Symptoms And Treatment Of Patients

A progress note from Dr. Chweyah, dated 06/26/2017, indicated that the claimant presented for follow-up of gout, muscle weakness, and weight loss. He had ongoing weakness of the legs with knee pain. He stated that her weight drop had stopped. His current weight was 210 pounds. Objective findings showed a pulse rate of 105 with a blood pressure of 92/60. His BMI was 28.56. He was diagnosed with an acute pain in both knees, muscle weakness in the legs, chronic gout, and weight loss. A referral to neurology and medications were recommended.

12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,

Generally, this is a well-developed man sitting comfortably in no acute distress. Skin is warm and dry. HEENT: Head is normocephalic, atraumatic. Pupils equal, reactive to light and accommodation. Sclerae are anicteric. Oral mucosa is moist without lesions. No JVD. No thyromegaly. Lymphatics: No cervical, supraclavicular, axillary, or inguinal adenopathy appreciated. Respiratory: Lungs are clear to auscultation bilaterally. Heart: Regular rate and rhythm. Abdomen: Soft, nontender. Positive bowel sounds. Liver and spleen not palpable. Strength is 5/5 throughout. Neurological exam is

EMG biofeedback: Can be utilized to receive information related to motor performance, kinesthetic performance or physiological response

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

Patient S is a seventy-eight-year-old male who presented to the ED in Rushville on October 25th with signs and symptoms of a stroke. These symptoms were leaning to the left side, a left facial droop, weakness in the left arm, and ataxia. The patient has no history of stroke. Patient S was admitted to 4-G in Memorial for a right-sided ischemic stroke. The patient has a history of atrial fibrillation (A-Fib), hyperlipidemia, bleeding problems, hypertension, sleep apnea, and a pacemaker. Patient S lives at home with his wife. Patient S was independent before the stroke. On October 13th, the patient had surgery of lumbar stenosis on L3, L4, and L5. The patient and wife reported increased serosanguinous drainage that soaked the dressing. Patient denied fever or pain at incision site. The doctor decreased Warfarin from 5 milligrams (mg) to 2.5 mg and prescribed a full dose of aspirin.

We will do an overnight SAO2 sleep study to rule out desaturation that may contribute to headaches and fatigue.

Polyuria: is more than normal or increased urine output. Water homeostasis is controlled by a complex balance of water intake, renal perfusion, glomerular filtration and tubular reabsorption of solutes, and reabsorption of water from the renal collecting ducts. When intake of water increases, blood volume rises and blood osmolality falls, lowering the release of ADH (arginine vasopressin, which promotes water reabsorption) in the hypothalamic pituitary system. With the lowering of ADH there is a rise in urine volume, which allows blood osmolality to return to normal. Urine containing large amounts of glucose has high osmotic pressure, which attracts water, so that urine output rises (osmotic diuresis).

A review of her medical records indicates that she suffers from chronic pain due to history of fracture vertebrae’s and due to her chronic neuropathy diabetes related. She also suffers from HTN-stable, hypothyroid-stable with medication, Dm-which is chronic and manage with Lantus and victoza, and impaired gait. She is nonambulatory and is dependent on her scooter. She was being followed by Dr. Glener for pain management but has difficulty getting to her appointment due to her homebound status.

Respiratory. The client denies a recent history of significant breathing problems. Client states as a child she had asthma but that has since cleared up. She denies cough, sputum, shortness of breath with activity, wheezing, or pneumonia. Client states she has no history of exposure to tuberculosis. The client has a history of smoking. She smoked for less than a year in 2007. She states she smoked 1/20th of a pack per day and quit cold turkey. Client stated she had bronchitis once in June 2016. Her physician prescribed an albuterol inhaler and a steroid prescription. Treatment resolved the bronchitis. The client states she has limited exposure to secondhand smoke due to neighbors smoking on their front porches in the townhome apartment complex where she lives.

Based on the progress report dated 12/10/15, the patient reported that she is taking tramadol with good relief and tolerating it well. She states that her pain levels are 6-7/10 without medication and 3-4/10 with medication.

In order to increase the quality of patient care, Medication Therapy Management or MTM continues to expand as some medical insurance, such as Medicaid and Medicare Part D plans, will now pay for the service. MTM is a medical care implemented by pharmacists whose goal is to optimize the drug therapy and therapeutic outcomes for the patients. With the addition to the MTM, the pharmacists can help reduce the readmission of hospitalizations, inappropriate medication use, and emergency department visits. This will help reduce the costs that patients and insurance companies spend on and increase the quality of care. MTM services are additional to provision of a drug product and include a broad range of pharmacist’s activities within the scope of

In this case, the issue is whether the treatment of the Patient during her second admission of April 7, 2016 through April 8, 2016, should be considered a separate admission for DRG payment, or a continuation of treatment from her previous admission of March 30, 2016 to April 7, 2016.

Annually more than one million people in the United States receive care in the intensive care unit (ICU) (Chandrashekar & Perme, 2009, p.213). Patients who are critically ill often require multiple therapies, monitoring devices, and mechanical ventilation. A majority of the critically ill patients remain in bed rest during their ICU and hospital stay. Prolonged immobility and bed rest have negative effects on patient outcomes leading to acute complications, longer ICU and hospital stay, and increase in mortality and morbidity rates (Dang, 2013).

Pneumomediastinum is a pathologic condition characterized by the presence of air within the mediastinum and within deep neck spaces. It can be further categorized as spontaneous pneumomediastinum or secondary pneumomediastinum. Spontaneous pneumomediastinum is a rare clinical entity seen without any precipitating factors. On the other hand, secondary pneumomediastinum is due to disruption of the aeordigestive tract, typically from previous surgery, trauma, severe retching, or foreign body ingestion. Pneumomediastinum can be exacerbated by activities that generate a valsalva maneuver, as in physical exertion. The treatment protocol differs substantially between these two entities, so it is crucial that physicians differentiate between the two by gathering the appropriate history and physical exam. We report a case of a healthy 44 year old male who developed pneumomediastinum with moderate head and neck subcutaneous emphysema after minimal trauma while boogie boarding. The patient remained asymptomatic except for mild dysphonia and head and neck swelling. An extensive PubMed search revealed several case reports of spontaneous pneumomediastinum. This is, however, to our knowledge, one of the few reports of moderate to severe spontaneous pneumomediastinum presenting relatively asymptomatically. With this case report we hope to add to the current body of literature and present an unusual presentation of spontaneous pneumomediastinum in a healthy individual.