...Sclerosis (MS) on October 2010. He stated the following: “For eight agonizing months Kayla lacked all filling in her legs. With the help of medication, slowly, the feeling began to return”. After being treated with the appropriate medication, Kayla picked up running. She felt that she would run as much as she could as long as her MS would allow her to do so. Kayla is now considered “one of the best young distance runners in the country” (Rinaldi, 2014). She is beating MS. Even though Kayla is one of the best long distance runners in the nation, at the end of every race spectators observe that something is wrong; that her MS is not gone. They observe that at the end of every race she collapses into her coach’s arms because she cannot feel nor control her legs. Although there is no cure for MS, medication plays a key role in controlling its progression, severity, and tolerance level so that those like Kayla can run a little longer. There are three different types of medications used for the treatment...
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...reported youth not listening; hitting her (mother) and throws things when she does not get her way. At the time of the CFT meeting Ms. Leal reports that Cindy behavior has improved. Cindy is currently back on her medication and is doing well in the home reports that Cindy has been helping out around the house and she has been more compliant with the house rules. Ms. Leal also reports that she has been getting a lot of support from Ms. Moseley, care manager from Family Preservation Services. Ms. Moseley teaches Ms. Leal parenting skills, household and stress management. Ms. Moseley also teaches Ms. Leal behavioral management techniques she able to utilize in the home for Cindy and her siblings. Ms. Leal feels that Ms. Moseley is a great support for her family. Family Preservation Services is a DCP&P contracted service. DCP&P are still open with the family. Ms. Kean provides care and supervision to the Gamez/Leal family. Action: Family Preservation Services provides the family with in-home crisis intervention and family education program for families whose children are at imminent risk of abuse, neglect, or out-of-home placement, and for families preparing to be...
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...Thesis Statement A patient prescribed a Dysphagia Mechanically Advanced Diet can have certain oral medications crushed and mixed with food at a consistency appropriate for the patient. Pathophysiology On October 6, 2015, in clinical, I cared for an 82 year-old female named Ms. M. She had presented to the hospital Emergency Room with altered mental status and shortness of breath. Ms. M had a past medical history including Parkinsonism resulting in dysphagia. The abnormal lab results that supported the eventual primary diagnosis of a urinary tract infection and possible sepsis include an elevated Absolute Neutrophils Count (ANC) 72%-normal ANC 55%-70% and decreased Absolute Lymphocyte Count (ALC) 16%-normal ALC 22%-44%. (Pagana & Pagana, 2013)...
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...Case Study Ms. J. O. is an 82 year old female with a variety of comorbidities including Alzheimer’s type dementia. She is a resident of a dementia unit of a local assisted living facility. She was brought in to the hospital for a fall from which she stated she had hit her head but never lost consciousness. On arrival to hospital she was noticed to be very confused with complaint of back pain, chest pain but alert. After a short period of time her GCS abruptly dropped to 3 requiring intubation. CT scan of her head showed no bleeds, strokes or abnormality. All lab values were within normal limits and her blood pressure was mildly hypotensive 93/55. Past medical history 1. Ms. J.O. has had numerous falls recently requiring multiple emergency room visits. Each visit also showed evaluation of altered mental status over her normal state of being. On one fall she suffered a pelvic fracture, sacral fracture and L2-3 fracture. Another fall she suffered a nasal bone fracture. She was treated for pain control for each visit and then returned to assisted living facility. Per family she has been at her facility for about a week before this fall. 2. 3. Type 2 diabetes 4. Ulcerative colitis 5. Anxiety/Depression 6. Hypothyroidism 7. Osteoarthritis 8. GERD 9. Alzheimer’s type dementia 10. Stroke 11. Peripheral neuropathy 12. Chronic back pain from falls 13. Hypertension 14. Knee surgery 15. Cataract surgery 16....
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...within the brain and between the brain and the body. MS affects one in every 500 persons, women twice as frequently as men. It is more common in young adults, and causes a variety of neurological deficits (visual loss, paralysis, sensory loss, ataxia, brainstem signs, psychiatric disorders, and dementia). Many MS cases evolve over a long period (20-30 years) with remissions and exacerbations. Some cases have an acute, even fatal course, and others go into a relentlessly progressive phase after a period of remissions and exacerbations. MS involves an immune mediated process that develops when a previous viral injury to the nervous system has occurred in a genetically susceptible individual. B lymphocytes, plasma cells, and activated T cells, along with pro-inflammatory cytokines, cause inflammation, oligodendrocyte injury, and demyelination. Early inflammation and demyelination lead to irreparable axonal degeneration and scarring (Huether & McCance, 2012). MS not only causes focal inflammatory changes but also causes diffuse injury throughout the central nervous system called MS lesions or plaques. MS lesions can occur anywhere in gray or white matter with localized areas of demyelination, changes in the components of myelin, damage to oligodendrocytes, extensive loss of neurons over time, and atrophy of the brain. Even normal appearing white matter is microscopically very abnormal. The multi-focal, multi-staged features of MS lesions in established disease produce symptoms that...
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...Multiple Sclerosis Sarah HCS 245 March 25, 2013 Dr. Tira Hancock MS, RD, CD, NBCT Multiple Sclerosis Imagine going to the doctor because you have tingling or numbness in you extremities or face, you are constantly tired, and having trouble seeing. You go to your physician and explain all of your ailments to your doctor. They diagnose you with fibromyalgia and vitamin B12 deficiency. After being prescribed medications for those diseases, two weeks later you experience bladder problems and walking difficulties. You return to the doctor with the added ailments. Since you came back with more ailments, they are more inclined to get a full family medical history, neurological exam, MRI, and spinal fluid analysis. The results come back from all of these tests that were ran at you second doctors visit, you are diagnosed with multiple sclerosis (MS). Multiple sclerosis is often misdiagnosed; this is because there is not a single test that tells doctors that a person has MS, and to be diagnosed with MS there needs to be signs in two separate areas of the central nervous system. This paper will describe what multiple sclerosis is, who is affected, environmental factors that contribute to MS, methods of controlling MS, and if social/cultural influences play a part in this disease. What Is Multiple Sclerosis? Multiple sclerosis is a painful disease that has scientists stumped. Many are calling multiple sclerosis an autoimmune disease, which means your immune system is fighting...
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...Kristin.Covalt@dcs.IN.gov Ms. Catilyn Postma was referred to Capitol City Family and Education Services (CCFES) for a Substance Use Disorder Assessment in order to determine the level of treatment needed to address her current substance use. Ms. Postma reported a history of substance use. She reported that she became involved with DCS due to domestic violence with the father of her child. Ms. Postma reported previous involvement with DCS when she was a child. She reported that she was removed from her parents’ home due to domestic violence and abuse. Purpose for Assessment The purpose of this substance abuse assessment is to gather and analyze information regarding Ms. Postma’s level of substance issues, current and future service needs. The Indiana Department of Child Services referred Ms. Postma for a substance abuse disorder assessment as a result of Ms. Postma’s use of substances. Assessment Tools: Substance Abuse Subtle Screening Inventory CCFES Intake Assessment Interview/Biopsychosocial Assessment: Ms. Postma is a 18-year-old Caucasian female who is currently residing at 5217 Madison Avenue in Indianapolis, IN. Ms. Postma reported previous involvement with DCS that involved domestic violence and abuse when she was a child. Ms. Postma was raised by her mother and aunt. She described the relationship with her mom as being horrible. Ms. Postma reported incidents of physical and mental abuse. During the time of the assessment, Ms. Postma reported a history...
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...Client Denise Holcomb is a 55-year-old African American female. She was born and raised in Cleveland, Ohio. Ms. Holcomb is a single mother of four children, three girls and a son. Ms. Holcomb has been diagnosed with Bipolar Disorder I. She is also the founder of Removing the Stigma, Mental Health Paraprofessional. Her current income is undetermined. Mental status Examination Ms. Holcomb is a 55-year-old woman of average weight and height. Ms. Holcomb was compliant during the course of the interview. During the time of her evaluation, she appeared well mannered and dressed well. In this sessions, Ms. Holcomb’s affect and mood was consistent with the questions being presented. Ms. Holcomb is familiarized time and place. She is also aware and knowledgeable about her mental illness. In the interview Ms. Holcomb’s did not present symptoms of tremor or abnormal movement. She also did not show signs of suicidal ideations, hallucinations or delusions. Ms. Holcomb responded to all of the questions very clear and automatically. Throughout the interview Ms. Holcomb maintained eye contact, her speech was very clear and she articulated her thought process very clear. When Ms. Holcomb addressed that her brother and her son both committed suicide she did not seem overwhelmed. From observation Ms. Holcomb appeared to be in good physical and mental health. Presenting Problem Ms. Holcomb is a 55-year-old African American female whose presenting problem is being diagnosed with Bipolar Disorder...
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...Assessment The purpose of this assessment is to determine what issues Ms. Haymaker has and to provide a treatment plan that will lead to a successful life change. Demographic and Identifying Information Name: Suzie Haymaker DOB/Age: 06/09/1977 37-years-old Chief Complaint: Mental health and addiction problems Source of Information The following information was utilized in this report: Clinical Interview with Suzie Haymaker, Medical Records, Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Background Information Ms. Haymaker is a 37 y/o Caucasian female born June 9, 1977. She currently lives with her same sex spouse (m. 10/9/2014) and they own their home. She states she has three minor daughters from a previous marriage. She state she has an Associates Degree and is currently working on her Bachelors Degree. Ms. Haymaker has been unemployed since 2009 and is currently drawing Social Security Disability (SSDI). Ms. Haymaker has a medical history of hypertension, uncontrolled diabetes, peripheral neuropathy, morbid obesity, atrial fibrillation, anemia and blood clots. In 2013 she was hospitalized for Carbon Monoxide Poisoning. She has had several hospitalizations since 2011 for reasons directly related to her physical health. ASSESSMENT AND TREATMENT 3 In 2008 Ms. Haymaker was accepted into a residential treatment center for substance...
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...50-word answer for each question following the scenarios. Use at least one reference per scenario and format your sources consistent with APA guidelines. Scenario A Acute renal failure: Ms. Jones, a 68-year-old female, underwent open-heart surgery to replace several blocked vessels in her heart. On her first day postoperatively, it was noted that she had very little urine output. 1. What is happening to Ms. Jones’s kidneys, and why is it causing the observed symptom? Since Ms. Jones just had open-heart surgery to replace the blocked vessels in her heart, her kidneys did not have enough blood flowing to them. This may have been a result from low blood pressure during the surgery, and they are struggling to work properly now the surgery is over (Mayo Clinic, 2012, Acute kidney failure). 2. What other symptoms and signs might occur? Some of the other symptoms and signs that might occur to Ms. Jones after she underwent open-heart surgery are headache, gastrointestinal distress, and the odor of ammonia on her breath. More important, high levels of blood potassium can cause muscle weakness and slow the heart to the point it stops (Zelman, Tompary, Raymond, Holdaway & Mulvihill, 2010, p. 242). 3. What is causing Ms. Jones’s kidney disease? Ms. Jones’s kidney disease is most likely because of the recent open-heart surgery she had. As a result, the low blood pressure during the surgery caused her kidneys to stop working properly...
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...Hyperlipidemia Scenario 1: 1. The resources I will need are brochures and education tools, updated procedural information and testing methods, and information for the pharmacist including parameters and knowledge of the test results. The furnishings I will need are chairs, tables, posters, and drawers or cases to keep and transport supplies. The supplies I will need are anything used for collection of samples including syringes and vials, or kits and devices used for less aggressive testing of cholesterol. 2. Regulations include that the site must be licensed to perform testing and must have a “Certificate of Waiver” license if it performs only waived tests. The sites must adhere to manufacturer’s instructions to perform the test, including “Good Laboratory Practice” such as trained personnel, competency, and evaluation. Must also agree to permit announced inspections of the site. 3. OSHA covers every aspect of workplace hazard avoidance. Regulations include health care workers and needle stick precautions, consistent use of personal protective equipment, and work practice and engineering controls in needle stick precautions. 4. Lipoproteins commonly tested for are LDL, HDL, and VLDL. LDL and HDL are the most important when discussing with a patient. 5. It is best to measure her total cholesterol and HDL. LDL can shoot up significantly after a meal. 6. Yes, her age, smoking, high blood pressure, and close relative put her as a candidate for CHD. 7. She...
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...accepted a report of alleged threatened injury of 8 year old Derrick Duerr by his father, Erick Duerr. Per reporter Mr. Duerr is diagnosed with the other specified psychotic disorder and is not taking any medication to address his current state of having delusions. Per reporter Mr. Duerr had been hospitalized a couple of years ago and prescribed medication which he took for a while. Per reporter. Per reporter Mr. Duerr indicated that he doesn’t like the side effect from medications and soon after discharge stopped taking them. Also, per reporter Mr. Duerr believes he has a mission or cause to take care of gang members during drug dealers on his block; either directly or by calling the police. Per reporter the concerns are that Mr. Duerr has little insight into the danger he could put his son regarding his “belief” and “cause” to take care of the drug dealers and gang members. Per reporter Mr. Duerr beliefs if necessary, he will die for this cause and when he is questioned about the risks or danger regarding his son being involved especially with the gang members who live next door per Mr. Duerr. Per reporter stated that Mr. Duerr believes in the cause as he will die for the cause. The outcome of the Assessment: This worker met with...
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... Overview Mr. Jones is a pharmacist employed by ACME Drug. He has a known drug problem and his drug of choice is Mepergan. Maria Smith is a cancer patient and customer of ACME drug company. Ms. Smith has been receiving Mepergan Fortis, a schedule II narcotic, as part of her scheduled pain treatment. The last time Ms. Smith had her prescription for Mepergan Fortis filled, Mr. Jones was the pharmacist on duty. Ms. Smith noticed that the medication was not working as it had in the past and returned to the pharmacy. The pharmacist on duty determined that the wrong medication was given to Ms. Smith, 28 Mepergan Fortis and 32 Feldene. Since the stock bottle of Mepergan Fortis remains in a locked drawer, the video was reviewed and it was discovered that Mr. Jones had transferred the Feldene capsules into the Mepergan Fortis bottle, and put the Mepergan Fortis capsules in his pocket. The amount charged to Missouri Medicaid for the Mepergan Fortis prescription for Ms. Smith was $117.00. The amount that would have been charged to Missouri Medicaid for the Feldene that was dispensed would have been $8.97. Further investigation by ACME Drug revealed that Mr. Jones had likely billed for a higher cost controlled substance and dispensed a lower cost non-effective medication to more than five other patients. Issues One of the immediate issues is the fraudulent Medicaid billing. According to USA today, there have been 14,663 providers and suppliers who have lost their...
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...Scenario A Acute renal failure: Ms. Jones, a 68-year-old female, underwent open-heart surgery to replace several blocked vessels in her heart. On her first day postoperatively, it was noted that she had very little urine output. 1. What is happening to Ms. Jones’s kidneys, and why is it causing the observed symptom? Ms. Jones just had open-heart surgery and her kidneys did not have enough blood flowing to them (possibly because of low blood pressure during the surgery) and are struggling to work effectively now (The Mayo Clinic Staff, 2011). 2. What other symptoms and signs might occur? Confusion, Fluid retention, fatigue, drowsiness, and an ammonia smell to the breath are a few other signs and symptoms that may occur with acute renal failure although some signs may be confused with post-operative complaints (The Mayo Clinic Staff, 2011). 3. What is causing Ms. Jones’s kidney disease? Ms. Jones’s recent open-heart surgery is most likely the cause of her kidney disease. Low blood pressure during the operation caused her kidneys to stop working because of lack of blood to the organ to filter toxins from the body (Leurs, 1989). 4. What are possible treatment options, and what is the prognosis? A variety of medication can be used to treat kidney failure in this case, including temporary dialysis (The Mayo Clinic Staff, 2011). The prognosis for Ms. Jones is good she will most likely recover, and suffer no long term effects. Scenario B Chronic renal failure: Mr. Hodges...
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...Assignments | | Macy LPN #1 | Pod 1 | | Mr. Black (UTI) | | Ms. Johnson (Crohn’s) | | Mr. Raynor (diabetic foot ulcer) | | Mrs. Tolento (CHF) Mr. Smith (pneumonia) | | Ms. Swanson (S/P hysterectomy day 2, in pod 2) | Ana RN | Pod 2 | | Mr. Smith (GI Bleed) | | Mr. Moretz (Night sweats, neg pressure room) | | Mrs. Flanco (S/P Colectomy day 2)Mr. Reddington (GSW) | Mike LPN #2 | Pod 3 | | Mr. Smith (Atrial Fib) | | Ms. Harper (s/p breast mastectomy) | | Ms. Levin (s/p attempted suicide) | | Mrs. Walnut (aspiration pneumonia)Mrs. Stewart (Diabetic Ketoacidosis) | | | Gilda CNA | Pods 1-3 | | | Explanation The following is a detailed explanation of the assignments made for this shift: Macy LPN: Macy was given her patients based of her skill and scope. She always volunteers to take on the Spanish speaking patients since she is more comfortable speaking in Spanish. The RN, after moving patients to different pods, she gave Macy one possible discharge today and what would be consider by some a difficult patient that can be abusive and refuses to be take care of be the other LPN on shift today. Macy also had to take on a total of 6 patients instead of six, the RN will cosign her notes at of shift. The patients given to Macy also had the least amount of IV medications to be given and this would be beneficial to the RN, since Macy is not certified to give any IV medications and the RN would then have to make herself responsible for those...
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