... |Oriented to place, time, and day. able to move upper and lower | | |Alert , oriented, ability to move extremities, papillary reflex |extremities. PERRLA. | | |Cardiovascular |Heart rate is 80 and capillary refill returned within 2 seconds | | |Heart rate, Pulses, Capillary refill, skin color, temp | | | |Respiratory |Pt is on 98% on room air. lungs sounds were clean air in clean | | |Respirations, use of O2, Lung sounds, O2 Sats |air out | | |Gastrointestinal |Active bowel sounds heard in all four quadrants | | |Bowel sounds, contour/shape of abdomen, | | ...
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...Geriatric History and Physical with Problem List and Plan Health Assessment Lab General Patient Information Client: 81-year-old Caucasian/Italian female Source: Client, seems reliable Marital status: Widower Religion: Catholic Occupation: House wife Formal education: High school Primary language: English, written and spoken Secondary: None Reason for Seeking Care: Shortness of breath and productive cough. History of Present Illness: Recurrent episodes of shortness of breathe and productive cough since 2008. First episode occurred when she was in her early 80’s. She was awakened in the middle of the night with a very painful right-sided chest pain and cough. There was no warning of a problem. She reports the pain was “tight and pounding”. The pain was a 10 on a numeric scale 0-10 lasting about 25 minutes. Patient states her cough worsens when walking long distances, especially without using her walker and her breathing becomes labored. She states her cough usually lasts about three days but has noticed it becoming more persistent and feels the need to cough up phlegm. She saw a physician for that episode. Diagnostic test confirmed a diagnosis of Chronic Obstructive Pulmonary Disease when she had her first episode of these symptoms. Her lung sounds presented with some wheezing on the upper lungs bilaterally, she had rapid shallow breathing with a respiration of 24. Upon walking long distances she becomes emotionally anxious; rest does not...
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...Case Study Patient age range: Mid 70’s Allergies: enalapril (hives); iodine containing compounds (hives) Diet: Regular Diet Activity: Skilled Therapy Mobility Group: Ambulate to bedside commode with assist of 2. Diagnosis: Arterial Occlusion; Thrombosed Popliteal Aneurysm (acute obstruction) Presenting Symptom(s): The patient’s chief complaint was left leg pain from the left knee down to the left foot. When asked the patient he was unable to appropriately respond to the question due to confusion. History of present illness: The patient is a male in his mid 70s. The patient presented with new onset left lower extremity ischemia. He was started on an IV heparin drip and transported to ED. He was found to have am occluded left popliteal aneurysm with occlusion of all tibial vessels. The patient was taken to the OR with vascular service for initiation of thrombolysis therapy. He is currently hospitalized for left lower extremity ischemia, angiogram, thrombolysis, bypass femoral popliteal thrombectomy, irrigation and debridement of wound, and a fasciotomy. Then, he was taken back to the OR for debridement of left anterolateral muscular compartment necrosis. This morning, he was noted to be “confused”. The patient was stable and oriented until at least yesterday evening. Per the primary team, he did not appear confused when seen at 6am. He was also noted to have a temperature of 37.4. He did not have any labs checked for 2 days, but this morning his labs...
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...I. Identifying information A.Gender: Female B.Age: 36 years old C.Place of Interview: New York Downtown Hospital D.Source of information: patient, patients chart E.Statement of reliability: Patient was coherent and reliable II. Chief Concern Patient was admitted to the labor and delivery department because of vaginal bleeding and lower abdominal pain. III. History of Present Illness The Patient is a 36 year old female, G2P1001, that is 28 3/7 weeks pregnant who presented to the emergency room with bloody mucus discharge, active vaginal bleeding, abdominal pain and occasional lower back cramps. A McDonald cerclage was placed on 10/13 due to thinned cervix and fear of miscarriage. Upon speculum examination, her cervix was closed and the cerclage was correctly in place. She was given two doses of betamethasone (12/3,12/4). She denies headache, dizziness and vision problems. She had a normal vaginal delivery in 1998 with no complications. IV. Past Medical History Medications: 1.Prenatal vitamins- 1tab/day, PO Past Medical Diagnoses: Patient denies any previous medical conditions. She stated that is has always been in good health and no previous diagnoses. Allergies: No known allergies Immunizations/vaccines: All of the patient’s immunizations were “up to date” Blood Transfusions/Surgical History: No transfusions, only surgery was the current cerclage placement and an appendectomy in 1982. V. Social History The patient denies...
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...COPD All respiratory diseases characterized by chronic obstruction to airflow fall under the broad classification of COPD, also known as chronic airflow limitations (CAL). COPD is a condition of chronic dyspnea with expiratory airflow limitation that does not significantly fluctuate. Within that broad category, the primary cause of the obstruction may vary; examples include airway inflammation, mucous plugging, narrowed airway lumina, or airway destruction. The term COPD includes chronic bronchitis and emphysema. Although asthma also involves airway inflammation and periodic narrowing of the airway lumina (hyperreactivity), the condition is the result of individual response to a wide variety of stimuli/triggers and is therefore episodic in nature with fluctuations/exacerbations of symptoms. Asthma: Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and constriction of bronchial smooth muscle, hypersecretion of mucus, and edema. Precipitating factors include allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections. Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum, and marked cyanosis. Emphysema: Most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping)...
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...home because of the smoky winds. The smoke from the fire is affecting many of the residents in the community, especially those with preexisting lung diseases. The local hospital is full and the emergency room is over crowed. Patients are in need of beds in the hospital. The entire staff is stressed and pressed to discharge patients quickly to make room for patients holding in the emergency room. In addition nursing staff is required to work overtime to meet the needs of the community. Next, the Neighborhood Senior Nursing Clinic has seen more seniors than usual this week because of the smoky winds. Many of the seniors have needed to use their oxygen more often than usual this week. The seniors have been advised by the nurse Karen at the Neighborhood Senior Nursing Clinic to stay indoors to avoid respiratory irritants. Unfortunately, there had been an increase in seniors coming to the clinic in the past couple of years related to lack of extracurricular activities available to seniors in the community. After that a second grade student at the neighborhood school was sent to the school nurse because of difficulty breathing. She was noted to have an increased respiratory rate, coughing frequently, and wheezing in the lungs. The school nurse Violet calls her mother to pick her up and advise her to take her to the doctor. In addition nurse Violet advises the mother to send the child’s inhaler to the school for the nurse to keep in the nurse’s office because the student revealed to...
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...For the purpose of this essay, the chosen aspect of care for the management of COPD is oxygen therapy, which is the medical intervention for administering oxygen. Oxygen therapy has been found to be beneficial in reducing breathlessness and increasing exercise tolerance (Journal of Community Nursing, (Edwards) 2005). However, the British Thoracic Society (2008) state that oxygen is a treatment for hypoxamia and, not for breathlessness because oxygen has not been shown to have any effect on the sensation of breathlessness in non-hypoxaemic patients. COPD is a disease that progresses slowly, as a result many other pathological occur, where people cannot breathe in and out properly because of long-term damage to the lungs, and it disrupts the normal ventilation and perfusion process of the lungs (Nurse Prescribing, Barnet, M. 2007). COPD damages airways in the lungs and causes them to narrow, which in turn makes it harder for air to enter and exit the lungs (British Lung Foundation, 2007). The narrowing and blockage of the airways are due to the increasing production of mucous and thickening of the airway walls. Over time, there is also damage to the air sacs where oxygen passes from air into the blood and the changes start with inflammation in the airways. This is the body’s way to responding to harmful substances, often due to cigarette smoking, over a length of time (NICE, 2008). There are over 900,000 patients diagnosed with COPD in the UK currently, and it...
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...cost effectiveness through the integrating and functions of case management, utilization review and management and discharge planning. Has accountability for the care, coordination and discharge planning of all patients. This position is accountable to the Director of Case Management. QUALIFICATIONS Associate degree in healthcare related field preferred. Bachelor’s degree is preferred. Licensed professional nurse may be considered. Bachelors or Masters degree in related healthcare field (such as respiratory therapy or social work) may be considered. Minimum of two (2) years of utilization review/case management experience or social work experience. Minimum of one (1) year experience in discharge planning from a hospital is preferred. Maintain current professional licensure in nursing or professional field of certification. Appropriate certification in case management preferred (e.g., Commission for Case management Certification (CCMC); Association of Rehabilitation Nurses (ARN)). SUMMARY OF MAJOR AND ESSENTIAL FUNCTIONS Provides hospital case management/utilization review and discharge planning to assure that the patient progresses through the continuum of care and is discharged to the least restrictive environment. Coordinate the integration of the social service function into patient care. Coordinate the hospital activities concerned with case management and discharge planning. Adhere to departmental goals, objectives, standards of performance, and policies and procedures. Ensure...
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...protect and prevent citizens from injury or potential harm, which involves helping people to prepare and respond to emergency situation, including people with disabilities. To plan and respond to community emergency require involvement of everybody in the community, including people with disabilities in identifying needs in evaluating operational management. The issues identified with people of disabilities include notification, evacuation, transportation, sheltering, access to information, medication, refrigeration, backup power, and to mobility devices or service animals en route to shelter. Emergency preparedness is pertinent for every community because it could be a life-threatening situation. Summary of the event that took place at the Neighborhood community as read under the course materials section in the newspaper articles and scenarios in the Pearson Health Science Neighborhood in season two, episode five from University of Phoenix student website. The Neighborhood has a population of 64,200, localized close to a forest and beside the bank of a river. The community has been experiencing fire out-break for five days and had caused irreversible damage to the land, it has destroyed huge acres of land and may be a threat to the town because of the windy climate. The people are developing respiratory problems because of the fire’s closeness to the city. The city officials are stipulating everyone in the community to remain indoor except it is necessary to do so because of...
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...Medline (1946-present) was searched using combinations of the following search terms ‘Intensive Care Units’ OR ’Critical Care’ AND ‘Patient re-admissions’. The searches were limited to abstracts in English language between 1990 and 2014. This search was then narrowed to ‘core clinical journals’ to increase the quality of the articles but this limitation cut the number of articles down to 2/3rd and even though these articles were saved under a separate folder, eventually all 91 articles were included in the final search. The term ‘Intensive Care Units’ were narrowed to include only ‘burn’, ‘coronary’ and ‘respiratory’ care units. The CINAHL and Cochrane Database search failed to reveal any relevant results. Results: My search generated 33 articles and their review shed light on a few recurrent themes identified as being the reason for early re-admissions. Premature discharge, time gaps between reaching the wards and being seen, lack of attention by ward nurses, lack of experience of medical staff in the wards were some of the themes identified. Conclusions: For a patient, coming back to the ICU is always a cause of concern for physicians, patients as well as their families. After reviewing a significant number of studies, we can see how certain factors have linear and non-linear relationships with readmissions to...
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...patients coming back to the emergency department after discharge. Guidelines from the national asthma education and prevention program recommends 40 to 80 mg per day in one dose or 2 divided doses. Use of inhaled corticosteroids is not suggested over systemic corticosteroids in the emergency department. Although, the use of inhaled corticosteroids should be implemented in patient long-term care at the time of discharge. Also the use of methylxanthines were once normal for the emergency department is now not suggested due to increased risk of unfavorable events and low outcome of...
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...their medical stay. During their time of suffering, healing, and/or grieving, many families look for someone to communicate with to help them through this tough process. For my profession career project, I was able to interview. She has been involved in case management for over four years. Case managers “function as a key part of patient care in the modern hospital system. Responsible for organizing a patient's case from admittance to discharge, a case management nurse understands hospital processes and the importance of making cost-effective decisions (Education-Portal).” She has her Bachelor’s Degree in Nursing and has a Master’s Degree in Social Work. Qualifications for becoming a case manager include, an “associate degree in healthcare related field, a Bachelor’s degree is preferred. Bachelors or Masters Degree in related healthcare field (such as respiratory therapy or social work) may be considered. Minimum of two (2) years of utilization review/case management experience or social work experience. Minimum of one (1) year experience in discharge planning from a hospital is preferred. Maintain current professional licensure in nursing or professional field of certification. Appropriate certification in case management preferred (e.g., Commission for Case management Certification (CCMC); Association of Rehabilitation Nurses (ARN)) (Ocean to Ocean, Healthcare).” The average salary range for a case manager with a Bachelor's Degree is $49,917 - $84,908 (Pay Scale).” As I interviewed...
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...Introduction: Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event such as the one described below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident. Scenario: It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog. Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then he is further...
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...assigned to be the case manager for Mr. B, a 76-year-old Caucasian male who was admitted to Kindred on June 29th, following his discharge from a local hospital. Mr. B was admitted to Kindred because he has multiple medical conditions that need to be treated. He is experiencing respiratory failure and is currently receiving high levels of oxygen. He also has pneumonia, and acute congestive heart failure. Since coming to Kindred, it was also discovered that Mr. B has developed masses on his lungs and prostate....
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...Introduction: Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event such as the one described below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident. Scenario: It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog. Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then he is further...
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