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Medical Case Report Presentation Template

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Case Report Presentation

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

Case Report Presentation

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.

Medical Case Presentation

Transcript: Boulanger David medicine student Medical case presentation Identity Identity Name: Johnson Forname: William DOB: 24th September 1979 Occupation: Teacher (school director) Social status: Married Child: 2 (girl: 12 boy: 8) Live in: Grenoble (France) Symptom(s) Symptom(s) - Dizziness - Headache - Muscle aches - Insomnia - Nausea and vomiting - Irritability - Loss of appetite - Swelling of the hands, feet, and face - Rapid heartbeat - shortness of breath with physical exertion - Coughing - Chest congestion - Pale complexion and skin discoloration - Inability to walk or lack of balance - Social withdrawal Family history (FH) Family history (FH) TIME FATHER: myocardial infarction (67) MOTHER: Diabetes (32) Siblings: NAD Past medical history Past medical history TIME appendectomy (14) tonsillectomy (15) withdrawal of wisdom teeth (18) Broken leg (23) Social history (SH) Social history (SH) TIME Walking Trekking Climbing Swimming Skiing Examination (O/E) Examination (O/E) examination (O/E) examination (O/E) Weight: 70 Size: 1.75 Weight: 70 Size: 1.75 BP: 140/80 BP: 140/80 P: 180 P: 180 Respiratory frequency 20 / Min Respiratory frequency 20 / Min P02: 92% P02: 92% T: 37.5°C T: 37.5°C DIAGNOSIS DIAGNOSIS Acute Mountain Sickness (AMS) ? Acute Mountain Sickness (AMS) Treatment Treatment Medications : acetazolamide, to correct breathing problems blood pressure medicine lung inhalers dexamethasone, to decrease brain swelling aspirin, for headache relief Other treatments Lower altitude Lower altitude At rest At rest Water Water

Medical Case Presentation

Transcript: O God, that men should put an enemy in their mouths to steal away their brains! That we should with joy, pleasance, revel, and applause transform ourselves into beasts! William Shakespeare (1564-1616) British poet and playwright. 48 year old Caucasian female "My stomach is really hurting" HPI 48 y/o lady with a PMH of alcoholic liver cirrhosis, and esophageal varices "My stomach really hurts" She's been having abdominal pain for the past 6 days. Describes the pain as dull (constant and diffuse) 8/10 in severity starting from the epigastrium moving to the lower part of the belly. She feels relief when she lies down and worse sitting up. She also mentions that she noticed gradual distention of her belly for the past three weeks. She denies any nausea, vomiting, weight loss, or fever but notices some swelling in her left leg. In addition, she has recently been experiening some shortness of breath. She has dyspnea on exertion but denies orthopnea and paroxysmal nocturnal dyspnea. Of note, she mentions that she had similar belly pain 2 weeks ago which was associated with episodes of bloody vomiting. She went to Eastern Shore Hospital, admitted for upper GI bleed, underwent a panel of tests that included an endoscopy, ultrasound, and ascitic tapping and diagnosed with liver dx. She also mentions that she felt a lot better after that and hoped to get tapping done at SAH. Past Medical History Alcoholic liver cirrhosis Grade one esophageal varices Anemia Hx of thrombocytopenia Anxiety disorder GERD Cholecystitis Alcohol abuse Past Surgical History Rhinoplasty Allergies Acetaminophen (rash) Oxycodone (nausea) Medications Propanolol 10 mg po BID Pantoprazole 40 mg po BID Lactulose 15 mg po Qday Spironolactone 25 mg po Qday Sertraline 100 mg po Qday Clonazepam 1 mg po BID Review of Systems General: Muscle weakness, fatigue, and chills HEENT: No headaches, vision change, hearing changes, sinus troubles, bleeding gums, swollen glands Cardiac: No chest pain, palpitations Resp: Cough (non productive) and wheezing Breasts: No lumps, pain, nipple discharge GI: per HPI GU: No trouble urinating, no pain on urination, no hematuria, LMP was three years ago Extremities: per HPI Skin: No rashes, lesions, or color changes Endocrine: No heat or cold intolerance, excessive thirst or hunger Neuro: No seizures, numbness, or tingling Hematologic: No easy bruising or past transfusions Physical Exam 99.0 T 76 P 18 RR 115/60 BP 97% on 2L nasal cannula Weight: 70.307 kg General: Middle aged lady, in obvious pain but no acute respiratory distress, alert and oriented to person, place, and time. HEENT: Scalp normal, pupils equally round and reactive to light and accomodation. Fundoscopic exam reveals normal vessels, tympanic membranes are normal, oral pharynx is normal, neck is supple, no abnormal adenopathy in cervical or supraclavicular areas, thyroid is normal without any masses. Cardio: No murmurs/rubs, heart sounds S1 and S2 are present. Resp: Decreased air entry over the rt lower lung field, some expiratory wheezing bilaterally. GI: The abdomen is distended and bulging at the flanks but not tense, diffuse tenderness to palpation exquisitely over the epigastrium, Murphy's sign not present, bowel sounds are present, positive for shifting dullness, liver palpable 2 fingers below the subcostal margin, unable to appreciate exact size of liver or any splenomegaly MS: No cyanosis, clubbing, or edema noted. Peripheal pulses in the dorsalis pedis, and radial arms are normal. Skin: Multiple spider angiomas over subclavicular region, face and shoulders Neuro: Alert, oriented x3, CN II-XII intact, power 5/5 all extremities. March 10: Hypoxic requiring 100%FIO2 and PEEP of 12. March 11: Breathing improving requiring PEEP of 5 and FiO2 of 40%. Renal function improving with the CVVHD March 12: Breathing treatment the same, worsening encephalopathy, sedated but arousable, does not follow commands this am, eye opening present. CT of abdmn showed mild ascites, possible ascending colitis. Displaying multiorgan failure. March 13: Family decides to change code to DNI/DNR and request pt to be extubated with pastoral services present. March 14: Pt displays agonal breathing, no longer arousable. On morphine drip for pain. March 15: Worsening agonal breathing, no longer arousable. On morphine drip for pain. March 16: Pt passes away at 6:21pm. SBP Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection in the peritoneum and severe consequence of ascites. Patients with cirrhosis who are in a decompensated state are at the highest risk of developing spontaneous bacterial peritonitis. Patients at greatest risk for spontaneous bacterial peritonitis have decreased hepatic synthetic function with associated low total protein level or prolonged prothrombin time (PT). The diagnosis is established by a positive ascitic fluid bacterial culture and an elevated ascitic fluid PMN count >250 cells/mm3 SBP Fever and chills occur in as many as 80% of patients.

Case Report Presentation

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?

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