Impaired Tissue Integrity Case Study

1000 Pt denied pain at this time and rate 0 on a scale of 0 to 10. Pt thanks me a lot for pain medication I gave her. Instruct the pt to report her pain early before it get worse so I can give pain medication. Pt verbalized understanding of the teaching. No sign of distress or discomfort at this time. Will continue to monitor………L.Gotora

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. Port is an 77 y/o female with chronic pain syndrome due to fracture vertebrae and neuropathy related to her diabetes. She is seen today at home for follow up at the request of ARNP Wheliham Irwin, Brittney for pain and symptom management.

I believe that tissue damage recovery strategies are very effective and important as a recovery strategies for athletes.

Patient continues to manage pain with medications which brings the pain intensity from 7/10 on an average down to 3-4/10 and allows her to continue activities of daily living (ADLs) with less pain and stiffness. Patient states that without medications, she will not be able to function or move due to increase pain

Resident alert, oriented and able to and follow two step verbal instructions. resident co-operated well with the assessment. Reported ongoing right shoulder and bilateral knee pain. hypersensitivity on his bilateral toes. Resident maintained ROM in the bilateral UE and LE, which is within the functional limits. Strength maintained at 4+/5 in UE and LE muscle groups. A decline in his endurance and activity tolerance noted from the last assessment. Some tightness noted in the bilateral hamstrings and calf muscles. Resident has good sitting and fair standing balance. His Tinetti score declined from 20/28 to 16/28 since the last assessment, which indicates a high fall risk. Resident ambulates short distance(SOBE noted) with one assist using 4WW

The patient has been diagnosed with bilateral peripheral neuropathy. She has been seeing Kishori Somyreddy, MD. Dr. Somyreddy recommended physical therapy, which she is not sure it helped with the neuropathy, but she does think it helps with her chronic back pain and she is feeling better from that standpoint. She has not been able to stick with the physical therapy exercises as much of late, but does plan on getting back to that now that she is settled and feeling less stress with all that she needs to do.

Per medical report dated 11/24/15 by Dr. Cano, the patient is complaining of severe numbness in the right hand, tightness around the right worse than left hand. She also associates this with dropping items. She is unable to button her shirts or raise her arms up to her elbows. This is continuous all day long. Also, associated is severe low back pain with numbness, radiation, and muscle spasm in the thoracic area, and numbness and radiation down the right sciatic nerve with severe low back pain. She continued to work, sixteen-hour shifts, seven days a week. At this time, she is unable to function. She states that she has had 24 sessions of physical therapy that has definitely helped her.

Soft Tissue Repair Case Study: The Four Phase of Soft Tissue Healing and Therapeutic Interventions that can be used to Aid Progression of Repair.

Complex regional pain syndrome (CPRS) formerly known as reflex sympathetic dystrophy is an autonomic and central nervous system disease that results in an individual’s experiencing chronic pain (Ferrillo, 2016). Pain usually happens in one or more generalized region of the extremities, such as the arms, hands, legs, or feet, but can also affect other parts of the body. Although the particular origin of the disease is undetermined, the majority of the time CRPS is caused by a significant trauma; such as a fracture, sprain, burn, cut, bruise, limb immobilization, or a surgical procedure (Ferrillo, 2016). CRPS stems from a neurological dysfunction that generates severe pain, mild or dramatic changes in skin color, temperature, and swelling in the affected area (National Institute of Neurological disorders and Stroke, 2015). There are two types of complex regional pain syndrome, type I is no apparent nerve injury and may it develop following a noxious event that may or may not have been traumatic. Types II develop after a nerve injury of the affected area (Carr, Cerda, & Fiala, 2016).

At today's visit he is accompanied by his wife. He is awake, alert and oriented. He reports that his back pain has improved with the pain regimen he was started on last Friday. He complains of lower back pain that he describes as achy and constant; he rates his pain as a 7/10 in severity. He states that his pain doe not radiate, but it affects his mobility and impedes his ability to get out of bed by himself. His pain regimen is Morphine ER 15 mg p.o every 12 hours and oxycodone/apap 10/325 mg p.o every 4 hours as needed for breakthrough pain. He has taken 6 as needed breakthrough doses daily since Friday. He states that his pain has improved but his goal is to have his pain a little better than 7/10, then he will be able to perform his ADLS

Patient education provided. I explained to the patient that he had seen PT on 10/11/2016 and was given strengthening home program with Thera-Band. I encouraged patient to comply with PT advice. Also I review with the patient on his hip x-ray in 09/01/2016 and explain it to him that it showed joint space narrowing on the left more than right and that is early degenerated joint disease changes, so with that I encouraged patient modification of his activity avoid what triggers the pain, avoid vigorous or intensive exercise to the affected area. Take medication as directed. Running five miles that is the kind of activity he can reduce to like two miles daily. Walking, stretching, and prolonged standing limit to like one or two hours daily. No prolonged standing, like four hours _____ or even like all day based on patient report. All questions were answered. General measures were discussed sometimes like rest, ice, and take medication as directed. Again, I discussed about Indocin, Keppra indication and adverse side effect with the patient. Will follow up with him in 180 days for his chronic left hip pain. I offered blood work of CRP and ESR, patient declined it. Will continue monitoring his chronic hip pain in 180 days. I also reviewed the lab with the patient and his Keppra is 17.3 and 1000 mg twice daily, which were checked on 11/18/2016, it is at therapeutic level. Will follow up with him in 180 daily for his

On admission, Ms. Kelly complained of low back pain ranging in intensity from 7 to 8, out of 10, on the pain scale where 0 is no pain and 10 is the worst imaginable pain. She subjectively describes this pain as throbbing, stabbing, burning and radiating down into both legs, left worse than right. In addition, she has sharp, stabbing, burning pain in both her arms, left worse than right, and experiences intermittent tingling and numbness sensations in both her hands. She has pain in her neck and shoulder that she defines as tension-type pain. Factors that can aggravate the pain include

Horses that are used for professional showing or athletic competitions are inclined to receive an injury involving tendons or ligaments, which can be career or life ending depending on the severity. The injured soft tissue usually has a poor blood supply so they are prone to healing with scar tissue. This makes the healed area less elastic and decreases the function of the tendon or ligament, and re-injury to the soft tissue increases. Another issue associated with soft tissue injuries is the inflammation of a tendon called tendonitis that can be seen in 43% of horses returning to work (Alves AG, Stewart AA, et al, 2011). Because of these issues regenerative therapy has been considered a more effective way to stimulate healing for orthopedic injuries.

Grade 1: This grade is where the ankle will be tender and swelling may occur however the ligaments will not be torn however there may be little tear.