SDC 4 Week: A Case Study

Scenario: Mr. B, a 67-year-old-man, came to the ER complaining of severe pain to his left hip and leg after falling over his dog at home. Left leg appears shortened with swelling in his calf, bruised, and limited range of motion.Mr. B has a history of impaired glucose tolerance and prostate cancer. Home medications include atorvastatin and oxycodone for chronic back pain. Mr. B’s labs, taken during a previous visit with his primary care doctor, revealed elevated cholesterol and lipids.

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

Patient L.H. is a 69-year-old married Caucasian male that is a retired teacher that lives at home with his

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

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.

Demographics: Patient is a 32-year-old, moderately built Caucasian female; separated once with 2 children. She lives with her children in her mother’s town house in the North-eastern part of the province. She is currently unemployed and receiving disability from the state from sustained back injury. She has Medicaid insurance; speaks English and practices the Baptist religion.

Client reported no known allergies to food or drugs. Client reported that she has 8 years daughter. Client indicated her physical health "average". Client reported that she does not have a current primary care physician at the time of assessment. Client reported that she is not currently pregnant and does not taking medication for medical purpose. Client denied any issues in this dimension. Indicated no current condition or medications that would interfere with treatment. Client exhibited adequate ability to tolerate and cope with physical discomfort. No immediate biomedical services are needed at the time of assessment.

On 12/22/2015, CM normally meets with the client every Wednesday but client walking in the social services office stating tomorrow she will not be available to meet for face to face meeting because she will be going apartment hunting. CM completed Bi-Weekly ILP Review and provided client with a list of broker name and telephone numbers. In the meeting client was dressed appropriately for weather. She appears cooperative and friendly.

Per medical records (2008-2014), the claimant had a history of multiple medical issues, including migraines, right hand tremors, alcohol abuse, obesity, gastro-esophageal reflux disease (GERD), nausea, abdominal pain, endometriosis and degenerative changes in the left knee. In 2014, she was evaluated for hip

Introduction: Jessie Buchanan, an 80-year old female, was admitted to Bethany Care Society in room 3088-1 at the center unit. She is an extensive assist, requires 1 staff assistance and uses the transfer belt to transfer from bed to her wheelchair. She was admitted here because none of her family members can look after her because they are all busy with their own personal life. Jessie prefers to stay at Bethany because she receives full-time care from the health care providers. Jessie had a history of edema on her right ankle because she was experiencing hyponatremia. Currently, she is on fluid restriction and every morning I would put her compression stockings to prevent the occurrence of edema. Her condition worsens when she was diagnosed with osteoarthritis(OA), delirium, depression, type 2 diabetes mellitus, schizophrenia, hypertension, and urinary tract infections. Her recent urine culture shows that she is positive for urine nitrite and urine leukocyte which caused the UTI. Jessie is incontinent and she wears an indwelling catheter. Jessie said that sometimes her knees are painful. She takes an analgesic to relieve the pain that she feels. Jessie 's blood sugar level is within the range. She is not taking insulin or any oral medications like metformin because she knows how to control it, by following the proper diet. Jessie always have a good sleep and never complains about her sleeping pattern. She is taking medications for GERD, iron supplement, bone health,

At today’s visit she is accompanied by her husband and private aide. Her husband reports that she is doing much better. He states that her pain has improved and she has not taken her pain medication since last visit. He states that her anxiety had improved extremely with the recent change in her Xanax. He states that he has hired 24 help for the patient and since she has not fallen. She reports that she is feeling well. The caregiver reports that the patient continue to suffers from hypotension and hypertension with variation in blood pressure. The patient also continues to suffer from chronic tremors as a result of her Parkinson.

This is 31 year old white male. Patient is here with several complaints as listed. Patietn was seen at UAB ED yeaterday for the same conditions and discharged without any treatment; "They don't like me there, UAB, because I have a long history of drug use and frequent use of their ER." Patient denies chest pain, SOB, N/V/ D. Patient is a current tobacco user with 20 apck year hisotyr. No substance abuse for the past 3 months. Current pain

Mrs. Cabrera is a 64 years old women with history of high blood pressure, vertigo, and bilateral meniscectomy 3 years ago. Client is currently taking medication on a daily basis for her health conditions. Patient takes pain killer medication at least 3-4 times a week if knee pain is present after ambulating around the home for household activities. Client lives with daughter, grandchildren, and other family members. Patient has a supporting family nucleus, they agreed to make arrangement if necessary to avoid and prevent any potential fall risk.

Intervention: Recent UAS assessment it was recommend by ARN to reduce hours from 2 days/5hours to 2days/4hours. On 03/07/2016, member verbalized to CM that he wishes to remain with 2 days and 5 hours. He has an unsteady gait, experiences dizziness (new medication Flomax 0.4 milligram), moderate pain due to Dx. Osteoarthritis and is at risk of falling (score 11). Also, member goes to the bathroom frequently due to Enlarged prostate. For those reasons, its recommendable that member continue PCA days/hours as coordinated. In addition, CM contacted via email Care Management Supervisor, Qi Zheng, on 03/08/2016 to informed and requested to continue current PCA services. Care Manager Supervisor, agreed to

Patient also, has history of hypertension, GERD, morbid obesity, anemia, and depression. She reported that the past few months, she has been feeling very weak and overall generalized deconditioning. Her ability to care for herself including her activities of daily living (ADLs), and her basic physical needs (like bathing, grooming, ambulation, meal preparation, transportation, errands, and housekeeping), had decreased, and cannot consistently carry them out.