After surgery, Mr. Baker is taken to a room on the medical-surgical floor. He has an IV infusing at 125 ml/hr, a PCA pump, and a nasogastric tube connected to low suction. He is receiving oxygen through a nasal cannula.
04/03 – 05/05 Highland General Hospital, Oakland, CA / Sanam Nejad , PA-C Orthopedic Surgery Completed pre-operative histories/ physical assessments for surgical admissions. First assist in several orthopedic surgeries. Management of post- surgical wounds. Performed several procedures including suture placements, drain placements/removals, wound dressings, e.t.c
Author of CAT (Date): Russell Leighty (2/16/15) Clinical Scenario: Adult female accountant complaints of right-sided lateral upper extremity numbness and tingling, pain, weakness, and dropping things held in right hand.
I stopped what I was doing to assess what was wrong. The patient’s abdominal dressing was soaked in fluid. I removed the dressing and noticed that in the middle of her incision site fluid was leaking and would not stop. I grabbed the gauze and applied pressure. After several soaked gauzes, I told the CNA to continue to apply slight pressure on that site and I went to get the
Per medical report dated 10/26/15 by Dr. Parsioon, the patient was initially seen on 9/14/15 for evaluation and treatment of cervical pain. At that time, he had neck pain without radiculopathy and bilateral hand tingling. IW stated that physical therapy made his neck pain increase and he wanted to make sure that it is okay to continue this. His chief complaint is pain in his neck radiating to the right shoulder and arm. He states the only time he gets the tingling sensation in the hand is
Initially, the dressings were dry and intact while the patient was still asleep. After 15 minutes of transition, Miss T was gagging, straining, and acted nauseated. I immediately inspected the wound sites and noticed a slight bloody discharge on one of the dressings. Alerting the PACU nurse was my immediate action to alert her of a possible bleeding as I had handed over the intraoperative bleeding in that area. As I continued observing, I noted an increase in the discharge. Hence, my inspection on the wound site which had its tape stripped off and active bleeding was noted. Slight wound dehiscence was apparent. I did all less invasive measures such as cleaning the incision site and the application of pressure dressing initially but to no avail. Notification of the surgeon all throughout was done and given importance. Immediately, I acted on stopping the bleeding through suturing of wound with a deep-
4.0 SYMPTOMOLOGY CTS encompass a collection of symptoms: • Paraesthesia in the first three digits along with pain, tingling, and numbness in the hand and wrist
Based on the progress report dated 02/16/16, the patient presents with persistent right arm and shoulder pain. She also complains of pain at the base of thumb and tingling in the
The surgeon irrigates with warm NACL and suction out to make sure no bleeding is occurring. He applies strips of surgical into the wound and begins to close using a silk 3-0
Radial aspect of the left index finger sutured. PLAN: The patient is to keep the wound clean and dry for the next several days. He will continue follow-up for suture removal in 5
Locoregional anesthesia was routinely used in non-fasting, cooperative or unfit patients while general anesthesia was the routine in patients who are uncooperative, irritable or medically fit. Pneumatic tourniquet was routinely applied at the midarm with pressure that was 70-100 mmHg above systolic blood pressure. Place the patient supine on the operating table with the arm on an arm board in 90° abduction, full extension of the elbow and forearm pronation. A straight longitudinal dorsal incision was used for exposure of metacarpals; however, proximal phalanges were exposed through a mid-lateral approach. The extensor apparatus was drawn aside and the periosteum was longitudinally incised and elevated to expose the fracture site preventing
Hemostasis was maintained with the neo point electro corderin. An elliptical excision was made a pound the right lateral neck after infra treating with 1 percent lidocaine with one, and one hundred thousand epinephrine. This was made to set the measurements of the full thickness graft for 3.5 by 2 centimeters. This was taken down to the skin and into the subcutaneous tissue with the 15 blade. The 15 was then used to dissect the full thickness skin graph off from the surrounding subcutaneous tissue. The wound was then closed using multiple interrupted buried foropedia sutures, and then a running subcuticular foroprolene stitch. Hemostasis was maintained prior to closer with the electro quarter. The full thickness skin graft was placed on a saline soaked lab pad during the closer of the right neck wound. The neck wound was also then cleansed; the sutures were applied.
History of Present Illness (Use OLDCARTS format). T.R. is a 50 year old white female that present in the office today as an established patient who is concerns about numbness and tingling in her right wrist and hand. She reports that the numbness and tingling started about 5 days ago. She denies pain, but described the numbness and tingling as intermittent in nature which radiates to fingers (thumb, the scound, third, and partially of the fourth digits). She noticed that her right hand grip is weak, and she is not able to hold a cup of coffee tightly. The numbness and tingling are aggravated by movement and relieved with rest. The numbness and tingling seems to feel worst when typing and less severe at rest. Denies having these symptoms
Proper After-Care is Essential Prior to being released to go home, patients receive instructions related to caring for their incisions and drains (when applicable). All the information included in their after-care instructions is designed to help patients avoid complications and monitor their healing. Keeping follow-up appointments with Dr. G at his surgery center in Miami is essential. At these follow-up appointments, Dr. Gershenbaum will remove the patient’s bandages, support bra and drains. He will also remove the sutures and examine her incisions.