Watc Case Study

PHYSICAL EXAMINATION: Vital signs are WNL. Apparently he has had no chills, night sweats, or favors. Generalized malaise and a lack of energy have been the main concerns. HEART: Regular rate and rhythm with S1 and S2. No S3 or S4 is heard at this time. LUNGS: Bilateral rhonchi. No significant amphoric sounds are noted. ABDOMON: Soft nontender. No hepatosplenomegaly or masses are detected. RECTAL EXAM: Prostate smooth and firm. No stool is present for hemoccult test.

At today’s visit she is found sitting in the chair, she is awake, alert, and confused. I am asked to seek this pain for new onset pain. The patient complains of acute pain in pubic area and right hip area, pain is dull, achy, severity 4/10, pain is worse with walking. At this time the patient is not taking anything for pain. The ALF staff reports that the patient has daily anxiety and has to be given Ativan three times daily. The patient ambulates with a walker. Gait is

Peripheral pulses posterior tibial and dorsalis pedis 2+ bilaterally. No edema on legs. Apical pulse regular rate and rhythm; s1, s2 noted. No murmurs, rubs or gallop rhythms. Denies dizziness, and fainting. Resp RR between 36-40 SpO2 85% per oximetry on 2 liters oxygen by n/c. Difficulty breathing and complaints of chest tightness. Patient unable to lay flat. Lung sound bilateral wheezes and crackles in right lower lobe. All other lobes clear A&P. Cough with yellow sputum. Tachypnea. Head of bed 45 degree. GI Last bowel movement 2 days ago, hard, long brown stool. Complains of constipation related to medication. Bowel sound are WNL in all 4 quadrants. Abdomen is soft, with no palpable masses. Poor appetite. Like sweet foods. Does not like vegetable or fruits. Like sodas, beer, scotch. Little water intake. GU Urinates every 2-3 hours. Yellow. No odor of urine. No history of UTI. One vaginal infection 2 years ago. No abnormal periods, last menstrual period 3 weeks ago. No pain or discharge. Skin Hair poorly groomed, dirty and oily. Nail are dirty and appear to be bitten. Skin clammy and moist with flushed color. IV IV of D5W at 125 mL in left forearm with 18

Breasts: no masses, no nipple retraction, no discharge. Heart: S1 and S2, no gallops, rubs, or murmurs appreciated. Abdomen is scaphoid, soft and non-tender with positive bubble sounds. Pelvic/ Rectal: deferred as patient has recently visited her GYN for a routine Pap smear. Neurologic exam reveals normal motor strength in all muscle

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia

The pt c/o abdomen8/10 pain x8 days. Pt was seen in the ER and in the clinic. However, current prescribed treatments are not relieving her pain. Pt states the her last BM was 2 days ago after taking Mag Citrate. Pt denies radiating pain. Due to increase pain level, per PA Alford the pt was instructed to go to the ER to be

At today’s visit, she is accompanied by her caregiver from senior bridges. She is awake, alert and oriented. Affect is flat. She denies pain at this time. She states that she suffers from chronic abdominal, dull, wave like, abdominal pain. She states that she takes her pain pill every other pain because her pain seems to occur every other day. She reports that she is feeling depress because she had an appointment schedule recently to remove skin cancer from her face and her daughter cancel the appointment. The care giver report that the patient has daily agitation, but taking the Ativan helps. The patient reports a fair appetite and having regular bowel movements.

PT. CALLED STATING THAT HE HAS GIVEN NORCO 7.5 AND IT WAS NOT WORKING. PT. STATED THAT HE HAS TO TAKE 1 ½ TABLETS TO TOLERATE THE PAIN ALSO STATED THIS WAS HIS SECOND CALL. I INFORMED PT. THAT I AM NOT THE NURSE BUT PER LAST NOTE THE NURSE IS JUST WAITING ON A RESPONSE FROM THE DR. I MADE THE PT AWARE THAT THEY ARE CURRENTLY IN CLINIC AND SOMEONE SHOULD BE IN CONTACT BY THE END OF TODAY HE UNDERSTOOD AND WAS OK WITH THAT.

Based on the progress report dated 11/10/16, the patient states that he is feeling slightly better in the lower back area. Pain and discomfort in her lower back is rated as 9/10. She reports constant low

After nurse gave pain medication, I went to patient’s room to see how he was doing. The patient was in pain and he rated his 8 on a scale of 0 to10. I told the nurse that patient was in a lot of pain.

At today’s visit, she is accompanied by her caregiver from She is awake, alert and oriented. The patient report that her pain at this time is 0/10 in severity, however she reports that when she does not take her Percocet she has chronic, intermittent, dull, achy abdominal pain. The patient is calm and cooperative, no anxiety noted, however the caregiver reports that the patient has daily anxiety, times varies, some days her anxiety is worse than other. No acute distress noted. The patient reports a fair appetite. The care giver educated on what to do in the event that the patient’s AAA

0900 Pt back to his room after breakfast lying down on his bed watching TV, call light within his reach. Ate 85% of his breakfast. Focus assessment completed. Alert and oriented x 4 and follow command. VS T 97.2, P 89, BP 120/60, O2 Sat 92 on 3-liter nasal cannula Pt denied pain at this time and rated 0/10 on a scale of 0 to 10 Heart sounds regular and even, S1 and S2 auscultated. Lungs sounds wheezing in all lobes during expiratory. Bowel sounds present and active in all four quadrants. ABD soft and non-tender to palpate. Pt denied ABD pain. Pt reported bowel movement this morning, (2/18/16)

Looking to confirm my WACC I located a calculation 3.27%, this made me feel slightly better about my calculation of 2.502%. Understanding that this rate could have used many different factors in determining the WACC. What I happened to notice was that after Walmart low numbers in the first quarter they have slowly begun to climb the ladder during the third quarter. From Walmart financials it is easy to see that they generate high returns for their investors by keeping their costs relatively low. While those business practices have given them a less than positive reputation it has done little to nothing for their bottom

The S&WB interim team appointed by the Mayor has installed the most ridiculous solution for 25 cycle power.