Detection Case Studies

The possible physical abuse section includes the assessment of bruising that appeared on several places on the patient’s body including right periorbital area and right maxilla along with swelling, redness and warmth. There was

Plan: The patient will be admitted, kept NPO, and an appendectomy will be performed by Dr. Rogers in the morning.

The patient’s vital signs have stabilized, with HR in the 70s, BP is in the 120s/60s, regular RR and 37.6o Celsius temperature. Graft site wound bed is pink with tissue granulation noted. The learner is expected to prepare the patient for discharge. This SCE prepares the learner for the following items of the NCLEX-RN test format:

Due to the skin being severely damages it’s going to take a long time to heal. The skin graft will help prevent infection and speed up the healing process.

PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal ligament and incised this

PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal

S: TM works in GA Final when she closed the Sante Fe’s back door on her left pointer finger. TM rates her pain at 10/10 pulsating type pain. After 20 minutes of ice TM rates her pain at 7/10. TM reports initial bleeding, copious amount from her left pointer finger distal phalanx. TM denies previous injury to the location.

Urgent treatment is important to stop further damage and treat the injury, so get immediate medical help!

I met Mr. Russell at the office of Covenant Occupational Medicine on 11/21/16. Mr. Russell reports his pain level at time is a 1 since stopping the work hardening program. When he is standing and walking for a period of time it will increase. He still has some numbness to his feet. The MRI showed a L4/L5 annular tear. There is no nerve root impingement. Dr. Zhang said there is no way to tell if the annular tear is old or new. He wants Mr. Russell to be seen by a Neurosurgeon. Dr. Zhang does not feel it is surgical but the doctor may have treatment suggestions.

The internal examination revealed four blunt injuries distributed in the thoracic and abdominal regions as shown in Table 1 and Figure 1A and 1B.

On 6/14/16 I met Mr. Blake at the U of M wound clinic, Midland location. Mr. Blake said over the weekend, the white end cap fell off his pin to the third toe. Since that time he reports an increase in pain to that toe. Mr. Blake reported that he called Dr. Biddinger’s office and he was told to come in on 6/15/16. Dr. Taylor examined the foot. He removed some calloused skin around the toes. Dr. Taylor stated the wound is completely healed now. He does not need to come back to the wound clinic.

The wounds that were located in the left sacrum and left hip had been present for more than 41 days and had serous exudate. The wound in the right hip had been present for more than 35 days and also had serous exudate. The provider cauterized the wound in the left sacrum after administering a local anesthetic and applied a special dressing to all 3 wounds. The plan was to follow-up “within 7 days.”

The onlay patch was then trimmed, laid over the repair and secured around the cord using 2-0 Vicryl suture. The wound was copiously irrigated with saline solution. Hemostasis was felt to be adequate. External oblique was then closed using running 2-0 Vicryl. Scarpa's fascia closed using 3-0 Vicryl. Skin was closed with running 4-0 Vicryl subcuticular suture. Attention was then drawn to the left where a curvilinear incision was made superior and lateral to the os pubis and carried it down through skin and subcutaneous tissue. Hemostasis was obtained with electrocautery. External oblique was opened in the direction of its fibers and an extremely large hernia sac was identified. Ultimately, the spermatic cord was identified and elevated using a Penrose drain. Cremasteric fibers were opened and it was inspected, no evidence of any indirect inguinal hernia was seen. The attenuated transversalis fascia was incised and then this direct left inguinal hernia was then reduced. Once this was done, an extra large mesh plug was introduced in the preperitoneal space and secured in the usual fashion using two sutures of 2-0 Vicryl to the conjoined tendon, shelving portion of Poupart's

The lateral neck is divided into 3 zones; this system is useful in the evaluation and treatment of penetrating neck injuries. Zone 1 extends from the clavicle to the cricoid cartilage and includes the thoracic inlet. This region contains the major vascular structures of the subclavian artery and vein, jugular vein, and common carotid artery, as well as the esophagus, thyroid, and trachea. Only subclavian artery and vein—which are inferior to the clavicle and ascend slightly superior to the clavicle—are relevant to this injury, as the rest are superior and medial to the stab wound. The other structures that were injured include the epidermis surrounding the entry of the stab, the apex of the lung, which is deep to the lateral of the clavicle,

He was visibly observed to be in pain during the interview as he was holding his left elbow with the laceration,