L. F.: Trauma Case Study

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.

Falls among any individual can cause significant trauma, often leading to an increase in mortality. According to the Centers for Disease Control and Prevention (2012), one in every three adults over the age of 65 falls each year. Long-term care facilities account for many of these falls, with an average of 1.5 falls occurring per nursing home bed annually (Vu, Weintraub, & Rubenstein, 2004). In 2001, the American Geriatric Society, British Geriatric Society, and the American Academy of Orthopaedic Surgeons Panel on Falls Prevention published specific guidelines to prevent falls in long-term

No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.

Exercises and physical activity have been associated with numerous health benefits including reducing incidences of falls and injuries among the elderly and the geriatric population. Appropriately exercise programs and cardiovascular fitness in older people improve strength and balance. The interventions included strengthening, endurance, balance, flexibility exercises, Tai Chi, stand up/step down procedure and walking exercises. In the first research, the findings were that program targeting balance, leg strength, and freezing gait were only effective in people with milder illnesses, as opposed to more serious disorders like Parkinson’s disease. The study was done for a period of 2 years. In the second research, the findings showed that a multi-component enhanced physical performance of the community indwelling adults but did not translate to psychological outcomes or reduced rates of falling.

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

Patient was in the ER room when first seen. PT was with her family members and family states that she speaks little English and that she has had abdominal pain for the past day along with bloody stools. Family states that she is on calcium supplements and no other medications. Last oral intake is 24 hours ago. Family states no known past medical history. Pt is in the hospital bed in the fetal position and towards the right side. Patient's airway is clear and breathing is normal. Skin is warm and dry. Patent is AAOx4. Assessment of head, neck, and chest show no signs of deformities. Abdominal area not assessed due to severe pain. Back is without deformity. The upper extremity shows no sign of deformities or trauma. The lower extremity shows

Falls are a common and complex geriatric syndrome that cause considerable mortality, morbidity, reduced functioning, and premature nursing home admissions. Falls have multiple precipitating causes and predisposing risk factors, which make their diagnosis, treatment, and prevention a difficult clinical challenge. Identifying effective interventions to prevent falls and fall-related injuries among older adults is a major area of research and policy development in geriatrics. Several published clinical guidelines review the evidence for fall prevention strategies and provide recommendations for assessment and intervention (Rubenstein & Josephson, 2006).

She converses appropriately. Blood pressure 92/60 supine. Blood pressure decreased to 72/50 standing. Pulse is 90 and regular. Weight 113 pounds. She has a normal appearance of her face and does not have a masked appearance of her face. She has good strength throughout her face. She has good strength of her extremities. She has only minimal cogwheel rigidity at the left wrist, but no cogwheel rigidity at the right wrist. She has no tremor of her hands. She moves her extremities freely and with normal speed. She is able to rise on her own from a sitting to a standing position, only minimal bradykinesia of standing. She walks fairly freely and there is a normal cadence of her gait. She did not have dyskinetic movements of her extremities. She is able to walk, including turning without losing her balance. She does not shuffle her feet when walking. She does not have en bloc turning. She has good posture stability

0900 Pt in her room lying on her bed with watching TV. Good appetite this morning, Ate 100% of her breakfast. Alert and oriented x 4 and follow commands. Vital sign T96.9, P 72, R 18, BP 113/61, O2 Sat 97 RA. Pt complained pain on her back and rate 6/10 on scale of 0 to 10. skin warm to touch and redness on the area. Lung sound clear and even to auscultated in all lobes. Breath sound regular and even. S1 and S2 auscultated. Abdominal sound presents and actives in all four quadrants. ABD soft, non-tender, no distended to palpate. Pt denied ABD pain. Pt stated last bowel movement yesterday night, medium, soft and formed. Call light within her reach, nonskid socks on, bed in down position. Will continued to monitor……………………….L.Gotora PNS2/WATC

In the case of Anne Morrell there are several normal physiologically changes that impact her quality of life. Anne is experiencing normal aging related changes to her musculoskeletal system. Changes in musculoskeletal tissue occur through the loss of muscle mass and strength which replace lean body mass which fat and fibrous tissue. These changes in tissue cause a decrease in contractile muscle force with increased weakness and fatigue (Boltz, Capezuti, Fulmer, & Zwicker, 2012). As discussed in her case study she reports back pain when standing or walking for longer than 15 minutes, needs assistance with steps, ambulates with a cane since she fell last year which affects her mobility and ability to perform her activities of daily living. This loss in Anne’s muscle function greatly increases her chance of falls and she also has an increased risk for disability.

Ivy, a 60 years old Asian woman sustains an ankle fracture from a fall in a shopping mall. After the surgery, Ivy goes to an Orthopedic surgeon for follow up, who does an initial history and physical checkup. Ivy has an active life. She walks every day about two miles and stays busy with household works. She has habits of drinking a few cups of coffee and a moderate amount of wine and also smoking. About two years ago she was diagnosed with rheumatoid arthritis.

Ms. Karen Harrison completed testing at the Sub-Sedentary physical demands of work level. Her ability to work full time at a sedentary physical demands level is limited due to the need for her to limit long periods of sitting. Sitting should be limited in general because the detrimental impact of prolong sitting (appendix II). Specifically in her her case she needs to exercise in small bouts throughout the day to recondition the right knee joint of load bearings capacity and the torso and hips musculature for the ongoing care of her low back. There were tissue mobility restrictions that are concordant with pain complaints and are a appropriate target for her to address with a home exercise program.

This model emphasizes the “TR assists persons to recover following threats to health and to achieve as high a level of health as possible” (Shank & Coyle, 2002, p.56). The initiative to increase opportunities for residents to ambulate on the unit better will in yield an outcome of stronger muscles. The Centers for Disease Control and Prevention list several reasons why “physical activity is one of the most important things you can do for your health” (The Benefits of Physical Activity, 2015). This initiative will promote health by stimulating residents to walk around thus strengthening muscles. It also provides health protection against future falls. “Research shows that doing balance and muscle-strengthening activities each week along with moderate-intensity aerobic activity, like brisk walking, can help reduce your risk of falling” (The Benefits of Physical Activity,

Methods: 30 Subjects were assessed for - walking capacity (6 minute walk test) & Self-efficacy for falls (Modified Falls Efficacy scale). Level of Activity Limitation (AL) & Participation Restriction (PR) was graded on validated ICF Measure of Participation and Activities. (IMPACT-S)