Case Study Bettye Hoffman

Ms. Castellano denies mental health. Client denies any in-patient psychiatric hospitalization or out-patient treatment. Client denies history of homicidal or suicidal ideation or behavior. Client denies history of Alcohol Abuse and Substance Abuse.

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

Claimant reports history of multiple medical complaints. Since the age of 60 she reports struggling with urinary incontinence, which impacts her functioning at work. She reports feeling ashamed and guilty that she is unable to control her urination and has the need to periodically utilize the restroom or go to her car taking time away from her responsibilities. In the past few years claimant has severe intensification of physical symptoms, including back pain, right shoulder and hand weakness, blood pressure, headaches, sleep difficulty, and depression-related fluctuating appetite, fatigue and sluggishness. She reports experiencing heart palpitations present (racing heart), dizziness, and fear of actual fainting, a feeling of choking and not being able to breathe, chest pains, nausea or intestinal pains, shortness of breath, tremors in the hands, hot flashes and tunnel vision. The claimant reports that she sleeps very minimally; averaging 3-4 hours of sleep per night on an interrupted basis due to physical and emotional pain. She reports that she has very poor mobility due to pain and depression-related poor motivation.

Patient CB is a 36 year old African American Female. She has a past medical history of hypertension, acid reflux, heartburn, and a hernia repair one year ago. She is a nonsmoker and reports never taking recreational drugs. Diagnostic tests related to her diagnosis include an abdominal ultrasound showing gallstones, an x-ray to verify stone presence, and tenderness with touch on the abdomin. CB was having a cholecystectomy because she was having pain in her abdomen related to gallstones. Her hernia was a result of a weakening of the abdominal wall.

REPORTER: The reporter/Social Worker (Bianca) called with concerns for the victim, Johnny. Johnny suffered from a stroke in 2015, and he was diagnosed with Schizophrenia. Johnny can feed himself and he utilizes a walker. Johnny suffered from renal failure and expressive aphasia. On today (7/22/2015), Johnny didn’t show up for his appointment, and Hazel (cousin/primary caretaker) didn’t reschedule the appointment. On today (8/28/2015), the reporter contacted the primary caretaker/cousin (Hazel Brassfield), but she didn’t receive an answer. The reporter doesn’t know who diagnosed the victim with Schizophrenia, but he doesn’t take medication for the disorder. The reporter is not sure the victim is getting the care he needs, after he had the stroke.

This condition is seen when a hemangioma is located in segment IV or close to the hepatic hilium (20).

She reported suicidal ideation, and visual and auditory hallucinations. She was anxious, had mood swings, was afraid of being alone, occasionally she was “too tired” to take her medications, and often yelled demanding things from the staff. She repeated questions that had already been answered. One of the records documented that the claimant stated, “I am 12 year old- I do not want to grow up … I wish I could have some tequila, tequila, tequila!” In more than one opportunity, she slept on the floor. She was “sometimes hysterical when reacting to hallucinations.” In late 2013, she was discharged into police custody and was transported to an emergency detention center. There were numerous episodes documented of aggressive, disruptive, hostile, agitated, and uncooperative behavior. The diagnoses listed included major depression with psychotic features, borderline personality disorder, mood disorder, and alcohol abuse. The mental health provider indicated that the claimant was unable to work full-time because of mental illness; she had and would predictably have repeated episodes of decompensation. She was homeless, or at risk of homelessness due to her mental

Urinary incontinence (UI) is one of the important underreported problems that leads to serious impact on physical, psychological and social well-being. According to research urinary incontinence guideline panel UI is defined as involuntary loss or leakage of urine which occurs when bladder pressure surpasses urethral pressure (Porth, 2014). With a knowingly higher incidence in females than males, this syndrome is a combination of age related changes and pathology of genitourinary system (Workman & Ignatavicius, 2013). Considering the frequent prevalence of UI, it is very essential for nurses to get education and this clinical update about pathophysiology, risk factors, clinical manifestations, diagnosis and treatment available.

Ultrasonography (US): Generally, typical hepatic hemangiomas are homogeneous hyperechoic masses with well-defined margins and posterior acoustic enhancement at US examination. In 10% of cases, the lesion may be seen as a hypoechoic lesion due to the presence of an underlying

. Client stated she wanted to have a better relationship with her children, stated she loves her grandchildren and expressed she want to see them more often. Client reported her husband committed adultery which lead the client to leave the marriage. Client reported feeling overwhelmed and afraid about the transition stages to obtain permanent housing. Client stated how she will handle daily activities and responsibilities when living alone? Client is receiving four types’ medications to treatment her depression and pain management due to a hip replacement last year and one pending in April 2016. DSM-5 Diagnosis: Depression-F32.9, Hypertension-l10, Unspecified glaucoma-H40.9, Opioid abuse-F11.10, in remission, Cocaine abuse, uncomplicated- F14, 10, in remission, Cannabis abuse- F12, 10,in

The latest progress report noted that the patient has neck and low back pain rated 7/10. The Physical exam revealed restricted ROM in the lumbar spine. TTP and

The most recent hospitalization was soon after the initial meeting with his case manager. Client reported he felt “under pressure.” He reported that work was stressful and he was having a hard time with his ex-wife and ex-girlfriend. Client also reported that his parents were overwhelming him by continually asking him questions about his illness; which, he stated, “makes it real.” Client reported he was also having difficulty with his medications. He stated, “They were making me feel really slow, so I stopped taking them.” He reports the medication “got rid of hallucinations, but I didn’t like the way they made me feel.” “So I stopped taking them and was hospitalized.” Client reported that once he stopped taking his medication, he began “contemplating suicide.” The second hospitalization occurred when the client was 23 years of age. Client reported his hospitalizations was a result of his “medication stopped working and I was getting command voices to harm other people.” Client reported that he “hospitalized himself.” The first time the client was hospitalized was at the age of 22. Client reports, he does not remember what occurred before his hospitalization and he only “remembers going.” Client thinks it was because he was “not on strong enough meds.” Clients meetings with his case manager are usually bi-weekly, unless the client is in need of assistance with paperwork, isolation, and monitoring. The client prefers bi-weekly meetings, due to having his child during the day. However, he generally attends all scheduled meetings. If he is unable to, he will call and cancel prior to their scheduled meeting. Client relies on his phone calendar to remind him of his appointments with his case manager, counselor, psychiatrist, and his monthly Invega

[Name] has a history of many endoscopies. Remote EGD showed antral gastritis, but more recent EGDs were negative for remarkable findings. Colonoscopy showed diverticulosis. She has no history of heart disease or hypertension. Medical history was essentially benign, except for cataracts, and recent cataract history.

Brief summary of the case (4-5 sentences). Katie reports a lack of self-confidence and was paranoid about her body image. She assumed that thin people had no problems and thought that losing weight might help all of her stresses. Katie started to restrict her eating and cut out fats, carbs and dairy, and took on cycling. Soon, she started to deal with an overwhelming voice that wanted her to continue her maladaptive behaviors to the point of her bones aching and her periods stopping. After having minor heart attack, she was enrolled in a psychiatric ward where she was in for 9 months of treatment.

Claims weighing 180lbs. Reports having lost weight within the past 5 years. Claims that diet has been the biggest factor for weight loss. Report making 1-2 bowel movements a day. Describes the stool as brown and solid. Denies significant feelings of being bloated or having increased gas. Denies any physical problems that affect bowel functioning. Denies any family history of abdominal or bowel disease. Denies ever having been diagnosed with bowel disease. Denies ever having had an infection in the bowel. Denies any significant nausea. Confirms some heartburn. Reports that it does not happen often and usually occurs with greasy meals. Reports using pepto bismol to treat heartburn. Additionally reports using pepto bismol in anticipation of indigestion. Denies any feelings of indigestion or bloating. Denies any