, mild myocardial infarction, chronic leukemia, enlarged prostate, sciatic or about 1 month, CLL with immune thrombocytopenia and splenectomy, diverticulosis, bowel obstruction, open cholecystectomy, lysis of adhesions, incisional hernia repair (12/12/2012), BPH with indwelling Foley. Family decided to take him off of hospice care and he will remain full code. At the beginning of the shift the patient was very tired, and did not seem

Carolyn had concerns about a throbbing pain in her neck, shoulders and upper/lower back. She also had concerns about a slight pain in her wrist. Carolyn has had a previous history of multiple musculo-skeletal surgeries.

This patient is a 62-year-old male who required inpatient hospitalization due to: Mr. C had a

In all patients, neuromuscular disease, biceps or labral lesions, shoulder instability, acromioclavicular joint arthritis, humeral head arthritis, adhesive capsulitis, calcific tendinitis, rotator cuff full thickness tear, previous surgery on the affected shoulder, and suspected cervical lesions were ruled out by clinical examination and radiologic findings with X - ray radiography and MRI.