Evaluation Of The Critical Clinical Components

History of Present Illness: Ms. Dahlberg is a very pleasant 69-year-old woman who suffers from poorly controlled asthma. She has a recent exacerbation requiring hospitalization at Anna Jaques Hospital in June. Since discharge, she states that she has done well. She has stable dyspnea on exertion. She does feel that perhaps it might be slightly worse given the heat and humidity. She is not complaining of any cough. She is compliant with her bronchodilator regimen.

R.J. is a 15-year-old boy with a history of asthma diagnosed at age 8. His asthma episodes are triggered by exposure to cats and various plant pollens. He has been using his albuterol inhaler 10 to 12 times per day over the last 3 days and is continuing to wheeze. He normally needs his inhaler only occasionally (2 or 3 times per week). He takes no other medications and has no other known medical conditions. Physical examination reveals moderate respiratory distress with a respiratory rate of 32, oximetry 90%, peak expiratory flow rate (PEFR) 60% of predicted, and expiratory wheezing.

A clinical microsystem is a “small, interdependent group of people who work together regularly to provide care for specific groups of patients” (Institute for Healthcare Improvement, p.1). It is the goal of this paper to discuss the findings of the Johnson Clinical Microsystem Assessment Tool to the microsystem where I am employed on-call, the Multnomah County Health Department (MCHD), HIV Health Service Center (HSC), a primary medical home for patients with HIV/AIDS. Additionally, I will address each of the 5 P’s of the microsystem; purpose, patients, professionals, procedures and patterns that will then inform a practice change for the clinic.

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Another Consultation Report dated 12/06/2016, indicated that the claimant presented with exacerbation of COPD, acute bronchitis, and pseudomonas aeruginosa. The CT scan of the chest revealed bilateral lower lobe atelectatic changes, fibrosis, and a small 1 cm left lower lobe nodular density. A pulmonary consultation was recommended. His blood pressure was 142/79 mmHg. The physical examination revealed bilateral decreased breath sounds and scattered wheezes. His glucose was 189. DuoNeb, IV Solu-Medrol, and IV antibiotics were prescribed.

Lungs: Diminished breath sounds in all lung fields. Resonant to percussion. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored.

Undecided, initially, because of her age the possibility of an inaccurate diagnosis, the differences of both the reliability and validity which may occur because of the difference in age, race, gender as well as socioeconomic status. However, in Clara’s case, it may just be a phase like many toddlers and adolescents go through. On the contrary, it can also be something a little more severe because of the fact that she is adopted,

Critical time intervention (CTI) was designed to be bridge that filled the gap between institutionalization and transition into the community. The hope of CTI is to prevent homelessness among individuals suffering from mental illness as well as develop a step- by- step initiative that could combat the growing problem (Critical Time Intervention, 2012). Buchanan (2006) estimates that 3.5 million individuals are likely to experience homelessness in a given year (Sadowski, 2009). The epidemiology of homelessness suggest that serious mental illness is neither a necessity nor sufficient enough for homelessness. It suggests; however, that individuals suffering from socioeconomically difficulties could inevitably accompany serious mental illnesses to form the abundance of homeless individuals, considering the majority of homelessness is attributed to mental illness cases (Montgomery, 2013). The purpose of this EBP is to integrate critical time intervention with programs simulated by Medicaid and already established initiatives of the Affordable Care Act of 2014.

Terrell Pollard called the office at 5:11Pm to inform me that he was unloading a car when he was putting in neutral the chain gave away allowing the car to roll down his bed catching his hand and car door on a post. I ask him if he need the medical squad to come out he said no that it was hurting but that he didn’t need the medical squad to come out. Told him to sit in the truck and to relax that I would be there in a few minutes to help him.

His condition started slow with just the bad cough on dry dusty days. Now we no longer ride him. We do not take him anywhere. My youngest daughter gets so upset because she wants to play with him, but his coughing gets too bad. We take it day by day with him lately his breathing is getting worst. It is hard to watch a loved one slowly get sick. He does eat and graze well and fat as can be. He even runs and plays in the field. Some days we watch him and is diaphragm is moving really fast and hard. His life span has shortened with the COPD

Jones had the following childhood illnesses that included mumps, measles, and chicken pox. He also was vaccinated for whooping cough, diphtheria, polio, and rheumatic fever. He stated he had no serious illnesses as a child but did break his arm from a fall from a tree. At the age of thirty, he had his appendix and gallbladder removed. He was hospitalized three years ago for what he felt was chest pressure but was determined to be acid reflux. Client states that he had tetanus shot three years ago and had both the flu and pneumonia vaccines last September. Client denies any skin problems, difficulty swallowing, or weight changes. He denies any urinary or bowel difficulties but states that since he has been taking diuretics his urine output has increased. Last set of labs drawn were within normal limits but his pulmonary function test (PFT) was abnormal. Spirometry (PFT) is a test of how well your lungs work and diagnose COPD ((Vestbo, Hurd, & Rodriguez‐Roisin, 2012).Client is alert and oriented to person, place, time, and situation. No neurological deficits

Unfortunately in the last few days Consuelo has developed what sounds like a viral infective exacerbation of asthma, having likely caught this from her children who have been unwell for the last couple of weeks. She reports nasal congestion, myalgias and cough and in the last couple of days her asthma has started to play up with breathlessness, wheeze and chest tightness.

allergies. CNS wanted to make sure they were clear about the symptoms they product relieved,

As a young doctor on call in one of the leading hospital in Nigeria, I had a patient, an 8 year old girl that presented with breathing difficulty accompanied with wheeze. The picture fitted so well into an acute asthmatic attack and we began management along that line. There was an initial improvement but this improvement wasn 't as expected and this made us probe further. The patient’s mother attested to the fact

The child I helped take care of was a 15-year-old adolescent male. He was brought into the hospital due to an asthma attack. According to his mom, he has had asthma for years and sometimes has more severe attacks causing him to come into the hospital. Throughout this paper, this child’s developmental stages and medical diagnosis will be discussed.