Intermediate Health Care Case Studies

Her drug screen showed positive benzodiazepines and blood alcohol was negative. Troponins were negative. Also, her initial work up showed acute kidney injury with a creatinine of 1.84, and potassium of 5.8. Her chest x-ray showed small amount of infiltrate in the right lower lobe. The CT scan of the head did not show any acute changes. The abdominal CT scan showed constipation and 6 mm opacity in her bladder. She had an electroencephalogram (EEG) which revealed diffuse generalized nonspecific encephalopathy. In addition, there was slowing of the left hemisphere consistent with left intracerebral lesion. The assessment diagnoses were acute respiratory failure (ABG of 87.287, pCO2 of 45.2, pO2 of 380 and biacarbonate of 20 on vent settings), altered mental status, attempted suicide, infectious process, medication use, hyperglycemic nonketotic, and less likely cerebrovascular accident given that her CT scan of the head was normal. She was admitted to the Intensive Care Unit under the care of Dr. Modupe Kehinde. She was intubated for airway protection and remained intubated until 5/23/2016 (7 days). She was on ventilator and was given nutritional support

On December 1, 2015, 65 year-old Loretta Macpherson arrived at the emergency room of St. Charles Health System, located in Bend, Oregon. Ms. Macpherson arrived to the emergency room complaining of anxiety. When interviewed about her medication history, Ms. Macpherson was unable to identify the medications which she had been prescribed after her recent hospitalization at St. Charles for brain surgery. After examination, the emergency room physician ordered fosphenytoin, an anti-seizure medication, to be administered via intravenous infusion to Ms. Macpherson. In error she received rocuronium, a paralytic drug, causing her to stop breathing and suffer a cardiopulmonary arrest. Ms. Macpherson suffered irreversible brain damage and was placed

The social context influencing Edith’s diagnosis and care began in the emergency room. Depending on the hospital and the time of day there is not always a radiologist available to read CT scans for the emergency room doctors so often they are left to interpret the scans themselves. Unfortunately, this may have been the case for Edith’s scan, therefore eliminating a positive social influence to help check for errors (pg.97). The ER doctor would have benefited from getting another perspective on the scan. Another physician may have focused more on the basal ganglia infract and less on the deterioration of Edith’s white matter of her brain.

Mrs. Dey reported she had been extremely sick with the anti-seizure medications and her primary care advised her to stop the current medication and go into the hospital. She was hospitalized overnight in observation and Dr. Hardy requested she come into his office the following Monday, September 11, 2017. Due to the unexpected appointment, I had a scheduling conflict and my colleague Laurie Wawrzynaik RN, BSN, MA, attended.

To temporarily solve a more serious problem, they gave her medication, and we were on our way. When the time finally came to see the neurologist, they had hooked her up to an EEG, which monitored her brain waves. They found nothing in this EEG, until a different hospital performed a 24-48 hour EEG. She was in the hospital trying to make sure she had her homework completed and was caught up, when the machine caught strange brain waves when she was doing her math homework. This was the first time the doctor told us it wasn’t seizures due to stress, but partial onset seizures. Her brain looks normal, but when a seizure hits, it starts in the left temporal lobe and travels to the right side of her brain, lighting up like a firework. This affects her mood and emotions, to where her brain must reboot in order for her to

The patient is an 81-year-old female who was brought to the ER there this morning while trying to make her bed she felt a little bit dizzy. She felt like the room was spinning and she knew she was going to go down. The next day she remembers is that she saw some blood on the right side of her eye she was on the floor she activated her alarm and the EMS actually had to climb thru a window to get her. The patient denies any palpitations prior the episode or any prior episodes of passing out the past. In the ER she was having a glucose level of 47. She has is quite significant history, she had a laminectomy done in February 2015, was discharged to rehabilitation where she had some problems with difficulty breathing and ended up in Saint Barnabas

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

Ms. Choi indicated that the marriage continued to deteriorate. The mother stated that she became unhappy with his behavior. The arguments between the parents became more intense and violent. Ms. Choi reported in 2009, the father continued to be physically abusive towards her.

1) Intermountain Healthcare has had a long history of success of continuous quality improvement over the years. What has led to that success?

Healthcare workers are in high demand. Healthcare workers are the people that take personal care of patients and help make a great difference in their life. Sussex Healthcare is now hiring people that are interested in starting a healthcare career or experienced workers that are simply interested in working for a well respected organization that provides plenty of opportunities for kind, caring, and industrious individuals to join the healthcare industry. Sussex Healthcare is located in Sussex, UK. The organization operates a group of care homes in the community. Their specialty is providing health care services to elderly patients, dementia patients, patients with physical handicaps, patients with mental disabilities, and more.

A 55-year-old mother of 3three is brought to the emergency department shortly after being found lying on her bed by her neighbor. They usually have coffee in the afternoon and when her friend did not answer the door, her neighbor let herself in. Upon finding the patient, the neighbor called 911. First responders reported numerous bottles of medications next to the patient’s bed, but mistakenly did not grab them. In the emergency department, the patient is is lethargic and disoriented to person, place, and time. Her husband and three children have not arrived and a clear past and present medical history cannot be taken. The patient begins to become restless and mumble incoherently and intermittently loses consciousness.

Female patient presented to the emergency room with status epilepticus and loss of consciousness with no other chronic disease history. Patient gave the birth by cesarean a day before she brought to the emergency room. For identification of cause of this situation, clinicians apply many clinical and others method like:

The seizures more violent, the brain fog never ending. At a loss as to what to do, we decided to take our chances in a bigger hospital; she was taken to the emergency room hoping that a neurologist would be available. Without a wait Keli was taken back to start testing. A doctor, nurses, and yes a neurologist came, she observed Keli, asked a few question then left, she had the results of the tests when she returned. “Keli, your MRI, and EEG are normal, you are experiencing pseudo seizures” Instant relief came to me and gratitude for the “not” answers received, not MS, not a brain tumor, not epilepsy. However, Keli did not experience the same instant relief; she asked “Are you saying that I am making this happen, that I am crazy? The neurologist tried to help Keli understand that her subconscious mind was telling her body an unhealthy way to deal with the stresses of her life. Keli just saw that she was weak, she was embarrassed that so many people who loved her and had been serving her were doing it without a justified reason in her mind. Keli left the hospital not ready for people to know her

The following case scenario is based on a fictitious patient, and it would be use on this paper as a guidance to develop a patient and family teaching plan. The situation: Mrs. Marquez, a 39-year-old Caucasian female was admitted into the Emergency Department due to complains of shortness of breath and anxiety. Patient cannot take deep breaths, appears overweight and denies Allergies to medication. The background: Patient has medical history for panic attacks, atrial fibrillation, and Grand Mal seizures; however, patient is not constantly taking her seizure medication. Patient previously had a cholecystectomy, and smokes 1 pack of cigarettes per day for 12 years. The Assessment: Patient vital signs 98.8° F oral, 109 heart rate, 26 respiratory rate, 150/86 blood pressure, SaO2 97% on room air. Denies pain. Neurological; Patient is 65 inches tall, weighing 246 lbs. She is able to move all extremities with strong pushes and pulls. States her “last seizure was two months ago.” Respiratory; Respirations are even, deep, and rapid. Lungs are clear on auscultation. Cardiac; EKG reveals atrial fibrillation; patient states, “It feels like my heart is racing at times.” Pulses are palpable +3 all extremities; capillary refill is instant. GI; Abdomen soft, no distended, and no tender with bowel sounds present in all four quadrants; skin is intact and warm. Current medications: Dilantin 400mg PO BID, Lexapro 20mg PO daily, Metoprolol 25

Patient is a 60-year-old Latin American female, who presents with her husband for evaluation of some spells. She seems to have two different things going on. She did report intermittent episodes of feeling of weakness with blurred vision, diffuse paresthesias and a sensation she is about to pass out or the sensation of before undergoing generalized surgery, feeling like she is being sucked down. There is no loss of consciousness with this. She is unable to give any further history, except these events have been going on for about a month. They are almost daily. She does note they happen after eating, at which point, she will fall asleep easily. Otherwise, she denies any loss of consciousness,