A is an 87 year old women, with a long history of health troubles including chronic kidney disease, congestive heart failure, coronary artery disease, a pacemaker insertion for her atrial fibrillation, type 2 diabetes, dyslipidemia, colon cancer, breast cancer, mild cognitive impairment and most recently paranoid psychosis.
Scenario: An elderly woman showed symptoms of near syncope and was admitted via ambulance to a small community hospital. She experienced an inability to move on her own and almost lost consciousness while watching her grandson play basketball. Her symptoms occurred during a visit to her daughter’s home, which is approximately 150 miles from Liza’s home. When Liza was admitted to the hospital, her daughter explained the numerous types and dosages of medications her mother was taking. She also mentioned that Liza had not been taking her Coumadin as directed by her physician for the past week or so. Liza was admitted to the intensive care unit for evaluation. Over the course of hospitalization, Liza’s condition worsened.
Rosa Lee is on several different medications for seizures and for her full blown AIDS. Not long ago she was admitted into the hospital for taking too much of one of her medications. This is due to
The patient was a female on her 80s who was admitted to the hospital because of the COPD exacerbation. She had a history of stroke with minor residual effects, smoking, hypertension, and schizoaffective disorder - a chronic mental condition that is manifested mainly by the symptoms of schizophrenia, such as hallucinations or delusions, and mood disorder symptoms like manic or depressive episodes (NAMI, 2017). Patient length of stay was more than 300 days. She had two daughters who visited her everyday.
They give a long list of diagnoses but the most prevalent is the fact that she has a rapidly progressing dementia. Note that she has a rapidly progressing dementia as well as a B12 deficiency. They describe a subdural hematoma in the CT scan reports. The one on 01/03 shows a lot of microvascular changes, a lot of cortical atrophy, and apparently, she had bilateral subdural hematomas that had converted to hygromas, but apparently the larger one on the left side still had some blood in it. When they repeated the CT scan of the head on 01/19, they commented that the hygromas were still present but there was less blood in the larger subdural. She had extensive blood testing, which basically was unremarkable. It did not appear that she had a urinary tract infection. Appears that since she has been here her status has been fairly stable. She was weak, but apparently, underwent physical therapy and made some improvement to where she became ambulatory in her gait. It looked like from the very beginning she was having a day/night confusion, was having a lot of un purposeful movements that might be have been contributed to either delusions or hallucinations. They gave her some Risperdal for the behavioral problems, but according to Cynthia she had taken Risperdal in the past and had an allergic reaction, and today when I have seen the patient there is a marked amount of periorbital edema
The clinical features Mrs Lee now 83 is displaying changes to health and cognition noted in the last three to four months, with two transient ischaemic attacks but no significant medical issues. Although currently taking three medications for high blood pressure. Changes in word finding, getting words mixed up and confusing identifying words. Insisting everything is fine showing a lack of insight into her changes or difficulties. Short term memory Mrs Lees has difficulty retaining recent memories, however long term memory appears reasonable. Although Mrs Lees home is reasonably well maintained, she is emaciated and personal hygiene is poor. There is also evidence of emotionally Liable being frequently teary with no reason. History includes
The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward
Mrs. Wilson is seen in her room at Glenbridge Nursing Home on 02/28/2018. She had an episode last night of chest pain. She is so ebullient and distracted that it is hard to get a straight history, it came on when she was asleep but she may been sitting up. She was seen by a nurse, a sat was taken. I am not sure if there were other orders taken, but there is none on the chart. She says that she spent most of this morning in the bed and still feels tired, but she does not think she broke out in a sweat. She was more short of breath. She is calling it is a "stroke." I had tried to begin tapering her diazepam by discontinuing the morning dose and apparently all daytime clorazepate was discontinued by error and she gets it only at night.
The following case scenario is based on a fictitious patient, and it would be use on this paper as a guidance to develop a patient and family teaching plan. The situation: Mrs. Marquez, a 39-year-old Caucasian female was admitted into the Emergency Department due to complains of shortness of breath and anxiety. Patient cannot take deep breaths, appears overweight and denies Allergies to medication. The background: Patient has medical history for panic attacks, atrial fibrillation, and Grand Mal seizures; however, patient is not constantly taking her seizure medication. Patient previously had a cholecystectomy, and smokes 1 pack of cigarettes per day for 12 years. The Assessment: Patient vital signs 98.8° F oral, 109 heart rate, 26 respiratory rate, 150/86 blood pressure, SaO2 97% on room air. Denies pain. Neurological; Patient is 65 inches tall, weighing 246 lbs. She is able to move all extremities with strong pushes and pulls. States her “last seizure was two months ago.” Respiratory; Respirations are even, deep, and rapid. Lungs are clear on auscultation. Cardiac; EKG reveals atrial fibrillation; patient states, “It feels like my heart is racing at times.” Pulses are palpable +3 all extremities; capillary refill is instant. GI; Abdomen soft, no distended, and no tender with bowel sounds present in all four quadrants; skin is intact and warm. Current medications: Dilantin 400mg PO BID, Lexapro 20mg PO daily, Metoprolol 25
The client name is Johnny. He is an eight-year-old, low SES African American male. He identified himself as Black. He lives with a seven-year-old stepbrother and mother in an independent home in inner city of Milwaukee. The client was referred to intensive outpatient unit by his mother due to suicidal / homicidal ideations (almost daily), impulsive / disruptive behaviors and mood instability both at home and school. Mother was also worried about his sexualized behaviors towards brother, cousin and peers. The client’s behavioral and emotional problems started at the age of four. He has multiple inpatient admissions over the past three years (Mom believes at least five admissions). The client had a multiple trauma history including sexual and
Our helpee reports experiencing anxiety every day. She feels a constant need to be in control of her surroundings and the people I her immediate care. I find this a direct result of her level of responsibilities as a caregiver. Her grandmother has been diagnosed with diabetes, congestive heart failure (has a pacemaker), and scoliosis (curvature of the spine) along with arthritis. She uses a walker and has a strict diet of no added salt or sugar. Her medications include blood thinner, digoxin, thyroid medication and diabetic medication. One medication requires bi-weekly blood test for levels, one requires monthly tests and the pacemaker requires an appointment to check for discharge and battery strength. Her grandfather has had at least two major strokes as well as two grand mal seizures, has a Foley-catheter and a g-tube. He also depends on a walker and can’t get in and out of bed, a chair or the bathroom without assistance. He is also on blood thinner, Dilantin and digoxin. He also has required weekly test for medication
Mrs A is a 71 year old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behaviour. Her daughter is concerned about her mother's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behaviour constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly mouldy. Her prescribed medications are:
She was still fairly independent in her ADL's while living at home, but obviously, some cognition problems because the daughter described that she would subscribed every magazine ad that came along, that she made contributions inappropriately to every organization, and apparently, she did a lot of shopping for multiple items that she really did not need. All of this culminated in the fact that she was moved to an assisted living in Jacksonville, Florida near where her brother lived in 03/2016. She was just there a few months, in 05/2016 sustained another fall, actually had a fracture of her frontal bone and had an associated intracerebral hemorrhage as a result of that. Following that fall and injury, she was referred back to the same assisted living facility, no longer ambulatory but she was admitted to their memory care unit where she has remained up until the time she came to Mayview yesterday. I have very few records from Florida, but I do have a physician making house calls note from 09/16/2016. Apparently at that period of time, she had a DVT in the left lower extremity. She was on Xarelto 15 mg a day. She was going to see a vascular surgeon for a Greenfield filter. She was getting some physical therapy through home health nursing but had very poor endurance and tone. She had a sacral ulcer at that time and a history of having a previous DVT one year earlier. It said
Background: A female collegiate softball pitcher complained of severe pain in her right elbow & sensory changes in her forearm & hand after throwing a curve ball during a pre-game warm-up. The ulnar collateral ligament (UCL) was found to be tender to palpation, as were the medial epicondyle & cubital tunnel over the ulnar nerve. Grip strength was decreased when compared bilaterally, & sensory deficits were noted as far distal as the 4th & 5th digits. Athlete did not report hearing or feeling any unusual sounds or sensations, & did not report any previous injuries to her elbow. Differential Diagnoses: UCL sprain, thoracic outlet syndrome (TOS), pronator teres strain, compression neuropathy, & cubital tunnel syndrome. Treatment: Musculoskeletal
The nature of combat injuries is such that bacterial contamination is frequently present in traumatic wounds.One of the natural purposes of free and unimpeded bleeding from wounds is to flush out potentially contaminating microorganisms that may have gained entry to the wound from the environment. The question then arises if a hemostatic bandage is successfully used to control potentially life-threatening bleeding, will it increase the chances of infection developing in the wound? The polycationic nature of chitosan is such that the substance possesses natural antimicrobial properties. The broad spectrum antimicrobial activity of N-carboxybutyl chitosan suggested it could be used as a wound dressing.