The patient is a 28-year-old female referred to Winnebago Mental Health Institute Out-Patient Resource Center from a Psychiatric Hospital after 2 months in-patient treatment. She has a 10-year history of mental health problems and received a diagnosis of schizophrenia in 2015. At the time of the referral Susan was single with no children. During her in-patient treatment, she had been prescribed an antipsychotic medication (thorazine) to assist in reduction of her perceived anxiety, potential aggressive behaviors, and to assist in decreasing hallucinations that she is currently experiencing ( Drugs.com, 2015). There had been no noted presenting problems regarding her physical health during this process and is observed to be in good
Client (AM) is a 20-year-old heterosexual African American female, born in Durham, and currently still resides there. Her primary language is English. She lives with her 13 moth old child (NM) in a one-bedroom apartment. The client is unemployed and currently receives SSI benefits. AM resides in subsidized housing because of her social security income. Client did not finish high school and has no desire to do so.
He reports the patient’s roommate was subsequently evicted from his home after the landlord inquired about the ambulance visiting. He reports he contacted her father concerning the patient residing within the family home, but the father has said no. In addition, he reports he has attempted to contact her uncle but has been unable to make contact with him. He reports he has attempted to make contact with her said friend who is considering allowing her the opportunity to reside with her but she has not answered her phone and he has been unable to leave a voice message. He reports no one wants her in their home, and the patient has “burned her bridges” with family members. He reports her family would benefit from counseling. In addition, he reports her family has high expectations of CPS. He reports her current case was not going to close within 12 days of 06/30/2017. In addition, the case will not
Patient is a 80 year old Caucasian male living with his wife in their home. The patient is originally from Penniviana and moved to Ohio for 10 years. Patient was previous married, but wife passed away over 10 years ago. Patient and his current wife, Mary have been married for 10 years, but have known each other for 15 years. Pt was within the Navy doing subrmine duty for 27 years. Patient moved to Big River area back in 1990 and worked as a volunteer sheriff in Riverside County for eight years. The wife has been a RN for 35 years, but is retired now. Pt has four step-sons, mike, ken, Rick and Bob in San Diego, who contact him once a week. Pt has three sisters, but 2 sisters has passed. One sister lives in Pennivina. Pt ambulates well without
This is an 89-year-old, was transferred here from Vidant Medical Center in Greenville, North Carolina on 01/21, for a multitude of problems including altered mental status. The patient can communicate but not well enough to really give a history. I have obtained all this history from her daughter Cynthia who works here at Mayview. I am told that Mamie was born in Edgecombe County right outside of Tarboro and she lived the majority of her life in those areas of Edgecombe County, Pitt County, and Martin County. She got married at the age of 19, and had 13 children. Three of the oldest children have died. Cynthia lives here in Raleigh and her sister Brenda works in Raleigh, but lives in Clayton. Mamie's husband died of some type of respiratory
The client is a Hispanic Male age 69, who was born in the Dominican Republic. The client communicates solely in Spanish. He has two daughters who both live in the Bronx. The client suffers from Diabetes, Cholesterol and moderate Dementia. The client has shakiness in the hands as a result of a surgery he endured in the brain. The client lives in a rented room in Inwood Heights. Initially, the clients presenting problem included finding adequate housing however, after completing the intake form I became aware that the client was over income for most housing assistance programs. When the client and I talked more about the reasons he wanted to find housing it became obvious that the client wants to feel valued by his children. Also the client mentioned wanting to overcome feelings of loneliness and isolation. The client copes with feelings of seclusion and solitude by coming everyday to the senior center. He also tends to use the defense mechanism rationalization and tries to rationalize behaviors for others including his daughter’s absence from his life. My interpretation of the clients functioning in the situation is that although the client is experiencing health impairments and sadness the client is very self-sufficient. He is capable and able to take care of his hygiene, he is able to feed himself and he is able to go to doctor’s appointments on his own. I do however; think he is in need of case management and emotional support.
She reported spending the majority or her life trying to gain his approval. Her father is now deceased (cancer). She reports being close to her mother and her siblings, particularly her sister. Mrs. Hudson’s development was within average limits and she reached all developmental milestones at the appropriate age. She is bilingual (Creole/French derivative is her native language) and she learned English once she immigrated to the United States. While Mrs. Hudson considers English to be her primary language she has never applied for citizenship. Mrs. Hudson completed college and medical school and worked part time as a primary care doctor so that she could be home with her children. Mrs. Hudson was raised Catholic and attended mass regularly as a child. She has since rejected Catholicism and now attends a nondenominational Christian church. Mr. Hudson is a firefighter. She and her husband are physically healthy as is her older son. Her daughter was diagnosed with a severe heart condition at 14 months which required several surgeries to correct. Her daughter is still monitored regularly by her doctor (Case Study,2016).
Hi, Karen, I attempted to send the invite again for patient 326270. I checked our email server to see if it was delivered and it shows an immediate block on her side as rejecting this our invitation email. I understand that her coworker is using the same domain but each email setting(s) can be individual. The message we are getting back on our email servers when trying to send her an invite to this email address is:
She reports that a lot of current medical condition stem from riding horses for 30 years and a lot of physical labor. The patient has 2 children-females. The patient does not get along with her oldest child due to conflicts with her patient's father and the patient was upset that her daughter sold one of her horses for profit. The patient does in fact get along with her youngest child, who is 25 years. The patient discussed the marital issues with her ex-husband. The patient was married for 18 years and divorced her husband in 2003 due to verbal, physical, mental, and fiancial abuse. The patient reports she is happy that she left her marriage; however, her husband had caused a lot fiancial issues in her life by fraudlant acts. The patient had attempted to go after her husband for the frauds he did by using the alimony and her name, but the patient reports she had a conflict with her attorney. Till this day, the action was
This is 34 year old WF. Patient is a resident at the Lovelady Center. Patient stataes she had a baby 7 weeks ago. She is depressed and misses her bacy. She is to stay at the love lady for 90 days, but possibly for 9 to 12 months. The bay is well taking care of by her boyfriend (the baby's father). Patient denies thoughts of suicide or homicide. Wants to get through the program and get back to her baby. Patient denies chest pain, SOB, N/V/ D, or fever.
Erica Yelverton /QDDP submitted, 8/16- 6/16 MARS, 8/16- 6/16 progress report, 8/6/16-8/9/16 Cross bridge nursing progress note, physician progress note & Baptist South inpatient 8/7/16 preliminary note, since her last visit Crossbridge admitted Misty on 8/6/16 due to suicidal threats, had incidents on 8/6/16 ( VA, Elopement) & 7/13/16 (PD, SIB & 1 PRN) and her tegretol level (6.2) was done on 7/18/16, currently she is inpatient at Crossbridge awaiting an commitment hearing on 8/16/16.She does not have a legal guardian.
Background information: Sally Sue is a white female in her mid-nineties residing in an apt with her boyfriend. Pt has an ongoing struggles with hallucinations for many years. Pt was admitted to SBBH involuntarily. APS is involved because of the phone calls that she made to the police officers. Pt has received therapeutic treatments in the past. Pt does have legal matters. Recently, pt went to court to get her days extended for longer treatment. Her barrier to treatment is she can hardly hear. Her major source of income is her social security. Her strengths is verbal and motivated for treatment. Her weaknesses
The patient is a 95-year-old female who presents to the ED accompanied by her nursing aide. The patient fell from an upright position at home while walking. She sustained an injury to her right elbow and claims that she did not lose consciousness. The patient's medical history is significant in that she is hard of hearing and she is legally blind I believe that she has had a retinal detachment in the past. The home health aide relates that the patient does not have any family members and is under a state agent whose name is Karen Sesto. Karen Sesto was contacted and she gave additional history stating the patient has been refusing 24/7 live-in help. She does not let people in the house, throws them out of the house, she finally agreed
My patient’s initials were C, J C, and he is a Caucasian male who worked in the construction field for 35 years. He is 76 years old. He told me that his father and mother were born in Germany and Sweden respectively. They met each other in Hawaii, where they gave birth to him. He displayed a level of wisdom that he developed over the years and looked at life with success. When he was 20 years old, he met his future wife who was 16 years old at the time. They dated for a couple of months before she went to boarding school. On her graduation ceremony, she introduced her best friend to him. As time went on he started seeing her best friend, and they got married, and had a child. After 10 years of marriage, they divorced and he was single for a while. He started to get in contact with his ex-wife’s friend through the mail. They connected, and got married. Unfortunately, they did not have any children together, but he looked at his life with the feeling of fulfillment because he had two grandchildren whom he loved. When he saw those children, he had a feeling of accomplishment because he was happy, and amused to be around them. He fostered an environment for his grandchildren, becoming a good loving father-figure and exemplifying wisdom.
Social History: The patient widowed and lives in a house with her two daughters. Currently employed as a supervisor at Walmart and has health insurance through her work. Works full time and enjoy her work. She enjoys spending time with her family. She is sexually active. She is currently in an intimate relationship for the past one year after the death of her husband and used condoms occasionally when having sex. Highest level of education is bachelor’s degree