Mr. Kelliher 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.

The patient is a 45 year old man who had GI surgery 4 days ago.  He is NPO, has a nasogastric tube, and IV fluids of D51/2saline at 100 mL/hr.  The nursing physical assessment includes the following:  alert and oriented; fine crackles; capillary refill within normal limits; moving all extremities, complaining of abdominal pain, muscle aches, and "cottony" mouth; dry mucous membranes, bowel sounds hypoactive, last BM four days ago; skin turgor is poor; 200 mL of dark green substance has drained from NG tube in last 3 hours.  Voiding dark amber urine without difficulty.  Intake for last 24 hours is 2500mL.  Output is 2000mL including urine and NG drainage.  Febrile and diaphoretic; BP 130/80; pulse 88; urine specific gravity 1.035; serum

The patient is a 64-year-old female who has had recurrent admissions to the hospital and recently discharged after being treated for a ESBL Ecoli urinary tract infection. She presents again to the ER complaining of abdominal pain and abdominal distention. Her medical history is significant for schizophrenia, knee replacements, diabetes mellitus, hypertension, past CVA, COPD and dyslipidemia. Workup in the ED reveals her to be anemic and hemoglobin on admission is approximately 9.6 with hydration dropped to 8.5. She is also thrombocytopenic. Her labs reflect chronic kidney disease and her urinalysis reveals large amount of blood in the urine. In the ED she undergoes a CT of the abdomen and pelvis which reveals her to have ascites and

On December 4, 2000, two-year-old Kailyn Marie Montgomery died in her home due to severe bodily injury while under the care of Kyle John Kelbel. Kelbel was arrested at the scene and questioned several times. The jury found Kelbel guilty of past pattern of child abuse, first degree murder, and second-degree murder. On July 23, Kelbel filed a motion for acquittal and for a new trial; he claims that the evidence was insufficient to support his conviction and much less to support that he committed a past pattern of child abuse against Kailyn. Kelbel argues that the district court failed to instruct the jury that they must find him guilty beyond a reasonable doubt.

Following Worthy’s investigation, on July 2008 two more federal charges were brought against Kilpatrick. Both of the new felony charges for assaulting or interfering with an officer of the law. Both counts are for obstruction of justice, there were also another charge of assault as well, which Kilpatrick would eventually plead no contest to the assault charge. The incident occurred when two officers went to serve a subpoena to a close friend of Kilpatrick. Based off the officer who was shoved by Mr. Kilpatrick, they were grabbed him by his shoulders and threw him, knocking him into another officer while trying to hand a subpoena to Bobby Ferguson.

Mr BW had a surgical history of anterior resection for bowel cancer and had undergone a colectomy post iatrogenic perforation. He had known hypertensive and non-compliant with his medication. At the same time, he was known to be alcoholic abuse, seizure and had prostate cancer, which was treated with brachytherapy that was well controlled.

A visit note from Dr. Robert Hendren (Urology), dated 09/20/2017, indicated that the claimant continued to have urinary frequency, urgency, and urge incontinence that required her 2 pads per day. She had microscopic hematuria noted on 08/31/2017. She had 3+ blood on urinalysis during the visit, but she had been undergoing her menstrual period. She had complaints of pain in the stomach, left arm, right leg, and foot. Urinalysis showed moderate blood with 30+ protein. Her BMI was 32.12. She was diagnosed with urge incontinence and hematuria. Cystoscopy was recommended.

Mr. S is a 29-year-old male with past medical history of (PMH) hypertension (HTN) and obesity who presented to local emergency room (ER) with headache and chest and back pain. Mr. s had been seen at urgent care three days prior for a headache and near syncope and was told to hold his metoprolol due to bradycardia. Due to health insurance related problem, he has been off amlodipine and lisinopril for a month.

Data: 51 yo M with a PMH of LAR on 07/31/2017 for a locally advanced rectal cancer. His postoperative course has been complicated by an anastomotic leak requiring multiple readmissions and drain placements by interventional radiology. He represented to VCU on 9/22/2017 with active GI bleeding. He was admitted to the STICU for resuscitation and given multiple units of pRBCs. He was embolized, stabilized, and transferred to the floor on hospital day 2. He continues to have dark blood in his stool, which was likely old blood. Urology was consulted for help managing indwelling foley, and recommend discharge with Foley (patient has hydronephrosis). Data: VS HR 77, BP 132/84, RR 16. spO2 94, T 37, pain 0.

Mr. Allison is a 26 year of male who presented to the ED via LEO reporting feeling depressed and suicidal ideation without a plan. Mr. Allison reported to nursing staff relational conflict with a female he started to see after his wife and he separated. At the time of the assessment Mr. Allison presents calm and cooperative. According to Mr. Allison 5 months ago his wife and he separated after a 7 year long relationship and 2 daughter. Mr. Allison reports for the past two months seeing another female who he has become involved with. Mr. Allison reports this new female told him a few weeks ago she cheated on him. Mr. Allison noted this female has issues with alcohol. He reported being a supportive person in her life, which has caused additional stressors in his life. He expressed feelings of depression. Mr. Allison describe feelings as feelings of hopelessness, worthlessness, tearfulness, sadness, isolation, increased sleep and fatigue. Mr. Allison reports relational issues, family conflict, legal issues, recent anxiety attacks and substance abuse as stressors contributing to his distress. He reports no history of self harm, no hospitalization for mental health, a strong support system (referring to his father, mother, and wife). Mr. Allison was seen on 10/08/16 and 10/09/16 for anxiety attacks, however was discharged. On 10/9/16 he mentioned issues with his recent female friend and reports he felt better over his situation and want to go home. No mention of suicidal ideation

D/A: Maurice Brown had one appointment this week. On 12/14, he was seen by Doctor Nat Ramani of the GI Associates of Delaware. According to Doctor’s note, consumer tolerated procedure well. He did not have fever, rash, or chills post procedure, but still complains of having periumbilical abdominal pain frequently for 2-3months. He describe pain as sharp in nature, rates it 7 out of 10, wakes him up from sleep at night, no exacerbating factors, radiates to both sides of his abdomen, alleviating on passing gas and having a BM. On 12/14, 12/17, Mr. Brown went for his dialysis. On 12/17, he went twice, in the morning at 10:00 a.m. and in the afternoon at 4p.m. when this writer his Case Manager asked him how his treatment was going? He said ‘’fine,

Patient CB is a 36 year old African American Female. She has a past medical history of hypertension, acid reflux, heartburn, and a hernia repair one year ago. She is a nonsmoker and reports never taking recreational drugs. Diagnostic tests related to her diagnosis include an abdominal ultrasound showing gallstones, an x-ray to verify stone presence, and tenderness with touch on the abdomin. CB was having a cholecystectomy because she was having pain in her abdomen related to gallstones. Her hernia was a result of a weakening of the abdominal wall.

The VA respects and values each individual client. The agency serves a variety of people from different cultural backgrounds. Therefore, the agency has several policies and practices in place that acknowledge diversity. In additional, the VA offers staff trainings monthly on various topics to include cultural competency. In the case of Mr. McNair, he was respected and valued.

Since BPH cannot be cured treatment is focused on reducing symptoms. Deciding how to treat BPH depends on how bothersome the symptoms are. The American Urological Association symptom index is an interactive questionnaire that can help to identify how bad the patient’s symptoms are and guide treatment. Symptoms that are mild or do not bother the patient may benefit from just watching them. Treatment of moderate to severe symptoms depends on how bothersome they are to the patient. For those who feel their symptoms are bothersome, surgery maybe an option or less invasive therapies such as transurethral microwave therapy or transurethral needle ablation. Complications of BPH such as inability to urinate, urinary tract infection, bladder stones, kidney damage, or ongoing blood in the urine should be treated with surgery. Alpha blockers relax the muscles of the prostate and bladder improving urine flow and can be used in men with moderate to severe BPH. Men with very large prostate glands may benefit from 5-alpha reducatase inhibitors which block the production of dihydrotestosterone. Combination therapy maybe used for patients with overactive