CC: Dyspnea. History of Present Illness: Mr. Hebert is a very pleasant 60-year-old gentleman who was referred from the Naval Shipyard clinic for the evaluation of dyspnea. At the present time, Mr. Hebert feels well, however throughout most of the summer, he stated he had been complaining of a persistent cold that manifested primarily with nonproductive cough, plus and minus wheezing but was most disturbed by his conversational dyspnea. He was prescribed Advair and found near immediate relief within three to four days.
Case Presentation A 58-year-old presented with complaint of pain in his leg and was unable to walk. Past history. • One year back, he fell from a ladder and suffered a left acetabular fracture.
Activities Daily living Robinson has significant limitations in activities of daily living. His appearance is often neglected. He often wears unwashed clothing and appears to be untidy. He barely sleeps at night because, he says,” he has bad dreams and thoughts of someone him again one because of being shot in the back, the three car accidents and family issues,” he has no family support. Ms. Lewis the case manager states “he walks very slowly and has difficulties remembering appointments with case management, physician and psychologist”.
I’m reading 10 Things to do Before I Die by Daniel Ehrenhaft and I am on page165. This book is about a 16 year old boy named Ted Burger who has been poisoned and only has roughly 24 hours left to live, so his friends make a list of 10 things they think he should do before he dies and they try to do everything before the 24 hours is over. In this journal I will be questioning and evaluating. I wonder if Ted will be able to finish his list. First, he will not be able to finish.
Clinical Scenario P.T. is a 25-year-old women who has been diagnosed with breast cancer with metastasis to her brain. She was recently readmitted to the hospital for pain management. She has two young daughters, who are 3 and 5. P.T. cannot care for herself, but is very aware that she will die. The nurse assists her in her daily needs: bedpan, flushing of implanted central venous access device (port), bathing, emotional support, vital signs, and pain management.
Patient 4: Meredith B., Female age 38. She’s a lawyer/rep. With an annual income of $102,000. She has type one diabetes and is expected to live eight months without the procedure. Patient 5: Hiram Y., Male age 44.
In St. Anne’s nursing home has two therapy gyms. The gym on the first floor is large and provides both, occupational and physical therapy. The gym on the second floor is smaller and is used more for patients who cannot tolerate much distraction. This room is usually used more for individual treatment sessions. The patient that I got to observe was seen on the first floor of the skilled nursing home.
Throughout the entire book, the main character, Luke Reid, had many characteristic changes. Luke went from thief, to a nobody, to a person that cared. Starting from always being a thief is a tough place to start from. At the beginning of the book, Luke is a thief who is really good at picking locks.
Background Information: Patient R.S. is a 78-year-old male with a background in accounting; his career prior to retirement 13 years ago as an accountant. R.S. was diagnosed with COPD, community acquired pneumonia, impaired gas exchange, TURP and shortness of breath. R.S. appeared to be worn out and exhausted, he was wearing the hospital gown, had a Foley catheter in, two PICC lines bilaterally in the antecubital area, air compression legs wraps bilaterally, and heart monitor and was also wearing oxygen. He was very friendly and cooperative with having to have his vitals taken, medication given, and bed bath done. R.S. spoke in a low, happy voice.
Module 3 Discussion 1. Evaluate the motivational interview (MI). a. How did you feel during the interview? I chose to interview a neighbor, a 79 year-old, man who asked me previously about heath care matters. He specifically was interested in his “cholesterol” and A1C values.