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CLINICAL VIGNETTE...

Transcript: Symptoms: A rotator cuff tear is a common cause of pain and disability among adults in the US. Past History: History of present illness: CLINICAL VIGNETTE... Shoulder Tear rotator cuff Abduction A 70 year old female returns today for re-evaluation of her R and L shoulder. Her R shoulder is improving with phsical therapy. She does have some pain anteriorly. Her L shoulder is continuing to cause her severe discomfort and pain at night time primarily. Now, she has difficulty reaching, grasping, pulling, and pushing to the L shoulder. Her pain is worsend and at this time she would like to proceed with L shoulder surgery. Treatment Plan: 140 degrees 70 degrees 40 degrees 90 degrees Findings: Shoulder Motion is Restricted THANK YOU!!! There are different types of tears. Partial Tear. This type of tear damages the soft tissue, but does not completely sever it. Full-Thickness Tear. This type of tear is also called a complete tear. It splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon. 90 degrees Right Left Normal Take home points: Laboratory Findings: History of present illness: Name: Caradaga, Adelaide DOB: April 26, 1968 DOI: June 26, 2014 Claim Number: 000690-006258-WC-01 History of present illness: 70 degrees 40 degrees 90 degrees ICD codes: 726.13 (L Partial Tear Rotatr Cuff) 726.2 (L Shoulder Region DIS NEC) External Rotation The most common symptoms of a rotator cuff tear include: Pain at rest and at night, particularly if lying on the affected shoulder Pain when lifting and lowering your arm or with specific movements Weakness when lifting or rotating your arm Crepitus or crackling sensation when moving your shoulder in certain positions Laboratory Findings: 180 degrees • The minimal invasiveness of the procedure will allow for quicker healing when compared to more serious surgeries. • Arthroscopy allows for less scarring and scar tissue so that you will have better movement in your arm and shoulder. • You will be able to regain more use from your arm and shoulder when compared to living with the damage or inflammation that was hindering it. • Arthroscopic procedures cause minimal blood loss. This allows for less bruising and pain during recovery. Acute Tear If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder. There are definite benefits to choosing shoulder arthroscopy. Not only will you gain the benefits of a repaired shoulder, but also the arthroscopic procedure itself is much more beneficial than choosing standard types of invasive surgeries. Statistics/Evidence based practice: Let's start!!!! Arthroscopy remains the safest form of surgery in treatment of shoulder tear rotator cuff Several factors contribute to degenerative, or chronic, rotator cuff tears. Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well. Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body's natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear. Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear. 140 degrees 90 degrees 180 degrees ICD/CPT Codes: Past History: Case Study: Demographics Causes: CPT code: 29826 (L shoulder Arthroscopy with Subacromial decompression) Continue physical therapy for the R shoulder Home exercise program Candidate for L shoulder arthroscopy with subacromial decompression and debridement Requesting an Ultrasling, physical therapy 12 sessions post operatively and assistant surgical assist for the L shoulder A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem. A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do. Flexion Degenerative Tear Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder -- even if you

Vignette Group PowerPoint

Transcript: Chapter Vignettes Group 4 Summary Born Bad -Esperanza and her friends, Lucy and Rachel, start mocking famous people. The game then turns into mocking her Aunt Lupe, who is blind. Her aunt then dies that day and she is ashamed. She then says that her Aunt made an impact on her because she always listened and encouraged her to keep writing. Characters Characters Esperanza: main character Lucy and Rachel: childhood best friends Aunt Lupe: blind aunt Conflicts Conflicts Man vs Self: "Most likely I will go to hell and most likely I deserve to be there." pg. 58 In Born Bad (italics), Esperanza learns to treat everyone with respect. Theme Theme Throughout the Vignette, Esperanza realizes she should not mock other people, especially the one's she loves. "And then we began to dream the dreams." Pg. 61 Coming of Age Coming of Age Summary Four Skinny Trees She is looking outside the window with her sister at four skinny trees and realizes the beauty surrounding her Esperanza: main character Nenny: Esperanza's sister Characters Characters Man vs Self "When i am too sad and too skinny to keep keeping, when i am a tiny thing against so many bricks, then it is I look at trees" pg. 75 -Even though she might struggle, she should still keep going with her life Conflicts Conflicts In Four Skinny Trees (Italics), Esperanza learns to look for the beauty in life. Theme Theme She learns to continue on in life when something gets in her way. "Four whose only reason is to be and be" pg. 75 Coming of Age Coming of age

ACP Clinical Vignette 2013

Transcript: Mr. HH is a 55 year old disabled, single, Caucasian male who presents with: 5 day history shortness of breath dizziness non-productive cough CYP3A4 CYP2E1 D-dimer - 2.06 Normal WBC - 13.9 At discharge: Bridged on enoxaparin Warfarin Stop EtOH use Follow-up with anti-coagulation clinic EtOH Troponin x 1 - negative Feb 2008 - 1st UIHC ETC visit intoxication chest pain dyspnea Past medical history: Coronary artery disease with stent placement 2010 COPD Alcohol dependence Hepatitis C Increased Anticoagulation April 2010 unstable angina bare metal stent placed RCA "I don't plan on drinking any longer." Over the next 2 weeks, readmitted x 2 with: depressed mood poor sleep poor concentration rumination of his PE intense fear that he would die from PE or "bleed to death" prominent active suicidal ideation suicide attempt by overdose alcohol intoxcation 2012 Discussion By: Andrea Ryan Mentor: Vicki Kijewski Feb 2008 - April 2010 10 ETC visits for: chest pain and/or dyspnea intoxication 5 ETC visits for: anxiety and/or depression suicidal or homicidal ideation INR 6-8 at admission Restarted and discharged on warfarin Drug (ie warfarin, argatroban, rivaroxaban) Past psychiatric history: Diagnosed depression age 17 after brother's death 1 suicide attempt by cutting (meth intoxication) Multiple hospitalizations Unreliable with follow-up Significant Imaging Studies Thank you! Vicki Kijewski Ravneet Dhaliwal Overall, anti-coagulation treatment must be individualized based on risks and benefits of therapy. Ability to maintain safety Reliable outpatient monitoring Other medical co-morbidities Psychosocial stressors Risk and severity of possible depressive episode Drug Moderate consumption Significant Laboratory Studies Chronic alcoholic 2008 Cardiac: Elevated rate Regular rhythm No rubs, murmurs, S3/S4 1. Depression has been shown to significantly increase morbidity and mortality in patients admitted with acute life-threatening illnesses, such as PE. CT Angiography: "There is evidence of scattered pulmonary emboli in the left lower lobe. No evidence of pulmonary thromboembolic disease in the right lung. No right ventricular strain." Anticoagulation 4. Many short depression questionnaires are accessible for discharge evaluation and may reduce discharge medical complications and readmissions. Vitals: HR 130 RR 14 BP 137/99 Not orthostatic SpO2 88% on RA 3. In studies of depressed cardiac patients, improvement in depression was associated with improved self-reported adherence to medications and lifestyle modifications. "I would rather kill myself..." Decreased Anticoagulation Drug EtOH Increased Anticoagulation Arterial blood gas (on 2L): pH 7.42 pCO2 40 HCO3 26 pO2 95 April 2010 - Nov 2012 10+ ETC visits for: chest pain and/or dyspnea intoxication 6+ ETC visits for: anxiety and/or depression suicidal or homicidal ideation November 6, 2012 dyspea lightheaded diagnosed with pulmonary emboli Nov 15 and 20, 2012: intoxication depressed mood poor sleep poor concentration rumination over PE suicidal ideation with attempt 2. Rumination was an independent predictor for the incidence and severity of depression 3 months after acute coronary syndrome (ACS), regardless of baseline depression scores or cardiovascular disease severity. Social history: Navy, dishonorable discharge Currently disabled Iowa Lodge, alone EtOH and IV drug use history 2010 Lungs: Increased effort of breathing Distant lung sounds Clear to auscultation No wheezing Drug Physical Exam 5. Oral anti-coagulation treatment in the context of alcohol dependence is a high risk factor for hemorrhagic complications. References Bauer et al. Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients. Am J Cardiol 2012;109:1266 –1271. Denton, E.D. et al. Psychosocial vulnerabilities to depression after acute coronary syndrome: the pivotal role of rumination in predicting and maintaining depression. Frontiers in Psychology 2012; 289:1-9. Donze, J. et al. Risk of Falls and Major Bleeds in Patients on Oral Anticoagulation Therapy. The American Journal of Medicine 2012; 125: 773-778. Miller, C.S. et al. Meta-Analysis of Efficacy and Safety of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) Versus Warfarin in Patients With Atrial Fibrillation. Am J Cardiol 2012;110:453– 460. Prandoni, P. Anticoagulant treatment of pulmonary embolism: impact and implications of the EINSTEIN PE study. European Journal of Haematology 2012; 89:281-287. Silverstone, P.H. Depression Increases Mortality and Morbidity in Acute Life-Threatening Medical Illness. Journal of Psychosomatic Research 1990; 34:651- 657. Weathermon, R; Crabb, D. Alcohol and Medications Interactions. Alcohol Research and Health 1999; 23:40-54.

timeline powerpoint

Transcript: STRATEGIC PLANNING FOR COLLEGE(UNF) Place Your Logo Here Angelisia Guzman Dr. Walton 5b entrance or placement exams UNF requires an ALEKS Placement, Preparation, and Learning (ALEKS PPL) Assessment to determine readiness for College Algebra and higher level math courses. It is important to take this placement process seriously, as students will only be able to take the level of math the test score supports. All entering first-year students who do not have credit for College Algebra or higher and are pursuing a major that requires College Algebra or higher, must take the math placement test entrance or placement exams placement exam What went well The ALEKS math placement test is available to all first time in college students admitted to UNF who are signed up for New Student Orientation. Students must take the ALEKS test online before registering for any Algebra-based math courses. New first time in college students should take the ALEKS test before their scheduled orientation date so they are able to register for a math course while on campus for Orientation. The ALEKS math placement test is available through Canvas, which you can access through myWings. When in Canvas, select "All Courses", then "2019/2020 Freshman and Transfer Math Placement". Once in Canvas, please review the appropriate content and proceed with the exam when ready. other courses What didn’t go well To help you determine your first writing course at UNF, you should take the Writing Placement online through Canvas before attending your orientation. The UNF Writing Placement consist of 2 sections: (1) you'll watch a short video and then write a brief essay response and then (2) complete a short multiple-choice quiz on your writing and writing history. The quiz questions in Part 2 are in part based on your experience in Part 1, so where possible you should take both parts in one sitting. However, that is not a requirement. Once you've completed the placement in Canvas, your answers will generate a course recommendation. That information is what you'll want to bring with you to your orientation advising. Opportunities UNF provides a comprehensive student financial aid program. Aid eligibility is based on individual need, educational costs and availability of funds. Awards may consist of scholarships, loans, grants, waivers/exemptions and/or work study. Funds are limited; therefore, students are encouraged to complete a Free Application for Federal Student Aid (FAFSA), found at www.fafsa.ed.gov, as soon as possible after it becomes available online on October 1 each year using UNF's FAFSA school code- 009841. The priority consideration date for financial aid is October 15. application for federal financial aid Opportunity 1 Opportunity 1 Inquiries concerning financial aid should be directed to One-Stop Student Services. Please be advised that: If selected for verification, students may be required to provide signed copies of relevant income tax information. Dependent students may also be asked to provide signed copies of parent tax information. Independent, married students may be asked to provide signed copies of spouse tax information. Other information may also be requested to meet federal verification regulation requirements. Student-specific information about financial aid requirements can be found in myWings. To be awarded financial aid, a student must be accepted as degree-seeking and be enrolled in a sufficient number of degree-applicable credit hours. Courses taken in an audit status are not eligible for financial aid, nor can they be considered when determining enrollment for financial aid. For financial aid purposes, full-time enrollment is defined as a minimum of 12 credit hours per semester for undergraduate and post baccalaureate students and a minimum of 9 credit hours per semester for graduate students. Students who enroll less than full-time may have their awards reduced or, in some cases, canceled. Please be advised that certain scholarships and institutional grants require enrollment in 15 credit hours for eligibility. Opportunity 2 factors to think about when choosing your college Here are some of the top factors to consider when choosing a college. -Academic Majors Available. -Affordable Cost of Attendance. -Location, Location, Location. On-Campus Facilities & Amenities. -Student Activities. -Career Services. -Do You Feel at Home on Campus? Goals The University of North Florida offers scholarships for freshman and transfer students at the undergraduate level. UNF is committed to helping students finance their college education. Whether you are seeking a scholarship based on academic achievements or financial need, we offer plenty of options. Read through our advice below or click a link to the left for quick scholarship listings. scholarships and application procedures GOAL 1 Goal 1 High school seniors If you are a high school senior, you should apply for scholarships at the same time as you apply for admission. For GOAL 2

Clinical Assessment Vignette

Transcript: Clinical Assessment Alyssa Villa / UHV 5/2/20 Diagnosis Diagnosis George a 16-year-old male The Case of George The Case that I chose was about George, a 16-year-old male that has had multiple suicide attempts and substance use. He has used multiple substances (marijuana, LSD, etc) since 13. Ct has also had a 2 week history of depression and ended up in the hospital due to a suicide attempt while in a Juvenile detention center. He has had problems with his parents and principal. The Case of George Diagnosis After reading that Ct has used drugs since the age of 13 there are multiple drugs he has used during this time. When he is not using drugs, he is more productive. During the substance use he has attempted suicide, been in arguments and has been put in a juvenile detention center. He was put in a youth home, away from his parents. I have chosen the diagnosis of Substance Abuse Disorder after reading the DSM-5. Diagnosis Diagnostic Criteria Diagnosing George with Substance Abuse Disorder Diagnostic Criteria Deciding on Dx Deciding on the Dx Emotional/ Negative effects of substances. Depression Mood Changes Decreased appetite Decreased interest Suicidal thoughts Feelings of guilt Continued use of substance after consequences Using marijuana, LSD, non-opioid sedatives. Ruling out other Dx Ruling out other Dx Regarding other diagnosis, I was torn between a few. I believed that he displayed symptoms of depressive disorder. I also looked into Substance induced bipolar disorder. I felt that looking at the symptoms and the behavior he displayed, it made more of a connection to the Substance Abuse Disorder. I looked at the symptoms and felt that they established a connection to Sub Abuse. Specific Signs Beginning drugs at the age of 13 The signs of depression while using the substance. Behavior resulting in negative consequences while using the substance. Poor school behavior Lack of interest Withdrawn Specific Signs Children Vs. Adults Differences between Children & Adults Diagnosis verses adults Difference Difference There is a higher prevalence in drug use in the ages of 18-24, George is close to this age group. Marijuana, I saw a higher prevalence for male individuals that are from ages 12-17 With the adolescent range that George is in, he shows changes in his mood, energy and eating patterns that were listed in the DSM-5. Difference Cont'd . There are also social and school indiscretions that were noted as well. George shows behavior that relates more to the adolescent age group. Difference Continued Diagnostic Specifiers Diagnostic Specifier Additional symptoms Additional Specifiers Specifiers How long he went without the arguments with family or others Any signifier as to why he argues with his parents More about the length of his depression and the moods that he experiences What leads to the use of a substance. Any relation to suicidal thoughts

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