...referred this file for medical case management. Instructions were given to meet with Connie Rae Blakeslee-Perez and assist with coordination of appropriate and related medical care, and identify needs to facilitate recovery. INTERVIEW SETTING On 5/8/17 I spoke at length with son Joshua. He has limited information regarding his others medical health or providers. On 5/9/17 I met with Ms. Perez and her husband at Hurley Medical Center. Ms. Perez is alert to her name. She is non verbal. Ms. Perez has a trachea placed with oxygen support and is unable to speak. Ms. Perez is bedbound and dependant on staff care. Mr. Perez signed and read the Michigan Case Management consent form. He reports their son Joshua is the contact. I was told that Joshua was not available for several days. Mr. Perez has limited medical information regarding his wife. MEDICAL FACTORS...
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...This file is now being closed as Mrs. Schaefer has returned to her pre-injury status. The adjuster has review documentation and case management can close the file. SUMMARY Mrs. Schaefer was a restrained driver who was involved in a motor vehicle accident. Mrs. Schaefer rear-ended another vehicle and recalled having front-end damage and EMS. Mrs. Schaefer did have a positive LOC at the scene and was transported to the nearest hospital, which was Beaumont Botsford. Mrs. Schaefer recalls being evaluated by several physicians and having diagnostic testing. Upon arrival to the Emergency room (ER), her GCS (Glasgow Coma Scale) was 15. In the ER, Mrs. Schaefer reported neck and back pain, she had a 10cm superficial laceration to her right hip, left...
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...Running Title: Acute posterior sternoclavicular fracture-dislocation in a 10-year-old boy Authors: Joseph Y. Choi, MD, PhD, Devin P. McFadden, MD, Vipul N. Nanavati, MD Corresponding Author: Francis G. O’Connor, MD Introduction A 10-year-old male was referred to the office after falling onto his left shoulder while playing football. At presentation, he denied any numbness, tingling or loss of sensation of his left upper extremity. Examination of his shoulder girdles revealed an internally rotated left shoulder and shortened clavicular distance. He did have a visible deformation of his left clavicle when compared to the contralateral, uninjured side and had excruciating pain to palpation of the clavicular and sternoclavicular area. The patient had full flexion and extension at the elbow. Shoulder deltoid was intact as were internal and external rotation of his shoulder. Furthermore, the patient denied being short of breath, feeling dizzy, or with difficulty swallowing. Radiographs of the left clavicle and sternoclavicular joint (SCJ) at the initial visit were remarkable for a posterior dislocation of the clavicle. A magnetic resonance imaging (MRI) study of the left clavicle and SCJ revealed that it was posteriorly displaced and edema was present at the fracture site. The physeal attachment to the manubrium was intact. Furthermore, the anterior portion of the clavicle was abutting the brachiocephalic and left subclavian vein (Figure 1). ...
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...This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. A 63-year-old woman presents with a 2-year history of progressive weakness and discomfort in her right shoulder, especially when she puts dishes on the top shelf in her kitchen. She is otherwise healthy and has had no injuries. Her physician diagnosed “bursitis” and gave her four subacromial corticosteroid injections; the first two seemed to relieve her symptoms temporarily, but the last two were ineffective. Physical examination reveals some atrophy of the muscles of the right shoulder and weakness when her right arm is elevated. Magnetic resonance imaging (MRI) reveals a large defect in the rotator cuff. How should her case be managed? The Cl inic a l Probl e m From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle. N Engl J Med 2008;358:2138-47. Copyright © 2008 Massachusetts Medical Society. The rotator cuff is a synthesis of the capsule of the glenohumeral joint with the tendons of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles (Fig. 1).1 The rotator-cuff mechanism precisely centers the humeral head by compressing it into the glenoid concavity. The individual muscles of the cuff help to provide strength in arm movement: the subscapularis in...
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...For facilities without neurosurgical coverage, prearranged transfer agreements with higher-level facilities should be in place. Consultation with a neurosurgeon early on the course of treatment is strongly recommended. The GCS score is used as an objective clinical measure of the severity of brain injury. A GCS score of 8 or less has become the generally accepted definition of coma or severe brain injury. Patients with a brain injury who have a GCS score of 9 to 12 are categorized as moderate, whereas individuals with a GCS score of 13 to 15 are designated as minor. In assessing the GCS score, when there is right/left or upper/lower asymmetry, it is important to use the best motor responses predictor of outcome. However, recording the actual response on both sides of the body, face, arm and...
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...remained untouched, much to the delight of the excavators. According to reports, tomb II held the remains of two individuals: a man and a woman. The debate in this issue lies in the identities of the remains found. Most theories and reports derived from extensive anthropological and archaeological analysis, suggest that the male remains are that of King Phillip II of Macedon, the predecessor and father of Alexander the great and his seventh wife Kleopatra, adversely numerous articles contend this, stating that the remains actually belong to his other son King Phillip III Arrihadeus and his spouse Eurydice. The most commonly employed technique used in the quest to determine the identity of the bones found in Tomb II, was the anthropological study of the bones. As mentioned above, there were two remains identified in Tomb II, the first being found in the main chamber (Chamber II) wrapped in a gold and purple cloth and entombed in a gold larnax, decorated by a gold wreath depicting myrtle leaves and acorns, the skeleton found was almost complete and is generally accepted to have belonged to a 35 to 55-year-old man, who had a height of about 167.3 cm to 168.9 cm (Musgrave, 1991, 16). These findings satisfy both the age of death requirement for Phillip II and Phillip III. The second set of remains were also found in a similar fashion, but instead in the antechamber of the tomb, wrapped in a purple and gold cloth and entombed in a gold...
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...Case Studies #1: Mr. MacPherson Mr. MacPherson came into the ER with burns on both of his arms and hands and on his face as the result of a grease fire in his kitchen. He complained of severe pain. His burns showed signs of blistering, swelling and fluid loss. According to the “rule of nines” (Thibodeau & Patton, 2010), it appears this patient has suffered burns over approximately 14% of his body surface (4.5% for each arm and 4.5% face for a total of 13.5%). These would be classified as second-degree burns (“Types of burns”, 2012) which involve the first two layers of skin and show signs of pain and blistering of which Mr. MacPherson complained. As a note of comparison, first-degree burns involve the top layer of skin, such as in sun-burn, and show signs of reddening, painful to touch, and mild swelling. Third-degree burns penetrate the entire thickness of skin and permanently destroy tissue layers, resulting in skin that is dry and leathery, appearing charred or having patches which appear white, brown, or black. Remarkably third-degree burns are often painless, although pain may be caused by patches of first- and second-degree burns which often surround third-degree burns (“Types of burns”, 2012). Case Studies #2: Margie Margie, who plays center on the women’s varsity basketball tem, complains that her knee is very sore and she felt a “pop” during a scrimmage tumble. Her knee, the largest and most vul-nerable joint in her body, buckles under her weight. ...
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...QAT TASK 1 Soap Note on patient SM Name Institution affiliation Soap Note on patient SM Patient initials: SM Sex: male Race: white Marital status: single Occupation: Student Source of information: the patient gives the information and he seems reliable. Problem Statement “I am here for a physical test on my right ankle. The ankle got sprained two days ago while I was playing soccer with some of my friends in the football pitch. One of them accidentally hit me. I did not make an earlier visit because I thought the effect was minimal and it would disappear after some time. The pain has been got worse over the last days and most especially during the night.” Subject HPI: A 22 white male came for a physical test on a sprained right ankle. The patient states that he is usually in good health. The patient denies case of diarrhea, and hemorrhoids. He denies instances of chest or abdominal pains. The patient denies instances of nausea. The patient claims that he has lost minimal weight over the past six months. Pertinent Medical Information Patient denies chronic medical conditions. The last exam for dental and eye were both done in year 2014. Current Medications OTC Ibuprofen, 200 mg PO prn ankle pain and Tylenol 1-4/month for headache. The patient should take no prescription medications, supplements or vitamins. The Cholesterol level is low according...
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...Case Study Ms. J. O. is an 82 year old female with a variety of comorbidities including Alzheimer’s type dementia. She is a resident of a dementia unit of a local assisted living facility. She was brought in to the hospital for a fall from which she stated she had hit her head but never lost consciousness. On arrival to hospital she was noticed to be very confused with complaint of back pain, chest pain but alert. After a short period of time her GCS abruptly dropped to 3 requiring intubation. CT scan of her head showed no bleeds, strokes or abnormality. All lab values were within normal limits and her blood pressure was mildly hypotensive 93/55. Past medical history 1. Ms. J.O. has had numerous falls recently requiring multiple emergency room visits. Each visit also showed evaluation of altered mental status over her normal state of being. On one fall she suffered a pelvic fracture, sacral fracture and L2-3 fracture. Another fall she suffered a nasal bone fracture. She was treated for pain control for each visit and then returned to assisted living facility. Per family she has been at her facility for about a week before this fall. 2. 3. Type 2 diabetes 4. Ulcerative colitis 5. Anxiety/Depression 6. Hypothyroidism 7. Osteoarthritis 8. GERD 9. Alzheimer’s type dementia 10. Stroke 11. Peripheral neuropathy 12. Chronic back pain from falls 13. Hypertension 14. Knee surgery 15. Cataract surgery 16....
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...friends at an amusement park, talking and laughing while waiting in line to ride a rollercoaster. One friend tells the other that she does not feel well. She looks pale. Suddenly, she falls to the ground. If her friend knows what to do, she may be able to prevent further harm to her friend, or even save her life. First Aid In many cases, emergency care may require some form of first aid. In a best-case scenario, emergency care is performed by an emergency care professional. However, in some cases, emergency care procedures are required before a professional can arrive on the scene. For this reason, it is important that the general population and, more importantly, all health care workers know how to perform emergency care. Agencies such as the American Red Cross and the American Heart Association train people to perform these life-saving procedures. Top of Form Question # 1 An emergency situation occurs when a person suddenly becomes ill or is injured and requires an immediate medical response. • [pic]True • [pic]False [pic] Correct Answer. Bottom of Form Top of Form [pic][pic] [pic][pic][pic] Question # 2 In a best-case scenario, emergency care is performed by whom? • [pic]An emergency care professional • [pic]The general population • [pic]A health care worker • [pic]All of the above [pic] Correct Answer. Bottom of Form Effective First Aid Providers To be an effective first aid provider, an individual should understand some...
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...and calcification of tendons. The other factor is called extrinsic factor which means coming from the outside. Some of the factors considered extrinsic are injury from accidents, falls and too much stress on the shoulders as a result of different movements involving exertion (Bilal, 2013). The injury is frequently associated with athletes who move their arms above the head in a repetitive manner like pitching, swimming, tennis and weight lifting (Wells, 2013). Paul’s occupation which is carpentry work and the repeated pitching and lifting of the ball during the rugby game eventually contributed to the irritation of his tendons from excessive pressure on the acromion process or bony knob of the shoulder. This also resulted to the swelling of bursa which is the lubricating sac between the tendons and the bones from subsequent rubbing against the acromion. Consequently, the shoulder becomes painful and if left untreated can lead to a tear in the rotator cuff and eventual injury to the shoulders (NMA News Direct, 2011). Predisposing Factors: Carpentry (repetitive lifting and pushing or pulling of the shoulders) Repeated arm rotation from pitching and passing of rugby ball Tendons tend to move in tight spaces. Continuous irritation of tendons and swelling of bursa (lubricating sac between the tendons and bones) If left untreated, may lead to rotator cuff tear. Figure 1: Pathophysiology of Rotator Cuff Tear based on Paul’s Condition....
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...Acquisitions Editor: Crystal Taylor Product Managers: Kelley A. Squazzo & Catherine A. Noonan Designer: Doug Smock Compositor: SPi Technologies First Edition © 2011 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street Baltimore, MD 21201 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the abovementioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market street, Philadelphia, PA 19103 USA, via email at permissions@lww.com, or via website at lww.com (products and services). Library of Congress Cataloging-in-Publication Data Lambert, Harold Wayne, 1972– Lippincott’s illustrated Q&A review of anatomy and embryology / H. Wayne Lambert, Lawrence E. Wineski ; with special contributions from Jeffery P. Hogg, Pat Abramson, Bruce Palmer. — 1st ed. p. ; cm. Includes index. ISBN 978-1-60547-315-4 1. Human anatomy—Examinations, questions, etc. I. Wineski, Lawrence E. II. Title. [DNLM: 1. Anatomy—Examination Questions...
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...PATHO Exam 3 Study Guide * Define KEY WORDS (terminology) listed in the syllabus * Answer the OUTCOMES in the syllabus as if they are questions * Review all Activities, Games, extra videos, journal articles, etc. posted in course contents * Review the handouts from class: case studies, matching, charts, etc. Normal Values | Intracranial pressure | 5-10 mm Hg | Blood glucose | 70-130 | Hgb A1c | <5.7% | Thyroid levels | | Parathyroid levels | | Types of bone cells | Osteoblasts | Bone forming cellsThey are responsible for bone growth and repair | Osteocytes | Osteoblasts that have become trapped, imprisoned within mineralized bone matrix (MATURE BONE CELLS) | Osteoclasts | Reabsorb or remove bone during growth and repair (also assist in the release of calcium and phosphate)**bone reabsorption; bone destroying cells | *So, if one is immobilized then the osteoclastic activity is greater than the osteoblastic activity in bone marrow decreases. This is why we have debone mineralization during immobilization. Maintenance of bone integrity | This occurs through remodeling and it is a 3 phase process where existing bone is resorbed and new bone is laid down [repairs bone, does not heal bones] | Phase 1 | Activation phaseThis is where a stimulus occurs, such as a weight baring exercise, causing the formation of osteoclasts | Phase 2 | Resorption This is where osteoclasts form a cutting zone and resorb or remove bone | Phase 3 | Formation...
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...Restorative Care Training for the Certified Nursing Assistant Trainer Manual TABLE OF CONTENTS Introduction Making the Most of the Training Making the Most of the Lesson Plans Making the Most of the Activities Trainer Preparation Welcome Module Activity T1 Welcome to the training Activity T2 Common Rules to Follow Activity T3 Successful Completion Activity T4 You will learn Trainer Preparation Module one Module one Trainer Preparation Module two Module two Trainer Preparation Module three Module three Trainer Preparation Module four Module four Appendix A Feeding Assistance Appendix B Fall Prevention Page T3 Page T3 Page T3 Page T4 Page T5 Page T7 Page T7 Page T8 Page T8 Page 7a Page 8 Page 27a Page 28 Page 35a Page 37 Page 104a Page 105 Page 114 Page 123 T2 Restorative Care; Training for the Certified Nursing Assistant Introduction Welcome to the program Restorative Care. This is the trainer manual used by trainers to teach nurse assistants and home health aides about caring for the person with Restorative issues. This manual accompanies the student manual, Restorative Care. This training is activity based. Participants are encouraged to share in the training process, to talk about relevant experiences if they choose and to ask questions. Making the Most of the Training Program Use this training manual as a guide for training individually or in groups. If you train on an individual basis it will be more effective to brainstorm with them than to use the...
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...Case Study for Final Exam Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. The name myasthenia gravis, which is Latin and Greek in origin, literally means "grave muscle weakness." With current therapies, however, most cases of myasthenia gravis are not as "grave" as the name implies. In fact, for the majority of individuals with myasthenia gravis, life expectancy is not lessened by the disorder. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Certain muscles such as those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder. The muscles that control breathing and neck and limb movements may also be affected. Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction - the place where nerve cells connect with the muscles they control. Normally when impulses travel down the nerve, the nerve endings release a neurotransmitter substance called acetylcholine. Acetylcholine travels through the neuromuscular junction and binds to acetylcholine receptors which are activated and generate a muscle contraction. ...
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