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Write a patient interview
Write a patient interview
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Assignment
Patient Interview Team # 29
You have had an opportunity to meet a real potential patient in their home environment. Hopefully, you were able to gain a different perspective on what a patient lives with and how it might affect patient adherence for medication. You need to remain sensitive to these types of issues as you educate patients and find ways to improve their ability to care for themselves.
The rules of engagement:
1) Discuss your experience with your team. Compare your impressions to determine the similarities and the differences. Why do you have different assessments of the “patient(s)” or the environment? What details are important to remember when guiding a patient to better health through self-medication or counseling
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During our visit, we noticed the patient was living under unsanitary living conditions. He lives within an incredible amount of clutter and furniture and thus some of us thought that he possibly struggles with hoarding, while others believed that he simply didn’t care to clean up around the house. Some of us also noticed the excessive amounts of pet hair and dander from his 3 cats and 3 dogs all over the furniture. After reevaluating his living condition, we agreed that such unhygienic conditions may be a key factor to his allergies.
Furthermore, we have different assessments due to our own personal background and culture. One person may view something as normal, while a different person might find it peculiar. We also may focus on different things as we observe the environment. Finally, it is important to be respectful when guiding the patient to better health. It is also crucial to remain free from any type a prejudice or bias and pass no judgment; to strictly focus on the patient’s health and well-being.
2) Create a chart to detail specific information based on what you learned and observed during the interview(s). The table should contain lines for 6 entries and should look
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Lives a sedentary lifestyle.
4)The patient doesn’t consume alcoholic beverages but he does chew tobacco.
4)The house was unhygienic and filled with dust and pet dander which may spark allergic reactions.
5)The patient drinks excessive amounts of soda and coffee each day with averaging about 6 cans of soda per day.
5) It was difficult to breathe in his home; the air was thick and we felt stuffy as a group. A/C filters may have not been changed in a long period of time.
6) The patient fills his prescriptions at the Walmart Pharmacy. His medications include Janumet (Metformin) and Victoza (liraglutide) for type 2 diabetes, atorvastatin for managing cholesterol levels, fluticasone and Qvar for allergy relief, benazapril for high blood pressure. He also revealed that he takes Vicodin, alprazolam, carisoprodol for any back or neck pain me may endure. Some other drugs he had on hand include: dicyclomine, pantoprazole, acyclovir, promethazine, hycosamine, vitamins and nutritional supplements.
6) Unorganized; doesn’t keep a checklist of the medications he takes each day. Lack of medication compliance due to
What risk factors and symptoms did Jessica present with prior to the physical examination that suggested a pulmonary disorder?
The EB’s case study said the female patient is 50 years old with symptoms of fever, chills, congestion, three weeks of coughing, shortness of breath when walking. The study implies that the patient is now seeking medical advice due to vital signs recording and the noting of decreased breath sounds and wheezing. She denies smoking and not taking any chronic medication.
Today he chooses to have a healthy life and control his diabetes. He takes one medication orally for his diabetes, Metformin. JR has a good, healthy diet as well as exercise habits like taking walks with his dog. JR takes seven medication on the daily with three being for his heart, one for his high blood pressure, one for his cholesterol, one for his diabetes and another one to prevent blood clots. After making sure there was no drug to drug interaction between any of this medications, I informed my patient that his medication can not cure diabetes and high blood pressure but control
A 61-year-old gentleman was admitted on 25/1/2016 to Letterkenny General Hospital with central chest pain after history of a fall. He also had drastic weight loss and loss of motor and sensory function. He walks with the aid of a walking stick as he has problems walking due to his lower limb weakness. The patient was a heavy smoker of 90 pack years (3 packs/day for 30 years) and stopped nine years ago. He stopped drinking seven years ago. He is married and lives at home with his wife. He works as a plasterer. He has a strong family history of ischaemic heart disease and type 2 diabetes mellitus. Two of his brothers had coronary bypasses and stents. His father died of a myocardial infarction. Two of his brothers are also type 2 diabetics. During
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
This service is experienced, documented, evaluated and paid for as Pharmaceutical Care. Pharmaceutical Care consists of a philosophy of practice, patient care process as well as a patient management system. Pharmaceutical Care has common integrated vocabulary consistent with other patient care practices such as medicine, dentistry and nursing. Philosophy of pharmaceutical care consists of a description of the social need for the practice, a concise and clear statement of individual practitioner responsibilities to meet this social need, the expectation to be patient-centered and the requirement to function within the caring paradigm. This philosophy of practice is expected and practiced by all health care professionals. The patient care processes must be consistent with the patient care processes of all other health care providers. These processes include the assessment of the client’s pharmaceutical needs, a health care plan that is constructed to meet the specific needs of the client and a process in which evaluates the health care plan to gauge the efficacy of decisions made and actions taken. Pharmaceutical care management system includes all resources needed to manage the client’s needs, which include the space provided, such as a clinic or hospital, an appointment system for patients, appropriate and ethical documentation, reporting of patient care, evaluation of decisions made and actions taken and payment of service
Ask if the patient is experiencing other problems. If the patient reports other challenges, link it to poor adherence and encourage compliance.
This approach acknowledges the uniqueness of each person and considers their social, emotional, and physical well-being. It involves respecting and understanding the patient, their family, and support system, and working together to provide individualized
The patient continues living alone. She is alert and oriented has multiple diagnoses of diabetes, depression, anxiety, fibromyalgia, Rheumatoid arthritis and HTN. There is a lot that has happened to this patient during this period. In the month of may 5/12/2016 she woke up with left hand 2 digit severe pain and discoloration ,she refused to go the ER instend she visits urgent care in Springfield and was ordered lab test that showed she had an increase in uric acids in the area . The following day 5/13/2016 she had an appointment with liver specialist DR , Samuel's (Hepatologist), he ordered a new set of labs. Results showed elevated Liver Function Tests, showed increases in potassium , increase protein , blood sugar were at 400 mg/dl. pt went home terrified as the doctor mentioned her liver is getting worsening and becoming more dysfunctional. On 5/16/2016 she had a following up with PCP and the doctor also mentioned that her kidney and liver functions have worsened. She has been taken off Metformin for and her Lantus was increased to 25 units at bedtime. Patient has also been instructed to start on a low sodium diet and she continues getting educated on proper diet required. On 5/27/2016 during skilled visit patient was found very lethargic and drowsy, skin pale, normal temperature to touch,s\n tried to arouse the patient, she woke up for a few minutes then fell back to
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
This case study seeks to rule out other diagnoses and analyze Mr. Duncan's symptoms, stabilize him and address his safety needs. Subjective and Objective Assessment Findings. Subjective Findings Mr Duncan presents with weakness, headache, diarrhea, nausea, palpitations, and low appetite. He has no past medical history and no known allergies.
The intake interview assists in establishing and diagnosing any problems the client may have. The therapist may then explain to the client what to expect during the interview, including the time duration. A good assessment/ or intake will focus on the individual situation, strength and coping mechanism. The intake form is for the client, it gives the therapist more information and an idea of who you are. The intake process that is considered of a series of questions and consent form that the client has to sign and agree to. A professional relationship between a counselor and a client begins with an intake interview.
These tools are helpful in framing my practice into interventions that are evidenced based and effective. However, I’ve found that allowing patients and their families to be the guide for the treatment plan gives then much needed control over their lives as a uncertainty and lack of control have become the norm for them. It also keeps me honestly engaged in intentional and active listening to the patient. I am always looking to them for cues on ways to join them on their journey. Listening to my patient from a person-centered perspective cures my need to solve everything for the patient. Many of them have the solutions and we are partners in discovering the road to those solutions. Even when a patient may be full of despair and feeling low, they continually express that they are more than a diagnosis. They are a person who has many influences that may greatly impact their illness experience. As their therapist, my role is to respect their desires and goals, and help them maintain optimal functioning in this
Medications are important part of patient’s life, in that without compliance or adherence to once prescribed medication, the patient’s disease will linger on and cause more complications in their body. Medication compliance is one of the most important topics discussed with the patients. Medication compliance has been described as the ability of the patient to follow correctly prescribed medication. Compliance of medication does not only point out prescription drugs but any therapeutic and medical equipment such as spacers, braces, crutches walkers among others recommended by the physician or nurse practitioner. Medication adherence also addresses the correct prescribed dose of the medication. Ideally, patients
The patient has also been suffering from frequent fevers in the past two months. He has also suffered from frequent headaches but has always taken painkillers (Bloland & Williams, 2003, p. 58). On fevers, the patient has frequently visited a local health clinic that has never done any diagnosis but has given medication, which reduces the fever.