Transcript: IS IT POSSIBLE TO SEND THE PATIENT HOME AGAIN? Social Worker Nurses Delirium >7-10 days indicates possible Dementia (NICE,2013) --> return home questionable 82 y.o patient, griefs, is multi-morbid, and lives alone --> not the best indications The patient will need multidisciplinary assistance and have proper cognitive as well as physical functions. Help her with administrative work Coping strategy other legal & personal matters Diagnostic Process 1.)To have the patient out of the delirium. The CAM will be used to assess the delirious state. Within the given time of 4 weeks a delirium should subside and the patient is under medical supervision and receives treatment. 2.)To increase the patients range of motion in her shoulder to near full range. Using goniometry to measure improvements. The fracture showed no complications and the healing process should be almost done after 6 weeks. 4 weeks are enough to make the transition towards long term goals like muscle strength MRS. JOHNSON Description of Case Administering medication Surveillance of Delirium D Delirium + Subcapital humerus fracture Hypotheses: -shoulder contractures, -global atrophy, -inability to perform ADLs First assessment done in the hospital Shoulder function: AROM, PROM, MRC, VAS Functional capacity: Barthel index Short term goals: Decrease hyperlipidemia Weight-loss Decrease further complications (cardio-vascular, GI, etc) Long term goals: Occupational Therapist Integrated Care Case Report Presentation Case 2 Andreas Heck Kealan Cahalane Orla O'Mahony Nutritionist T OT Treatment to create safe living environment for individual living Nurse assist at home with some exercises also ensure safety Social Worker organize regular family check up on patient Possible: Permanent Nursing Home Relearning of everyday activities Help when possibly reintegrating her home M (Helping with) self-care Overall assistance Feeding if necessary Discussion 1)To increase the patients muscle strength in her shoulder to at least an MRC grade 4 in abduction, flexion, and extension. The patient receives daily treatments. There are no underlying conditions that would hinder her from regaining muscle strength in 4-6 weeks. 2)Prepare the patient to return home. Measuring her capabilities using the Bathel index, FES, TUG, MMSE. The patient should be able to return to her former level of health as she has no apparent incurable conditions. She was staying at home before injuring her shoulder. We aim to achieve this after 10 weeks. Doctors Diagnosis: Subcapital humerus fracture (6 weeks ago) Transferred to nursing home a week later. Delirium developed (5 weeks ago) Current problems: Confusion, disorientation, hallucinations, movement restrictions in shoulder Patient: Mrs. Johnson, 82 Housewife Widow lives alone at home
Transcript: Case Preparation 1st Visit 2005 Age 25, diagnose of Irritable Bowel Syndrome (IBS) Age 47, diagnose of Fibromyalgia Syndrome Age 55, diagnose of Osteoporosis Cholecystectomy, in 2010 No major traumas reported chief complaint of chronic nature -> important impact on her quality of life: pain and functional disability, source of psychosocial distress sense of disbelief and impotence Chief Complaint ID Number: 2955 Age: 55 Gender: Female Body type: Slightly endomorph Occupation: Housemaid since age 30 (before worked as an administrative) Social factors: Married, 2 children 2010 Superior Trapezius tension with occasional paresthesias on the 4th and 5th finger >10 years evolution Unable to quantify using Pain VAS --> "report being mild and sporadic" Occurs when lying down, improves with movement Motive of Visit Relevant Past History Quality of Life Impact Evidence Based Case Report Presentation Relevant Family History • Anagastra (1/24h) -> Proton Pump Inhibitors • Diazepan (1/24h) -> Benzodiazepine (taking it for 8yrs) • Tryptizol (1/24h) -> Antidepressant (taking it for 8yrs) • Bisoprolol (1/24h) -> Beta-blockers Secondary Complaint Flag System Categorization Pain at the lumbo-sacral region, centrally located Deep and achy. Pain VAS: 2-3/10 (when not in crisis) Occasionally radiation (thighs & abdomen) --> no dermatomal pattern defined Aggravating Factors: Standing Relieving Factors: Resting in D.D Patient Identification Medication Body Chart of reported pain There is currently a controversy on the effects of antacids on the risk of developing osteoporosis. Research suggests that long-term use of antacids can cause serious skeletal disability, as a result of calcium malabsorption in the body.
Transcript: Autopsy- The time of death was at 8:45 .a.m. Jimmy was born in Omaha, Nebraska for most of his life. Lately, he has been unemployed for some time, and recently got a job at McDonalds. He has recently been Case Report Presentation Suspects- Time of Death logan roberson,keegan cook,gregorya pratt,jay External examination found a single stab wound in his upper right quadrant of his abdomen. There was also evidence of trauma in the occipital lobe of the brain. Conclusion- The conclusion for this case is that Jimmy is not guilty, and that Timmy is the killer. Based off of the evidence from beneath Jim Bob's fingers, the DNA Evidence shows that Timmy was the killer. Basic Case Details On 10/5/05, at exactly 9:45 p.m., a body of was discovered in an Elevator. Mr. Jim Bob was found dead in an elevator. There are only two men who could have possibly been at the scene of the crime and had an alibi. DNA- There was some Skin Particles that were found beneath the victim's fingernail's. Under further lab analysis, CSI discovered that the DNA of Timmy was found beneath the Fingernail. add logo here
Transcript: o Pain Recommend painkillers o Fear Additional Questions Hypotheses o Kinesiophobia/fear of falling Education How to get up from floor How to fall properly o ROM Mobilizations Stretching o Inability to load upper body Education Adaptation Compensation • Unsafe transfers: o Muscle weakness o Coordination problems o Inability to load upper body o Decreased ROM o Kinesiophobia o No knowledge • Balance problems: o Lack of coordination o Muscle weakness o Pain o Fear • Decubitus • Cariovascular endurance Goals Improve transfers What are reasons not teach the patient how to fall? Case Report Presentation How likely is it that she will fall again? o Lack of coordination/balance Walk Standing on one leg Different surfaces Turning in place o Muscle weakness Decubitus Treatment Balance exercises Long Term Balance Endurance Short Term Transfers Muscle Strength Kinesiophobia Assessment • Timeframe • DHS/fixations • Type of fracture • Medication • HSQ • ADL’s • Falling mechanism • Comorbidities • Pain o Where o Severity o Course during the day o Development of pain Cardiovascular endurance How will the osteoporosis influence the treatment? Discussion questions • Transfers • Timed Up and Go Test • Tinetti • Tampa Scale • Falls Efficacy Scale • If necessary: breathing o Core stability Bridging Turn with a ball Nudge while sitting o Upper and lower extremity muscle strength Teraband exercises General information Multidisciplinary and integrated care • 2-3x/week, 30 min, • Group sessions • Homework exercises. • Find a hobby • Mental state • Coping strategy • Education • Other problems o Ribs o Shoulder o Breathing o Contractures o ROM • Decubitus Additional questions and Assessment What would be different in the healing process with a dynamic hip screw, as opposed to conservative treatment?
Transcript: Biography Margaret Floy Washburn Washburn used her experimental studies in animal behavior and cognition to present her idea that mental, not just behavioral, events are legitimate and important psycholigcal aread for study in her book, The Animal Mind. This went against the establishe ddoctrine in academic psychology that the mental was not observable so not appropriate for serious investigation. Beside her experimental work she also viewed a higher mental processes and how it's relates to physical movement. What Was Her Contribution? Is it significant and how does it relate to me? Psychology Report She was the leading American psychologist in the early 20th century. She published two influential books that most psychologist use. After graduation she was offered the Chair of Psychology, and worked there for six consecutive years. Yes her work is significant. It relates to me because she opened a door for me if I ever made the decision to major in psychology. Now I won't be denied that right just because I am a female. Born: July 25, 1871 In New York City, NY Impact: She was a leading American psychologist in the early 20th century. First woman to be granted a PhD in psychology. Second woman to serve as an APA (American Psychological Association) President. She is mostly known for her experimental work in animal behavior and motor theory developement. The Animal Mind covered a range of mental activities, beginning with the senses and perception, including hearing, vision, kinesthetic, and tactual sensation. The books' later chapter focused upon consciousness and higher mental processes. However, the dominant focus of the book is animal behavior. Washburn's motor theory argued that all thought can be traced back to bodily movements What brought about this research? By:Ayanna Shaw Early Life She was raised by her parents in Harlem and she was an only child. She was of English and Dutch descent. She loved to read so she was always advanced. She graduated at the age of 15. Due to her lack of Latin and French, she only gain prepartory status but began to have a strong interest in psychology. She also became a memeber of Kappa Alpha Theta sorority, and this was her very first encounter with the field of psychology. After this she became determined to study in psychology. Later on June of 1894, she gave her oral presentation, and became the first woman to receieve a PhD in Psychology. Resources: Died: October 29, 1939 in Poughkeepsie, NY due to a stroke "Margaret Floy Washburn (1871-1939)." Margaret Floy Washburn Biography. N.p., n.d. Web. 10 Feb. 2017. Pardon Our Interruption. N.p., n.d. Web. 10 Feb. 2017. "A Mead Project Source Page." Mabel F. Martin: The Psychological Contributions of Margaret Floy Washburn. N.p., n.d. Web. 10 Feb. 2017. THE END!!
Transcript: Timeline Roger's Trial Lexicography Sadistic Self Proclaimed Tendency to hurt others Evil Motives Relishes role of a killer Guilty Reason 1- Accomplice in murder Reason 2- Right hand man to the corrupt Reason 3- Psychiatric report Work Cited http://www.shmoop.com/lord-of-the-flies/roger-timeline.html Furtive Inner intensity of avoidance & secrecy Sadist True evil Submissive https://www.accessnorthga.com/detail.php?n=252320 Character analysis http://www.shmoop.com/lord-of-the-flies/roger.html http://icecreambloke.com/category/news/page/2/ Introduced as a furtive boy. Roger is the boy to suggest that they have a vote, rather than allow Jack to become chief automatically. Roger smashes the sandcastles of the three littluns: Henry, Percival, and Johnny. Roger follows Henry after the sandcastle incident and throws stones at him. Roger climbs the mountain with Jack and Ralph. Roger is there when Simon is killed. Roger sharpens a stick at both ends. Roger and Robert discuss Jack and how he is a “real chief.” Roger learns from Robert that Jack is going to beat Wilfred. Killed Piggy Rescued Investigators Report
Transcript: Case Study Report Naisthika Kumar Patient Background - 2 year old female child - No remarkable medical history - Born full term, no immunodeficiency Background How it started? - Fever of 39.8 - No rash,chills & convulsions - Ibuprofen was given - Fever rose to 40.3 - Had wheezing, SOB, coughed up yellow phlegm & slight runny nose Nov 10 What happened next? - Received an intravenous infusion of 0.14 g Zithromax and 120 mg rographolide as well as aerosol inhalation of 2 mg budesonide - Oral ibuprofen & acetaminophen - Persistent fever --> 40 Nov 11 What happened next? - Persistent fever, wheezing & SOB - Rash on torso & limbs - Light cough - Appetite improved, no N/V & convulsions Nov 12 Admission : Sent to an ER at first after which she transferred to the hospital Nov 13 What happened? 3 hours prior -Had a 15 minutes respiratory & cardiac arrest -Administered adrenaline 4 times -Treated with tracheal cannula & mechanical ventilation Patient's Physical Condition: During -No spontaneous breathing -Absent pupil reflex to light -Deep comatose state On arrival : - ECG done - Bloody fluid visible in indwelling GI decompression tube In current hospital *CSF refused* Diagnosed with : brain hernia & acute CNS infection Brain CT Extensive brain swelling Decreased brain parenchymal density Narrowed cerebral ventricles and cisterns Chest P/A Fuzzy Coarse bilateral lung markings Visible small patchy shadows in right inferior lung & a clear pulmonary hilus Routine CBC -Blood-gas analysis showed metabolic acidosis (treated with sodium bicarbonate) -Presence of bacterial infection, administered vancomycin & meropenem -Immunoglobulin given for immune support What else? Doppler US showed patient’s anterior and posterior cerebral circulation which corresponded to the diagnostic criteria for brain death Nov 15 Outcome - patient proceeded to develop multiple organ failure & couldn't tolerate spontaneous breathing - patient's guardian stopped treatment Nov 17 Lab Tests Differential Diagnosis - Herpes and pulmonary edema - High pathogenic influenza virus infection - Fulminant myocarditis Let's Discuss! What is the relevance? RSV RSV is the major cause of lower respiratory tract illness in children mostly <2 y/o - Causes up to 80% in infants <1 y/o - In most cases, virus not fatal - Most severe infections & well-defined high-risk groups: infants with - a history of premature birth - chronic lung disease - congenital heart disease - cystic fibrosis - immunodeficiency Most children with RSV infection were previously healthy, and it is often difficult to predict deterioration of RSV infection Mechanism In this case RSV-related encephalitis usually develops within 1-2 days after onset of clinical symptoms, such as high fever, cough, & fatigue. However, the mechanism underlying the rapid progression of related encephalitis remains unclear. Possible causes: -CNS infection -coinfection with bacteria -dysfunction of host immune system
Transcript: Boxes which need to be modified: -Professor/a: Depending on the gender modify it and just add your name. Watch out! There are two boxes!! -Nivell ( level) : Write down the level they are doing. -Participant: You have to write down name and surnames. -Terms: Fill in the correspondent term. It is really easy, you just have to follow certain steps. If you do not follow them, we will send back your student's reports for you to modify them. -There are two main parts: Term evaluation and comments. Every term you will have to fill in with their marks, leaving the previous ones. - Interacció ( interaction): if the participant interacts / participates . There are 4 possibilites: Ok, Good, Very Good or Excellent. -Writings: Pass or Not pass. -There is no average mark! Therefore, participants will see how they are doing in each skill. They are adults. In the comments section is where you have to write down your opinion. Report templates Acadèmia Formate -Reports have to be sent to the language school in advance. We have to check for spelling mistakes, appropiate comments and translation. - Send a whole group in a file. -Every year , we have to modify reports and Ferran and myself have to rush up because teachers do not pay attention. That is why, we will send back anything not been appropiately filled. - Translations have to be done for minors. So, their feedback must be in English and Catalan/ Spanish. -First / advanced students do not have reports! -Write down as well when we are coming back in the comment!!! At the bottom of the sheet, modify: Professor o professora (depending on the gender) and date. -Once we print the reports, you will have to sign them. -Exams have to be handed in in reception as well. Children's template: The format is different. -You grade your pupils according to their abilities and evolution throughout the term.
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