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Case of heart failure
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SUBJECTIVE This 89-year-old lady is seen at MCCRC on 03/28/2017. She was admitted here from Johnson City Medical Center on 03/23 after her second hospitalization for acute on chronic heart failure and a respiratory infection. She was sent home but instead of to a Rehabilitation Center when the family felt they could care for her then they could not get her out of bed. She has early dementia and much of her history is difficult to obtain, although she says that I had seen her mother some 30 years ago and prefers to talk about that era. She says she has never smoked. Her present medications at this facility include spironolactone 25 mg daily, a multivitamin, calcium, vitamin D, and vitamin K. She is on glucosamine. She is on citalopram …show more content…
Her blood pressure earlier is 130/70. Her heart rate is irregularly irregular at about 115 beats a minute, SpO2 on two liters is 96, although her respiratory rate is 26. Temp is normal. Head, eyes, ears, nose and throat reveal no abnormalities. No temporal artery tenderness. Neck is supple. I see no JVD. I hear no carotid bruits. There is coarse rhonchi and wheezes bilaterally. I do not hear a rub. Consolidation is not well heard. Heart rhythm is irregular regular. PMI is displaced lateral on mid clavicular line. Abdomen is soft and nontender. The low ribcage impacts on the superior iliac crest bilaterally. No organomegaly is detected. There is a midline scar. There is trace ankle edema bilaterally and no calf tenderness. Peripheral pulses are reduced. ASSESSMENT 1. Chronic atrial fibrillation. 2. Acute on chronic congestive heart failure. 3. Influenza A, recently diagnosed with ER visit over the weekend. 4. Chronic cognitive impairment, etiology unclear, possibly vascular. PLAN Will continue the present medications. We will watch carefully for bleeding problems. Will continue with physical therapy efforts to get her back on her feet. She may need further medication for controlling heart
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
Thank you for referring Gentian Balashi, a 37-year-old gentleman of Albanian origin who immigrated to Australia 18 year ago. Gentian is a current smoker of 10-15 cigarettes per day and in total has smoked for five years. He works as a farmer and keeps pet dogs. His only regular medication is Nexium.
- If all of the options were explored, and patient is given antibiotics and is treated without any pain or suffering than the treatment identifies with the ethnical principles of autonomy, non-maleficence, and veracity. In turn, Mrs. Dawson will be happy with the outcome of the procedure.
Case conceptualization and treatment planning is used by therapist to assist in determining a client’s diagnosis, goals, and treatment plan that is most effective in determining the issues surrounding the clients diagnosis. It is crucial that the client’s treatment plan is specific to the individual, is relational and appropriate to the needs of the client.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Jenny is a 32-year old Caucasian female who reports that she currently lives in Vincennes, Indiana. Jenny reports that she is seeking services because her friends have encouraged her to talk to a therapist. She reports of experiencing anxiety like symptoms when she is in congested areas. Jenny stated that this is her first time seeking services. She mentioned that she has had no previous issues like depression, or anxiety. Jenny stated that she has missed work because of her symptom like panic attacks, however she is not in the position of losing her job.
Ms. Swicegood arrived early to her apartment accompanied by her father. She appeared her stated age of 20 years old. She was well groomed wearing casual clothes, blue shorts, plain T-shirt and sneakers. Her height is 5’2” and weight 116.6 LB. The client’s father said that at times she is argumentative however, there was no sign of this behavior during the interview. She presented cooperative and distracted at times. Her ears were pierced but she had no tattoos or scars. She denied the use of alcohol, drugs or cigar. The interaction between the client and her father was active and
Rebecca is a 31yo G2 P1001 who was seen for an ultrasound evaluation and FTS. She overall denies any major medical disorders other than she is hypothyroid and on replacement therapy. She also has a history of a LEEP procedure but that occurred in 2012. She did have a full-term delivery over 2 years later that went to 39 ½ weeks with an 8 lb 12 oz infant. Overall on today’s assessment, she has no complaints.
[Name] returns. The last time we saw her she was admitted for chest pain, and T-wave inversions. The T-wave inversions were old, but they did evaluate her for pulmonary embolism, and also cardiac causes. She did have a CTPA protocol, and a nuclear stress test; which were satisfactory. She did have a slight heart murmur, and I asked her to follow up with me again.
Trachea is midline. Thyroid nonpalpable, not tender. Carotid arteries 2+ and = bilaterally; no bruits.Respiratory Rate is 18, even, unlabored respirations.Breath sounds clear in all areas.S1, S2 auscultated over aortic, pulmonic, erb’s point, tricuspid and mitral areas. Pulse rate 80. Radial 2+. Brisk Cap refill.KO is alert and oriented x3(person,place, time).Responds appropriately to verbal stimuli; no slurring of speech. Grips, flexion, extension strong bilaterally.Abdomen firm and round. Skin smooth with no lesions. Bowel sounds x 4. General abdominal tenderness reported. Reported last BM was formed this morning.Full ROM, no pain in neck, arms and legs. Able to maintain flexion against resistance and without tenderness. No redness, cyanosis,edema or varicosities in the upper and lower extremities. No calf tenderness. All peripheral pulses present, 2+ and =
It seems that your encounter with M.L. was a interesting one. I must say that living to 100 years of age is nothing less than remarkable. She definitely should be allow to eat and do whatever she likes. She seems like a quiet lady with , no-nonsense having demeanor. At times when we as healthcare providers want to make ourselves comfortable with the strangers that we are just meeting we have to be mindful in the way we do it. Some joke, giggle or use terms of endearment like, "sweetie" or "honey" or "doll". This is not approrpriate and is not always appreciated by the patient. It is important to know that most of the patients we will be providing care for are from another generation. What we do during this modern
Based on the medical report dated 12/07/16 by Dr. Sunadresan, the patient presents with increasing back pain, radiating to both knees. Past medical history is significant also for hypertension, for which she takes lisinopril. She also takes Tylenol with codeine.
Again since she is coming to us as clinicians with a diagnosis; and we know that there recurrence, one can consider safe to start treating this patient with this initial diagnosis. However, there should be several sessions of therapy, lab test, and reviewing her health’s history before, one can prescribe any medication.’
1. Yes, I think that the girls took a substantial step toward killing their teacher. The girls already had an entire plan, and they were working on following through with that plan. To me, that sounds like a substantial step. Our textbook says a substantial step is, “Significant activity undertaken in furtherance of some goal” (Schmalleger & Hall, 2014, p. 99). Bringing the poison to school is a significant activity that was supposed to help them reach their goal of killing their teacher. Before the court ruling, Tennessee court followed the Deputy rule to determine if someone had taken a substantial step toward committing a crime. Still, the court determined that this test should be abandoned. As an alternative, they created a new test to figure out if a substantial step had been taken. With this new test, they concluded that if “an actor possessed materials to be used in the commission of a crime, at or near the scene of the crime, and where the possession of those
This case study aims to provide insight into the principles of establishing disciple and creating an effective learning environment as a day-to-day casual primary school teacher. This response will outline the problems of practiced conveyed in the case study and display the applied solutions to assist the learning environment. Theoretical perspectives will be identified and links will be made between theory and practice. Alternative, evidence based solutions to the problems stated in the case study will also be identified.