The Setting Of Recent Management By The Eye And Ear Hospital

The author read Mrs. X’s medical notes prior to their initial consultation to afford herself the knowledge she required should she need to prescribe for her when fully qualified. It was evident from reading her medical notes that there were a few considerations to take note of before commencing any treatment, such as her medical history, drug history and allergies. Her past medical history consisted of Type 2 diabetes mellitus, which was diet controlled, hypertension, hypercholesterolaemia, neuropathy, rheumatoid arthritis and raynauds syndrome.

I will analyse the prevalence of the condition and what the potential causes may be. My interests have been directed to pre hospital care and community lead treatment packages, which are potentially available to the patient, as this is the acute environment, which I will have contact with in my employment as a paramedic. The initial reading was to understand COPD as a chronic condition, what is COPD? and its prevalence in the population. The (World health organisation, 2000), states that one in four deaths in the world are caused by COPD. In 2010 (Vos T Flaxman etal, 2012), says globally there were approximately 329 million, which is 4.8% of the population who are affected by this chronic condition, In the UK (NICE, 2010), have estimated that 3 million people suffer from COPD, with more yet to be diagnosed. This information about the amount of people living with this condition was surprising, as I little knowledge of its existence. During the early 1960’s (Timothy Q. Howes, 2005), says the term COPD had been designated as a single term unifying all the chronic respiratory diseases. Since then the term COPD, has been sub divided in to three umbrella areas, Bronchitis, Emphysema and Chronic asthma, which are separate conditions, which I have been previously aware of as their individual conditions. The 58 year old patient who we visited,

Mrs A has a condition called Rheumatoid arthritis this this is a chronic progressive inflammatory autoimmune disease that commonly affects the hands and feet but also in

D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is an acute

There are no cure for this disease. However, there are different treatment to prevent further deterioration of the lungs function in order to improve the quality of life of the patient by increasing capacity of their physical activity. One of the main severe complication a patient with COPD can develop is exacerbation. Increased breathlessness, increased sputum volume and purulent sputum are the signs and symptoms of exacerbation. Early detection of the signs of exacerbation can help keep the condition of the patient from worsening. The treatments of COPD mainly aims at controlling the symptoms of exacerbation such as taking inhalers. Patients who are over the age of 35 and ex-smokers with chronic cough and bronchitis are recommended to have spirometer (NICE, 2004). This is because it is possible to delay or prevent patients from developing severe case of COPD is identified before they lose their lungs functions. Oxygen therapy is another treatment for COPD as the patients with this condition has high

No history of skin disease. Skin is pink, dry, and void of bruising, rashes, or lesions. No recent hair loss; head is normocephalic. Pupils equally reactive to light; no history of glaucoma or cataracts. Ears are in normal alignment; no history of chronic infections, hearing loss, tinnitus, or discharge. Nose and sinus history includes clear nasal discharge “since last October”, and occasional nose bleeds; states she use to get nose bleeds often as a child. Mouth and throat are absent of lesions; no bleeding gums, sore throat, dysphagia, hoarseness, or altered taste. Neck is void of pain, swelling,

occurred on Sunday. She states she was seen by the “eye doctor earlier today” and

No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.

The general health of the patient is currently being compromised due to present illness mentioned above, but is stable. L.H. reports his usual health to be, “normal and not too crazy like this”. Patient has some fatigue noted while conducting daily activities; No recent weight change, fever or sweat. The skin noted to some discoloration on upper right side of back. There is no pruritus, rash or lesions present. Bruises noted bilateral on arms. Patient reported taking baby aspirin as daily medication. His hair is greying and thinning with no hair loss.

Ms. Manock has had by and large very stable symptoms, since her last visit in February. She has had no exacerbations of her COPD. She should continue use of her Symbicort as well as her Xopenex HFA on a p.r.n. basis. She should also continue use of her supplemental oxygen with exertion and with sleep. Given the severity of her COPD, I have suggested reengagement with outpatient pulmonary rehabilitation and Fit For Life, which she is willing to do at this time. I have also encouraged self-directed exercise at home. She has also mentioned some increasing postnasal drip and I have suggested continue use of her Zyrtec as well as over the counter Nasonex to help mitigate her

weight loss. Her physician noted small patchy areas of vitiligo and a scaly rash across her nose, cheeks, back,

She reports a history of back pain, ovarian cysts excision, and breast tumor. She denies chest pain, shortness of breath, or palpitations. Patient reports that her immunizations and preventive care are up to

Patient’s WBC were on the normal parameter (11.6). Patient did not present signs and symptoms of

The agency that I am currently placed at is the University Eye Center, (UEC). This mission of the organization is improving the sight of people who are suffering from low vision and head trauma due to an accident or pre-existing eye conditions which results in Glaucoma and Cataract. The mission is also rooted in education and services to the communities. While the primary vision of the University Eye Center, (UEC), is to help create programs through the graduate center for vision research, the center for international programs, the career development center, and the MBA Certificate program among many others (University Eye Center Suny College of Optometry, 2017). In 1956 the original vision of UEC was to provide graduate school

Ineffective breathing pattern related to decreased oxygen saturation, poor tissue perfusion, obesity, decreased air entry to bases of both lungs, gout and arthritic pain, decreased cardiac output, disease process of COPD, and stress as evidenced by shortness of breath, BMI > 30 abnormal breathing patterns (rapid, shallow breathing), abnormal skin colour (slightly purplish), excessive diaphoresis, nasal flaring and use of accessory muscles, statement of joint pain, oxygen saturations of 85-95% 2L NP, immobility 95% of the day, and adventitious sounds throughout lungs (crackles) secondary to CHF, hypertension, pain caused by gout and arthritis, and obesity