Pelshaw Pmr Reflection

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.

He is total care with his ADLS, he is able to verbalized his needs but unable to perform them. He reports that he had a colostomy placed in 2011 and urostomy placed in 2014. His father provides hygiene care and changes for both his colostomy and urostomy bag. He has bilateral arm/hand contractures and he has gotten weaker. He is getting OT and PT from kindred home health. He uses a hospital bed with air mattress and his father changes his position every 3 hours. He reports pain in his legs and back that is constant, dull and aching. His pain is worse with movement and dressing change. His current pain level is 8/10 on a pain scale. His pain regimen consists of fentanyl 75 mcg patch every 72 hours and oxycodone 5 mg p.o every 6 hours as needed for breakthrough pain. He has been taking 2 prn doses daily because he did not want to run out of medication. He states that 2 prn dose is not effective in relieving his breakthrough pain. He previously was getting his medication from his PCP but since his condition has deteriorated his parent who are elderly is not able to get him to the

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.

S- 3671 dispatched to a m pt C/O of abdominal pain and black stool. Pt is a 49 y/o m whose C/C is abdominal and lower back pain. Pt also states that he is experiencing cramping around his left ribcage. Pt states that he has been experiencing N/V/D for the past four days. Pt also states that his bm's have produced black, watery stool since the monday prior to the incident date. Pt is able to provide EMS personnel with a detailed medical Hx that includes HIV, acid reflux, and recently diagnosed COPD. Pt also states that he recently stopped smoking cigarettes. Pt is also able to provide EMS personnel with a list of medications that he is currently taking that includes Duloxetine, Stribild, Ranitidine, Aripiprazole, oxycodone, and proair. Pt states that he has not taken any of his prescribed medications for the past four days prior to the incident date. Pt states that he has allergies to Kaletra and gabapentin. Pt states that his primary

The patient Matt is a 19-year-old Caucasian male that was admitted to the unit and being treated for lethargy, excessive thirst, recent unexpected weight loss, fever and frequent urination. Patient is uninsured, a college athlete (runs 3-5 miles a day on the cross country team), works 16 hours a week on the night shift, lives with five of males and says his diet consist of fast food, prepackaged meals and admits to having 3-4 beers, 3-4 day a week and has an allergy to penicillin (hives) and sulfa drugs. Patient was treated for a UTI once 3 months ago. The patient’s current vital signs are: temperature of 101.6F, heart rate of 99, respiratory rate of 22, blood pressure of 119/76, SaO2 99% on

After extubation, the patient endured acute delirium. The attempt to control agitation using ativan, haldol, and thorazine was not successful. Consequentially, dexmedetomidine was used to sedate the patient. Seroquel was started and dexmedetomidine was in the process of weaning off when he developed a fever to 102.7 degree Fahrenheit (°F), worsening acute kidney injury (AKI), leukosytosis, hypotension on post-operative day (POD) five. He underwent CTA chest and Computed tomography (CT) of the abdomen and pelvis with and without contrast which revealed cecal and ascending colon pneumatosis. IC was suspected. Since Mr. S was sedated, assessing for symptoms of IC were not possible. However, he had three bowel movements (BM) on POD four and one BM on POD five without melena or hematochezia.

An attending physician statement completed by Dr. Peter Chweyah (Internal Medicine), dated 06/16/2016, indicated that the claimant presented with complaints of lower extremity weakness, neuropathy, weight loss, acute renal failure, and gout, as well as anemia. Objective findings showed an extreme weakness of the legs and pain in the feet. He also had diabetes mellitus type 2, chronic kidney disease, and hypertension. It was noted that the claimant was totally disabled from 05/30/2017 through 06/15/2017 and 05/23/2017 - 05/26/2017 secondary to gout.

This week for the reporting period, I had an opportunity to travel with a case worker to pick up a child in CPS custody from Millcreek in Pontotoc, MS. I observed the way the child acted. The workers at Millcreek said the child was a handful and to be careful. I also had the chance to transport two teenagers in foster care to school. Both of the children went to different schools. They said it was pretty cool to have someone young taking them to school instead of the older workers. I thought that was kind of funny. It was easy to talk to them and they seemed comfortable being in the car with me. I also had the opportunity to pick up a child from school and take them to New Beginnings which is a counseling clinic and afterwards I took the

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Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

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,

We talked about the importance of maintaining his medication regimen. I have encouraged him in the future, if he is having any problems with the pharmacy to contact us immediately to assist him and I did write him a refill of his atorvastatin to restart that at 20 mg daily #30 with no refills. At that point, he will be with his new physician and can have his blood work done with them for the lipids and the liver function testing. He does have a lab slip given to me at his last visit for a recheck so that if he does have his visit with her changed in early August, he could do labs for me and I can notify him about any changes that need to be made. He is to continue with his Coumadin. We had a very long discussion about the fact that he has not had his INR drawn as recommended. I reviewed the risks associated with INR value that is too low, as well as an INR value that is too high. He assured me that he would do the INR either today or tomorrow and he knows to contact me within 24 hours of doing the testing if he has not already heard about the result in the meantime. I emphasized the absolute importance of this. He will continue to monitor for any worsening neurologic deficits. Any concerns, he will call 911 and be seen immediately at the

Also, I see that the SAE (Acute Upper Gastrointestinal Hemorrhage) that caused this hospitalization on was reported on 13Apr2017, but the event occurred 05Mar2017 to 14Mar2017 were you aware of this hospitalization prior to the patients week 24 visit on 12Apr2017, as SAEs need to be

The patient is 66 year-old male who is brought to St. Joe's ER by BLS after being found with altered mental status at home. The patient reports he used heroin 2 days prior to admission. The patient was found by his brother hallucinatin with bladder or bowel incontinence the morning of presentation. The patient has not eating in approximately 4 days. The patient himself denies having any complaints, but he is a very poor historian. His medical history is significant for prior heroin and cocaine abuse, alcohol abuse of unknown duration, hypertension, cirrhotic liver, he has had an anterior cervical discectomy of C5-C7 with anterior compression in May of 2012 and a closed reduction of C6-C7 billateral dislocation , cholecystectomy in the

Case Description: A 25 year old healthy male who is a very active running back in the sport of football came to the emergency room. The patient has a history of previous