Glen Reha's Case Summary

He admits to a 25 pound weight gain over the last few months. The patient was

Scenario: Mr. B, a 67-year-old-man, came to the ER complaining of severe pain to his left hip and leg after falling over his dog at home. Left leg appears shortened with swelling in his calf, bruised, and limited range of motion.Mr. B has a history of impaired glucose tolerance and prostate cancer. Home medications include atorvastatin and oxycodone for chronic back pain. Mr. B’s labs, taken during a previous visit with his primary care doctor, revealed elevated cholesterol and lipids.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

. The Corps of Engineers would be allowed to build a protective dike but only in a manner mutually agreed to by the Department of Interior and the Corps. This was a controversial provision, reflecting what was then accepted practice with respect to hurricane protection, and there was serious disagreement in Carteret County as to whether a protective dike would be a wise move. Finally, an area of about 250 acres at Lookout Bight, belonging to Sanford busi-nessman Charles Reaves, was “mysteriously” excluded from the Seashore and another provision entitled any property owner owning property as of January 1, 1966, developed for non-commercial, residential purposes on July 1, 1963, to a 25-year right of use and occupancy.

HISTORY OF PRESENT ILLNESS: David Lockman is a 44-year-old male who injured his right knee on July 21, 2015 when a circular saw came into contact with his medial right knee. He was taken to the operative suite by Dr. Lin for an emergent irrigation and debridement. He tolerated this very well. He was admitted overnight for antibiotic coverage, and discharged with instructions to weight bear as tolerated with the use of a hinged knee brace and walker. He was doing well but presents today with ongoing pain of 6-7/10. His biggest concern was that the swelling, redness, and edema was now extensive down the leg and into the ankle and foot causing him some ankle pain, as well. He has been using Norco for control of his pain. He is not taking any antibiotics currently. He is set up for

An attending physician statement completed by Dr. Peter Chweyah (Internal Medicine), dated 06/16/2016, indicated that the claimant presented with complaints of lower extremity weakness, neuropathy, weight loss, acute renal failure, and gout, as well as anemia. Objective findings showed an extreme weakness of the legs and pain in the feet. He also had diabetes mellitus type 2, chronic kidney disease, and hypertension. It was noted that the claimant was totally disabled from 05/30/2017 through 06/15/2017 and 05/23/2017 - 05/26/2017 secondary to gout.

Upon assessment, I found that both her lower legs had +1 edema, were red, skin was a bit peeling, and warm to touch. She reported a bit of tenderness on palpation. The right leg, however, had black “scabs” towards the outer side; upon palpation, I noticed that they were under the skin and I could not feel any bumps. Other than her lower legs, her skin was dry and intact, color consistent with her ethnicity, no surgical incisions, and mucous membranes were pink, moist, and intact. She had a #22 IV in her left hand, and the IV site was clean. She was oriented x3, calm and cooperative, had clear speech, had no weakness, no flaccid tone, and no numbness. Her strength was normal in upper extremity, and her lower extremities moved against resistance. Her pupils were round, equal in size, and reactive to light. Her blood pressure was 133/76, heart rate 94, oxygen saturation of 98% on room air, respiratory rate of 18, oral temperature of 36.7

Mr. Lewis is seen for Dr. Craane at Oak Park Heights. Mr. Lewis is a 74-year-old gentleman with multiple medical problems, including rheumatoid arthritis, hepatitis C, diabetes mellitus, hypertension, and severe respiratory insufficiency. His recent history is well known to us as he was originally at Faribault when he became ill with the current episode of leg ulcerations. He was being treated for rheumatoid arthritis and severe COPD at that time and had significant edema in his legs. He was being treated with methotrexate for his rheumatoid arthritis and was also on low dose prednisone at that time. He developed very, very painful leg lesions that quickly developed from darkened skin lesions to undermined ulcerations that had a gangrenous

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

Introduction: Jessie Buchanan, an 80-year old female, was admitted to Bethany Care Society in room 3088-1 at the center unit. She is an extensive assist, requires 1 staff assistance and uses the transfer belt to transfer from bed to her wheelchair. She was admitted here because none of her family members can look after her because they are all busy with their own personal life. Jessie prefers to stay at Bethany because she receives full-time care from the health care providers. Jessie had a history of edema on her right ankle because she was experiencing hyponatremia. Currently, she is on fluid restriction and every morning I would put her compression stockings to prevent the occurrence of edema. Her condition worsens when she was diagnosed with osteoarthritis(OA), delirium, depression, type 2 diabetes mellitus, schizophrenia, hypertension, and urinary tract infections. Her recent urine culture shows that she is positive for urine nitrite and urine leukocyte which caused the UTI. Jessie is incontinent and she wears an indwelling catheter. Jessie said that sometimes her knees are painful. She takes an analgesic to relieve the pain that she feels. Jessie 's blood sugar level is within the range. She is not taking insulin or any oral medications like metformin because she knows how to control it, by following the proper diet. Jessie always have a good sleep and never complains about her sleeping pattern. She is taking medications for GERD, iron supplement, bone health,

This is an 82-year-old gentleman, who was referred from Dr. Gretchen Marsh’s office because the patient’s BUN and creatinine were high, as he has acute kidney injury. The patient went to Dr. Marsh’s office yesterday and was having generalized weakness. He does not have any vomiting. No diarrhea. No fever. No cough with expectoration. No sharpness. No wheezing. No headache. No dizziness. No passing out. No rectal bleeding. No hematemesis. No abdominal pain. No sore throat. No stuffy nose. No cough with expectoration. No burning, frequency, or

Musculoskeletal- erosive destructive changes in the elbows, wrist, and hands consistent with rheumatoid arthritis, has bilateral total knee replacements with stovepipe legs and perimalleolar pitting edema 1+. I feel no pluses distally in either leg.

Impaired skin integrity related to limited mobility, impaired tissue perfusion, decreased cardiac output, altered nutritional and hydration status, increased moisture, decreased sensory perception and excess weight as evidenced by patient being bed reddened 95% of the day, +2-+3 peripheral edema, stage III- IV coccyx pressure ulcer, drainage from the coccyx ulcer, high blood pressure, decreased oxygen saturation between 85-95 % 2L NP, weak peripheral pulses, obesity, excessively dry skin, sores on both legs (blister-like), denial of pain regarding dressing changes, and excessive diaphoresis with movement secondary to CHF, hypertension, hyperlipidemia, and non-insulin dependent type II diabetes.