Patient Four
L. H. a 22-year-old female who came into the clinic as a new patient complaining of lower back pain. Vital signs include: height 62 inches, weight 108 lbs., and 16 respirations. The patient stated that her back pain has gone on for quite sometime now (about 2 years total). She works as a nursing assistant in a nursing home in Wahoo. The physician stated that he wanted to taper her off tramadol (she takes 150 mg a day). He also wants to taper her off Effexor as well. The doctor noticed that the painful region was in the patient’s upper left side of her back. He recommended to the patient that L1 to L2 and L2 to L3 facets would benefit from steroid injections. The patient and her mother wanted to make sure they met their
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deductible before agreeing to the treatment recommendations. We told them that we would give them a call on pricing, while they called their insurance company as well. The only thing the doctor was worried about with this patient, was that she is at higher risk of having osteopenia or osteoporosis when she gets older.
He also stated that there were a few options that the patient could do, but money would probably be an issue because insurance won’t cover plasma injections or stem cell injections. This was out of the question for the patient, but Saunders Medical Center will call them with pricing details later. The physician showed me how to properly check clonus and Hoffman; this was neat to see on an actual person (patient was normal). This concluded my visit with this …show more content…
patient. Patient Five C. C. a 51-year-old female patient who came in for a follow-up visit. Vitals include: height 61 inches, weight 100 lbs., and respirations 16. The patient is currently a nursing assistant on a rehabilitation floor. The patient stated that her neck has been hurting for a few years now and doesn’t seem to get any better with injections and therapy. Patient has also tried pain medication, and nothing seems to be working. She has no known allergies noted. History includes hypertension. She is currently on Cymbalta (30 mg capsule PO every day). Patient stated that the pain in her neck radiates down the spine and to the shoulder. The doctor came into the room and explained to us that the body is like a tree trunk. When you break a branch, the pain might not originate at the spot it broke (the branch), which is why the patient has tingling in the left arm. Dr. Lankhorst stated that the patient has disc disease; patient rated pain as a 4 on a numeric pain scale. Doctor recommended the patient receive 3 to 4 and 4 to 5 right cervical facet injections; patient agreed. This concluded my visit with this patient. Patient Six C. R. a 47-year-old female region five patient who came into the clinic for follow-up pain control. The patient had down syndrome and was mentally challenged. The indication for the visit was because the patient’s pain in the back and legs was increasing and becoming un-tolerable. The patient has been acting out by throwing herself on the floor from her wheelchair; patient is wheelchair bound with straps around the waist to hold her in her chair. The patient is acting out and has been self-mutilating herself with biting. The patient’s caregivers stated that Lyrica costs too much (about $600 as opposed to the cost of Gabapentin, costing only $4). The doctor said that it is hard to tell what is truly going on in these types of patient’s, especially ones who don’t communicate; this patient could barely communicate with us. The only change the doctor did, was prescribing Glucosamine for now and possibly Lyrica if this medication doesn’t work. According to WebMD (2018), Glucosamine is a chemical that we all have in our bodies, this chemical/supplement helps build tendons, ligaments, cartilage, and it will help increase the fluid around joints in the body; doing this by making the fluid thick. WebMD (2018) found that research suggested patients to use this medication/supplement because it helps build/increase the cartilage and fluid around the body’s joints, which means this helps prevent breakdown of cartilage and fluid from happening. This concluded my visit with this patient. Patient Seven G. G. a 92-year-old female who came in for a follow-up visit from an injection she received in the right SI joint about two weeks ago. The patient stated that the pain was better when she received the shots and stated throughout the past two weeks that she felt good. The patient rated her pain as a 7 for today using a numeric pain scale. Vitals include: height 65 inches, weight 133 lbs., and 20 respirations. The patient stated that she didn’t want to get another SI joint injection because she said the pain is tolerable and she thinks its due to her age and just wants to leave it alone. The doctor said that was totally up to the patient and agreed with the decision she made. The doctor explained to the patient and I that our bodies have things called osteoclasts, well these osteoclasts will dig up tiny microfractures in the bones, while things called osteoblast, are the cement crew that come through to fill the wholes with new bone. I thought this was a great way of explaining how the body’s bones work. The reason why he explained this to us is because the patient has a diagnosis of osteoporosis. This concluded my visit with this patient! Surgery: Sacrococcygeal Ligament Injection According to the Virginia Interventional Pain and Spine Center (2016), the procedure consists of the following: lying prone position; using an x-ray machine to locate the tailbone (doctor showed me this); clean the site with antiseptic solution (betadine); multiple x-rays to help guide the correct needle placement; localize the skin (usually burns when injected, this can be the worst part of the injection); the physician will enter the injection into the ligament (steroid and local anesthetic injected slowly); and the procedure is completed now.
This procedure didn’t last long, I would say about 5 to 10 minutes
total. Patient One T. J. a 38-year-old male scheduled for a sacrococcygeal ligament injection. We took the patient back to the OR room and had him lay in the prone position. We pulled down his pants below his waist to expose the buttocks and upper thigh; we also lifted his shirt up halfway as well. Dr. Lankhorst came in and injected Lidocaine first to numb the site and then gave a steroid mixed with bupivacaine 0.5%. The injection was over, this was easy. The patient reported that he had immediate relief. The doctor advised the patient to not swim for the next 24 hours; he can do everything else (normal activities); and the patient could shower with no restrictions the day of the injection. The patient is currently on Cymbalta. This concluded my visit with this patient. Reflect I really enjoyed my clinical day, listening to the pain specialist was awesome. I found it interesting and I made sure to ask a lot of questions. My major question was what he does with pain medications (narcotics), due to the opioid epidemic we are faced with in today’s world. He stated that he tries to find alternative routes to treating his patient’s pain, such as using therapy, injections, Gabapentin, Cymbalta, and so on. He doesn’t ever hand out pain medications that easy he said; which is good when thinking of the epidemic. I learned so much today and plus, I’m excited I get to work on my assessments and talking with the patients all one-on-one because they let me do them all by myself. I can’t wait to see what my next shift has to offer!
Lee Lor was a fifteen year old Hmong girl. She was diagnosed with an acute appendicitis. During the operation to remove her appendix, doctors discovered an eight inch cancerous tumor in abdomen. Without consent they removed the tumor which cost Lee an ovary and part of fallopian tube. The doctors told her parents after the procedure what had happened and promised that she was still fertile and able to still have children. The Hmong people do not accept the western world tradition and science. They hold on strongly to their ancient traditions, are animist, and very spiritual. When the parents were made aware of the extra procedure taken place they did not trust the doctors and refused Lee further treatment including chemotherapy.
T. Paulette Sutton is one of the world’s leading experts in bloodstains and is the former Assistant Director of Forensic Services and Director of Investigations at the University of Tennessee, Memphis. She has been involved in nationally known murder cases and has worked hard during her long career to make a position contribution to the legal system. Sutton says, “Its best for my fellow man that we get the killers off the street.” Since 2006 Sutton has been officially retired but continues to teach, consult, and testify about her area of expertise.
...lood pressure medication in order to keep his blood pressure in the normal state of 120/80. Other than taking medications, there is another alternative such as surgery, such as “ventriculosmy, craniotomy, and carotid endarterectomy” (Kluwer, 2012). The patient also has the option of going to a rehabilitation center where the patient may be able to receive speech therapy, occupational therapy, and physical therapy. In addition, the rehabilitation center may also include “functional electrical stimulation” (Kluwer, 2012).
middle of paper ... ... Having a splenectomy conducted will not cure the disease, it will only make it go into remission. Works Cited Gonzales Gus. “Hereditary Spherocytosis.” http://emedicine.medscape.com/article/206107- overview.
The ethical discernment model described by Slosar (2004) and developed for use at Ascension Health will assist us as we analyze this case. It reminds us that discernment engages our spirituality, intellect, imagination, intuition, and beliefs. It is decision-making that reaches into the heart of our beliefs about God, creation, others, and ourselves. It therefore requires structured time for reflection and prayer from the beginning and throughout the process.
HelloFresh is a food delivery service. Like others in the food delivery industry, they deliver meal kits and recipes. They deliver a recipe sheet for you to follow, and they deliver the exact amount of ingredients you need to cook and complete the meal. HelloFresh do not advertise themselves as a food delivery company (which is fair enough), they say they are a meal kit service, but some people think this means they deliver the tools and equipment to make meals, which is not so, they only deliver the ingredients and the recipe.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
The claimant is a 25-year-old female who was injured in an industrial-related incident on 01/23/16. She presented with a work-related low back pain associated with a right lower extremity radiculopathy. The request is for Methyprednisolone. However, .there was no mention that the claimant had inflammation. Further, this medication was not part of her medication regimen nor part of the treatment plan. Also, as per cited guidelines, oral corticosteroids are “not recommended for chronic pain.
The patient is a 40-year-old male with chronic lower back pain and radicular symptomatology in the left lower extremity and then the right. The patient underwent epidural steroid injection therapy on 08/18/2016. The patient underwent a right L5-S1 and an S1 transforaminal ESI under fluoroscopic guidance. The patient states that he did fairly well after injection therapy up until 12/2016 when his symptoms began to come back though not nearly as intense as they were before. Previously, he was having the radicular complaints on a continuous basis. Currently, he states that he has the same type of symptoms but they are not present all the time. He also notes that his symptoms may have also gotten worse as a result of a recent urologic surgery that he underwent which required him to be lying on his back with his legs elevated for several hours until the procedure was completed. He currently denies any new changes with regards to his bowel or bladder function or increased pain with Valsalva-type maneuver. No recent fever or infection. No weight loss. No new constitutional symptoms.
An emergency department note dated 11/02/2017 indicated that the claimant presented with a low back pain and right hip pain. His back pain started a month ago and had been worse the past 2 weeks. He stated that pain is aggravated by sitting and slightly relieved by standing. His BMI was 31.92. A lumbar spine x-ray was ordered and medications were provided.
Heather is a 26yo, G3 P1011, who is currently 24 weeks 2 days as dated by ultrasound. She is relatively healthy. She has one prior full-term delivery without complications. She was referred today to evaluate her lower extremities. Her issue started on Black Friday, when she came home from shopping, she noticed red areas all over her legs. It started as 4-5 but quickly developed into several on her bilateral shins. After a day or two they became nodules and then turned to discolorations such as bruises. During this time, she was evaluated in your office and there was concern for varicosities and possible phlebitis. She was started on Lovenox and an aspirin. She was seen by vascular surgery and there was no evidence of DVT’s. She was
Disputes are almost unavoidable between people when there are disagreements or misunderstandings. In the construction industry, contractual relationships could lead to dispute. To resolve disputes, construction disputes are most likely encouraged to use Alternative Dispute Resolutions such as arbitration, mediation, and mini-trials to resolve their disputes faster and keep the dispute confidential and at lower cost (Ray, 2000). The construction case presented in this paper first resorted to negotiation; however, it could not give the parties a resolution which led to a mini-trial.
Transfusions of red blood cells, platelets, and plasma are critical to a patient's return to good health,
inform clinical practice based on best available published evidence. CPGs are systematically developed statements based on systematic reviews that assist practitioners to make clinical decisions40.
The purpose of this paper is to analyze, diagnose, and to determine a proper treatment plan to work toward the beneficial prognosis for the individual indicated within the case study.