devry hit111 all week discussions 2015 latest winters

Class, in this thread we will be looking at patient documentation and patient encounters. The purpose of this thread is to familiarize you with the Key Concepts found in Terminal Course Objectives (TCOs) 1 and 2. You must address all of the questions located after the example of surgical history and patient encounter of Darryl McFadden.

SURGICAL HISTORY

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and vomiting. The initial onset of the pain was about 48 hours prior to presentation. The pain was progressive in nature and began radiating to the back. Late yesterday, the patient drank some Alka-Seltzer and went to bed. He was awakened during the night by the pain and began vomiting. The patient states the pain is constant and has localized to the right lower quadrant. His last bowel movement yesterday afternoon was normal. He does have a history of irritable bowel syndrome; however, he states that this pain is different than the pain he has had in the past.

Past Medical History: Irritable bowel syndrome, last exacerbation 6 months ago. The rest of the past medical history is unremarkable.

Past Surgical History: Tonsillectomy and adenoidectomy in early childhood; umbilical hernia repair at age 4.

Medications: None

Allergies: No known drug allergies

Social History: The patient is employed as a computer programmer. He is married and has no children. He has smoked a half a pack of cigarettes daily for the last 10 years. He drinks alcohol rarely.

Family History: Both parents are alive and well. One sister has Down syndrome. Paternal grandfather has COPD, hypertension, and diabetes mellitus.

Review of Systems: Negative except for complaint of pain in the right lower quadrant.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 ^oC (101.4 ^oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Laboratory Data: Hemoglobin 14.6, hematocrit 43.6, and WBC 13,000. Sodium 138, potassium 3.8, chloride 105, C02 24, BUN 10, creatinine 0.9, and glucose 102. Urinalysis was negative.

Diagnostic Studies: Flat plate and upright films of the abdomen revealed a localized abnormal gas pattern in the right lower quadrant with no evidence of free air.

Impression: Appendicitis

Plan: The patient will be admitted, kept NPO, and an appendectomy will be performed by Dr. Rogers in the morning.

Discussion Questions: Identify one or two medical terms in this report. Deconstruct the components of specific medical terms to identify their meanings. In addition, please pay attention to the spelling and pronunciation of the words.

DISCUSSION QUESTIONS:

1. Reviewing the surgical history, provide the following in your post.

A. Identify one or two medical terms in this report. Deconstruct the components of specific medical terms to identify their meanings. In addition, please pay attention to the spellingand pronunciation of the words.

B. Define the abbreviations found in the surgical report. How did you find the meaning of these abbreviations?

C. Using what you’ve learned about word parts, describe the types of surgeries listed in the patient’s past surgical history.

2. Reviewing the outpatient encounter of Darryl McFadden, accomplish the following and report in your findings and comments in your post.

A. Go to Research a Disease or Condition in the ADAM multimedia encyclopedia. Read all the information under allergies and look at the six images, the photo, and the video on allergies. After studying the material, summarize or paraphrase any information that you use in response to the discussion question this week. Be sure and cite your source appropriately. Do not copy and paste information.

B. If Darryl McFadden was your child, what questions would you ask the doctor on the first office visit?

3. General questions:

A. Define in your own words the four types of word parts.

B. Identify each of the major body planes related to where they cross the body.

Class, in this thread we will be looking at musculoskeletal system terminology and related patient encounters. The purpose of this thread is to familiarize you with the Key Concepts found in TerminalCourse Objective (TCO) 3. You must address all of the questions located after the example of dischargesummary and patient encounter of Carol Champion.

Discharge Summary

Admission Diagnosis: Multiple compression fractures of T12, L1, L2, and L4

Discharge Diagnosis: Same as above, non-acute fractures

History of Present Illness: This is a 70-year-old African-American female with a long history of multiple fractures dating back to 1992. She has a history of significant osteoporosis diagnosed in 1998. The patient also has a history of osteoarthritis and had a right total hip replacement in 2000. Two days prior to admission, the patient missed the final step coming down the stairs in her home. She caught hold of the railing but twisted as she did so and developed some back pain. This became progressively worse over the next 2 days to the point where she was having difficulty ambulating and she went to the Emergency Room.

On evaluation in the ER, it was noted that she had compression fractures of the T12, L1, L2, L3, and L4 vertebrae. However, these could not be ruled out as new or old fractures due to lack of previous X-rays in this area. The patient was admitted for further evaluation.

Past Medical History: The patient is retired and lives in an independent living apartment in the Pine Valley retirement community. She does not smoke and has no alcohol intake. She has osteoporosis and osteoarthritis. Also of note is that approximately 10 days prior to admission, the patient had sustained a distal radius fracture of her left forearm for which she was treated with a splint by an orthopedist.

Physical Examination: This is a well-developed, well-nourished elderly female in no acute distress. She had moderate discomfort on movement. Her HEENT exam was essentially normal. Her lungs were clear. Heart had a regular rate and rhythm. Abdomen was soft and nontender. Her rectal area showed good tone. Her back showed moderate tenderness to palpation in the upper lumbar and lower thoracic area. Neurologically, she was completely normal with cranial nerves being intact. Motor was 5/5 in all extremities except for the left extremity, which was not examined secondary to the arm being in a splint. She had deep tendon reflexes 2+ and equal. Her sensory exam was normal.

Hospital Course: The patient was admitted and on the day following admission, she had a bone scan that revealed moderate degenerative joint disease of the T&L (thoracic and lumbar) spine with no evidence of acute compression fractures. The patient was placed on bed rest and was started with physical therapy and ambulation with which she has steadily progressed with decreasing pain and tenderness. The patient is now ambulating using a walker with a platform for her wrist splint.

Social Services and Physical Therapy were consulted. She is ambulating well with her walker and it is felt she will do well staying with members of her family over the next 10 to 14 days, after which time she will be able to go back to living in her apartment.

The patient will follow up with the Orthopedic Clinic in 10 to 14 days. She will follow up with her private physician for the wrist fracture upon discharge.

Discharge Medications: Tylenol #3, one or two p.o. q 4-6 h. p.r.n.; Fosamax 5 mg daily, and she will continue with her Calcium t.i.d.

OUTPATIENT OFFICE ENCOUNTER

Carol Champion is a 46-year-old retired professional ice skater who was seen initially by Physical Therapy on 12/30/10. She indicates that she fell on her left shoulder and arm while ice skating on 12/29/09. She was first seen by Beth Ranowski and given Codman's exercises. The patient continued to have shoulder pain and saw Dr. Owens on 1/04/10 and was referred for physical therapy due to her complaints of limited range of motion in the left shoulder secondary to pain. Her assessment was rotator cuff of the left shoulder with limitations in active range of motion.

DISCUSSION QUESTIONS:

1. Reviewing the Discharge Summary, provide the following in your post.

A. What does it mean in the spinal X-ray when it says, “These could not be ruled out as new or old fractures?”

B. What other terms in this case study refer to structures and conditions of the musculoskeletal system?

2. Reviewing the outpatient encounter of Carol Champion, accomplish the following and report in your findings and comments in your post.

A. Go to Research a Disease or Condition in the A.D.A.M. multimedia encyclopedia. Read all the information under rotator cuff tendinitis and look at the images. Read shoulder arthroscopy under the Read More section. Read one of the Care Points. Go to CLINICAL ILLUSTRATIONS (outside the encyclopedia on the ADAM home page) and look at isometric exercise.

B. After studying the material, summarize or paraphrase any information that you use in response to the discussion questions this week. Be sure and cite your source appropriately. Do not copy and paste.

C. What advice would you offer Carol Champion regarding what she should do if the physical therapy does not resolve the shoulder pain?

3. General questions:

A. What are the major structures of the bone and their respective subcategories?

B. Define each term into its common word parts. Write these word parts in sequence; use a slash when necessary to indicate a combining vowel.

1) Bursectomy

2) Osteochondroma

3) Osteomalacia

4) Periostitis

5) Tendonitis

6) Spondylosis

Class, in this thread we will be looking at integumentary and endocrine systems and their related patient encounters. The purpose of this thread is to familiarize you with the Key Concepts found in TerminalCourse Objectives (TCOs) 7 and 8. You must address all of the questions located after the examples of case study and patient encounter below.

OPERATIVE AND PATHOLOGY CASE STUDY

Preoperative Diagnosis: Multiple basal cell carcinoma temporal right lower lid

Anesthesia: Local

Operation: Pentagonal full thickness excision of multiple basal cells right lower lid; right lateral canthoplasty (surgical repair of the canthus)

Procedure: The patient, a 28-year-old Hispanic male, was brought to the operating room and placed in the supine position. Under nasal prong oxygen and cardiac monitoring, the right lower lid and surrounding area were anesthetized. The right face was prepped in the routine manner. The head and body were draped to expose the right eye.

Two, approximately 1.5-2.0 mm, round nodular ulcers centrally cratered, indurated lesions were outlined on the right lower lid not extending above the lateral canthal line. Medial to these lesions was a large milium (keratin-filled cyst). A pentagonal incision was outlined incorporating approximately 1 cm of lid margin. A horizontal lateral canthotomy (surgical division of the slit between the eyelids) was made and the tissue below it was undermined. The pentagonal incision, with the base being the lid margin, was then excised by outlining with mosquito forceps followed by scissors excision. Hemostasis was achieved with bipolar cautery. The lateral canthal flap was further undermined and the lateral canthal skin incision was extended approximately 0.5 cm temporally. The medial lid margin was then sutured to the lateral canthal ligament. The horizontal incision of the lateral canthotomy was closed and pentagonal lid gap was closed. Tobradex ointment and Telfa pad was placed and ice applied.

The patient tolerated the operation well and left the operating room in satisfactory condition.

Pathology Report

Clinical Data: Rule out malignancy, lesion of eyelid

Diagnosis: Basal Cell Carcinoma

Specimen Site: Eyelid

Gross Description: The specimen is received in formalin and labeled with the patient's name. It consists of a 0.1 cm punch biopsy of light tan, wrinkled skin excised to a depth of 0.2 cm. On the surface, there is an irregularly pigmented area measuring 0.1 cm. Entirely submitted.

Microscopic Description: Sections of the submitted skin biopsy show a multicentric basal cell carcinoma. The tumor is formed by masses of small, darkly basophilic, ovoid cells that tend to palisade around the periphery. Marked basophilic degeneration of collagen is seen in the dermis. There is focal lymphocytic infiltration of the dermis. The tumor extends to margins of the biopsy.

OUTPATIENT OFFICE ENCOUNTER

Margaret Smith is a 61-year-old black female who presents with complaints of depression, weight gain, sensitivity to cold, joint and muscle pain, and fatigue. She states that she feels tired even after getting a good night’s sleep. In addition, she has gained 20 pounds over the past 3 months, which she says is atypical for her because she has maintained a relatively constant weight of 140 pounds over the course of the past 30 years. She finds that she must wear a jacket whenever she stays in an air-conditioned room, even if the room temperature is moderate. She also notes dry and cracked skin, especially around her heels and must apply moisturizers twice a day, which have not seemed to alleviate the excessive dryness.

DISCUSSION QUESTIONS:

1. Given one or two common medical terms found in the Operative and Pathology reports, deconstruct the components of specific medical terms to identify their meaning.

2. Reviewing the outpatient encounter of Margaret Smith, accomplish the following and report in your findings and comments in your post.

A. Go to the A.D.A.M. multimedia encyclopedia and click on Research a disease or condition. Under hypothyroidism, read all the material under the main headings. Look at the four images.

B. After reading the material, summarize or paraphrase any information that you use in response to the discussion questions this week. Be sure and cite your source appropriately. Do not copy and paste information.

C. Discuss possible causes of Margaret’s hypothyroidism. What are some early symptoms of this disorder? What are the risk factors for developing hypothyroidism?

3. General questions

A. Describe the structures of the skin.

B. Describe the structures of the end

Class, in this thread we will be looking at nervous and special senses systems and their related patient encounters. The purpose of this thread is to familiarize you with the Key Concepts found in TerminalCourse Objective (TCO) 5. You must address all of the questions located after the examples of case study and patient encounter below.

CASE STUDY

Mrs. Markus is a 37-year-old woman with a history of migraine headaches and visual field disturbances. She has a left medial lower quadrant defect (an area of reduced visual function) that was noted in December of 1999 and has been stable. She recently developed a right temporal lower quadrant defect, which was first noted in September of 2004 and has had worsening symptoms in October.

An MRI in November showed a normal study of the brain including visual cortex and periventricular white matter, with a normal study of the orbits, optic nerves, and extra ocular muscles. A pituitary microadenoma (small benign tumor of the pituitary gland) of approximately 3 mm on the left side of the gland was found with no compromise of the optic chiasm. Mrs. Markus underwent further evaluation by MRI with pituitary cuts and the microadenoma was again noted left of midline causing no compression of the optic nerves nor invasion of the cavernous sinus. The microadenoma is approximately 5 mm.

Past medical history is also significant for depression, asthma, and a hiatal hernia. Her current medications include Prozac, Imitrex, and Azmacort MDI.

In summary, Mrs. Markus is a patient with an incidentally noted pituitary microadenoma on MRI. This is reportedly new when compared with prior studies. We cannot explain the new visual field disturbances except for the adenoma. A pituitary workup has been initiated and her prolactin level is mildly elevated but this can be secondary to her medications, especially Prozac, which can cause hyperprolactinemia. Thyroid function is normal and a growth hormone test level is pending. I will proceed to rule out hypercortisolemia and Cushing's disease.

OUTPATIENT OFFICE ENCOUNTER

Howard Solo is a 65-year-old patient and a retired airline ground maintenance technician. He worked for 40 years for American Airlines. He complains of tinnitus and hearing loss that have worsened over the past year. An audiogram was obtained on July 24, 2009 at the time of the patient's initial visit. This audiogram revealed an average 75 dB (decibel) hearing loss through the speech frequencies in the right ear with an average loss of 80 dB loss in the left ear.

DISCUSSION QUESTIONS:

1.After reviewing the case study, discuss the following in your post. Given the above medical case, perform a quality assessment of the medical terminology used by identifying one or two terms that may be inaccurate or confusing within the context of the case presented.

2. Reviewing the outpatient encounter of Bernard Collins, accomplish the following and report in your findings and comments in your post.

A. Go to Research a disease or condition in the A.D.A.M. multimedia encyclopedia. Read all the information under Hearing loss - occupationaland look at the image entitled Ear Anatomy. View the video entitled Hearing and the cochlea. Read the related articles underHearing loss. Under Learn About a Test, read the information in Audiometry.

B. After studying the material, summarize or paraphrase any information that you use in response to the discussion questions this week. Be sure and cite your source appropriately. Do not copy and paste.

C. Discuss how you would classify the type of hearing loss that Howard has experienced. Include the degree of severity of hearing loss based on the results of the audiometry. What kind of treatment would you recommend?

3. General questions:

A. Define the parts of the brain.

B. Name and define the cranial nerves I-XII.

Class, in this thread we will be looking at reproductive systems and their related patient encounters. The purpose of this thread is to familiarize you with the Key Concepts found in TerminalCourse Objectives (TCOs) 9 and 10. You must address all of the questions located after the examples of the case study and patient encounter below.

OPERATIVE CASE STUDY

Preoperative Diagnosis: (1) Pregnancy, uterine, nondelivered at 40+3 weeks estimated gestational age, (2) arrest of dilation

Surgeon: Randy Chornack, M.D.

Anesthetist: Dr. Androsini

Anesthesia: Continuous lumbar epidural

Operation Performed: Lower primary cesarean section with Pfannenstiel skin incision and low transverse cervical uterine incision.

Indications For Surgery: The patient is a 29-year-old female, G1 P0 (this abbreviation means the first pregnancy, and that the patient has never delivered a child), last menstrual period May 24, who presented at 40+3 weeks estimated gestational age in early active labor. The patient had progressed through the transition phase at which time an intrauterine pressure catheter was placed due to difficulty assessing contractions on the external monitor. She progressed to 6 cm with fetal vertex at 0 station and in the occiput anterior position. She was contracting every 2 to 3 minutes with contractions that were 64, representative of adequate labor. The fetus had an episode of bradycardia to the 80s lasting approximately 10–12, minutes which responded to resuscitative measures including positioning and application of oxygen with a return to a baseline of 160s with some hypervariability; however, no further deceleration (slowing of fetal heart rate). In the face of adequate spontaneous labor and failure to progress beyond 6 cm for a period of 2 hours and 30 minutes, a decision was made to proceed to primary cesarean delivery.

Findings: At 10:03 p.m., the patient was delivered of a liveborn female infant with Apgar scores of 9 and 9 and weight of 3,422 g.

Description of Operation: In the OR under continuous lumbar epidural, the patient was prepped and draped in the usual fashion for cesarean delivery including sterile insertion of Foley catheter. She was placed in the supine position with a right hip role. A Pfannenstiel skin incision was made, the rectus fascia was dissected off of the underlying muscles that were then separated in the midline, and the peritoneal cavity was entered. The visceroperitoneum overlying the lower uterine segment was elevated, incised, and the bladder was dissected away from the lower uterine segment. A low transverse cervical incision was made and was extended with the bandage scissors. The amniotic cavity was entered, revealing moderate meconium.

The fetal vertex was palpated, elevated, and delivered. The baby was suctioned on the maternal abdomen. The remainder of the infant was delivered. The cord was doubly clamped and cut. The infant was passed up to the pediatricians in attendance. The placenta was manually extracted intact. It was a three-vessel cord. Pitocin and 2 gm of Ancef were added to the IV fluid after delivery of the placenta.

The uterus was exteriorized and the uterine incision was examined. There was found to be a right inferolateral extension. There was also noted to be dissection in the myometrial layers of the lower uterine segment where a venous sinus had been entered with copious bleeding. This was controlled with interrupted figure-of-eight sutures and reapproximation of the myometrial layers. Closure of the right inferolateral extension incorporated the right uterine artery in the repair. This was closed in a running locking fashion with #1 chromic suture, as was the remainder of the uterine incision. Good hemostasis was obtained. The bladder flap was then approximated using a running stitch of 2-0 chromic suture. The abdominal cavity was thoroughly irrigated and suctioned free of clots. The uterus was returned to the abdominal cavity, the parietal peritoneum and the fascia were closed. The subcutaneous tissues were thoroughly irrigated and found to be hemostatic. The skin was closed with staples and sterile dressing was applied. The patient left for the recovery room in stable condition. She received 2400 cc of lactated Ringer's interoperatively and had 125 cc of urine output. Estimated blood loss was 1,000 cc.

The patient tolerated the procedure well. There were no complications.

Addendum: The pediatricians suctioned the infant postpartum, revealing no meconium below the cord.

OUTPATIENT OFFICE ENCOUNTER

Susan Barnes presents to the office today with a low-grade fever and lower abdominal discomfort. She states that she has a strong, persistent urge to urinate and that when she does, she experiences a burning sensation. Her urine is smoky brown in color and has a strong smell to it. We have requested a clean-catch urine specimen from the patient and will order a stat urinalysis and urine culture.

DISCUSSION QUESTIONS:

1. Given the above Operative Case Study, identify one or two situations in which appropriately and accurately used medical terminology enables health information professionals to successfully support clinical staff functions

2. Reviewing the outpatient encounter of Susan Barnes, accomplish the following and report in your findings and comments in your post.

A. Go to Learn about a test in the A.D.A.M. multimedia encyclopedia. Read all the information under urinalysis and look at the two images. After reading the material, summarize, or paraphrase any information that you use in response to the discussion questions this week. Be sure and cite your source appropriately. Do not copy and paste information.

B. Why is a urinalysis considered a diagnostic test?

3. General questions

A. Define the structures of the male reproductive system.

B. Define the structures of the female reproductive system.

C. Discuss briefly the cycle of pregnancy and childbirth.