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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.

Psychology Report

Transcript: Research Focus: Influencing Perception Changing Specific Behaviors Sublimal message is a brief auditory or visual message that is presented below the absolute threshold, which means that there is less than 50% chance that the message will be perceived. Method. For several weeks, subjects listended to two different tapes titled either "Improve Self-Esteem" or "Improve Memory". Then they were rated any improvement in these behaviors. Double-blind procedure. Researchers had to control for any possible placebo effects, such as subjects' showing improvement because they believed they were hearing powerful subliminal messages. Therefore, subjects were not told which subliminal messages the tapes contained. for example, some tapes labeled "Improve Memory" contained subliminal messages for improving memory, while others contained subliminal messages for improving self-esteem. Thus because of the double-blind procedure, subjects were unaware of the fact that some tapes' subliminal messages did not match the tapes' labels. Result About 50% of the subjects reported improvements in either self-esteem or memory. Self-fulfilling Prophecies involve having strong beliefs about changing some behavior and then acting, unknowingly, to change that behavior Influencing Perceptions Cultural Diversity: Influence on Perception Cultural influences are persuasive pressures that encourage members of a particular society or ethnic group to conform to shared behaviors, values, and beliefs. Perception on Photos Perception on Motion Perception of 3 Dimensions Perception of Beauty Perceptual Sets learned expectations that are based on our personal, social, or cultural experiences. These expectations automatically add information, meaning, or feelings to our perceptions and thus change or bias our perceptions. Extrasensory Perception (ESP) is a group of psychic experiences that involve perceiving or sending information outside normal sensory processes or channels. Four General Abilities- telepathy, precognition, clairvoyance, and psychokinesis. Telepathy is the ability to transfer one's thoughts to anoter or to read the thoughts of others. Precognition is the ability to foretell events. Clairvoyance is the ability to perceive events or objects that are out of sight. Psychokinesis is the ability to exert mind over matter- for example, by moving objects without touching them. Together these psychic powers or extrasensory perceptions are called psi phenomena. the term psi refers to the processing of information or transfer of energy by methods that have no known physical or biological mechanisms and that seem to stretch the laws of physics. Testimonials as evidence Ganzfeld procedure is a controlled method for eliminating trickery, error, and bias while testing telepathic communication between a sender- the person who sends the message and a receiver- the person who receives the message. Replication a powerful weapon for evaluating research findings Telivision Psychics Television Psychics. =) A hotline in the early 1990s that claimed themselves having ESP. Phi movement refers to the illusion that lights that are actually stationary seem to be moving Apparent Motion Real Motion refers to perception of any stimulus or object that actually moves in space. Apparent motion an illusion that a stimulus or object is moving in space when, in fact, the object is stationary. Virtual reality refers to a perceptual experience of being inside an object, moving through an environment, or carrying out some action that is created or stimulated by computer. Remote and robotic surgery Psychotherapy. In a psychological application of virtual reality, clients with such fears as spiders, flying, or heights are exposed to the feared stimuli in a three-dimensional environment where everything appears very real. First Impressions The End Which of the three rotates fastest?

Psychology Report

Transcript: Human Emotion: Putting the Pieces Together ARE THERE CULTURAL DIFFERENCES IN EMOTION? The construal of the self affect the personal emotional experienced. The need to enhance the self and its independence in individualistic cultures leads to prevalence of emotions that stress the uniqueness and separation of the individual There are three predictive indicators of happiness: (1) social relationships (people with an active social life, close friends, and a happy marriage are more satisfied than those who lack these intimate connections), (2) employment status (employed people are happier than those who are out of work—regardless of income), and (3) physical health (people who are healthy are happier than those who are not). Reflecting the impact of these and other factors, research shows that happiness levels vary, and remain relatively stable, from one culture to the next (Diener & Suh, 2000). National happiness and life satisfaction ratings are highest in Iceland and lowest in Bulgaria. On the basis of more than 100 thousand survey respondents from forty-four countries, the United States ranked ninth in the world and Canada ranked twentieth (Veenhoven, 2000). Emotions are universal phenomena; however, they are affected by culture. While some emotions are universal and are experienced in similar ways as a reaction to similar events across all cultures, other emotions show considerable cultural differences in their antecedent events, the way they are experienced, the reactions they provoke and the way they are perceived by the surrounding society. PURSUIT OF HAPPINESS Scientific studies of happiness (as subjective well-being) provide a lot of information about it: thus, a person’s level of happiness usually stays within a certain genetically determined range despite life’s ups and downs, happiness relates to activity in specific parts of the brain and to the presence or absence of serotonin and dopamine, and we have evolved to pursue happiness. Self and emotions Bases of cultural differences Self construal Subjective vs. objective emotions END The view of the self as independent in individualistic cultures leads to the perception of emotions as a unique personal experience. The emotional reality is therefore taken as subjective: different people are expected to have different emotional worlds, and to react in different ways to the same experiences. Self construal JOSEL JAMES FETALINO PRESENTED BY: Self and emotions ROOTS OF HAPPINESS The way a person perceives her/himself in relation to the surrounding human environment affects one’s emotional world. Collectivistic cultures emphasize the fundamental relatedness of individuals to each other, for example by valuing attending to others, fitting in, and harmonious interdependence with them. Subjective vs. objective emotions

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?

Presentation Case Report

Transcript: Case Study Report Naisthika Kumar Patient Background - 2 year old female child - No remarkable medical history - Born full term, no immunodeficiency Background How it started? - Fever of 39.8 - No rash,chills & convulsions - Ibuprofen was given - Fever rose to 40.3 - Had wheezing, SOB, coughed up yellow phlegm & slight runny nose Nov 10 What happened next? - Received an intravenous infusion of 0.14 g Zithromax and 120 mg rographolide as well as aerosol inhalation of 2 mg budesonide - Oral ibuprofen & acetaminophen - Persistent fever --> 40 Nov 11 What happened next? - Persistent fever, wheezing & SOB - Rash on torso & limbs - Light cough - Appetite improved, no N/V & convulsions Nov 12 Admission : Sent to an ER at first after which she transferred to the hospital Nov 13 What happened? 3 hours prior -Had a 15 minutes respiratory & cardiac arrest -Administered adrenaline 4 times -Treated with tracheal cannula & mechanical ventilation Patient's Physical Condition: During -No spontaneous breathing -Absent pupil reflex to light -Deep comatose state On arrival : - ECG done - Bloody fluid visible in indwelling GI decompression tube In current hospital *CSF refused* Diagnosed with : brain hernia & acute CNS infection Brain CT Extensive brain swelling Decreased brain parenchymal density Narrowed cerebral ventricles and cisterns Chest P/A Fuzzy Coarse bilateral lung markings Visible small patchy shadows in right inferior lung & a clear pulmonary hilus Routine CBC -Blood-gas analysis showed metabolic acidosis (treated with sodium bicarbonate) -Presence of bacterial infection, administered vancomycin & meropenem -Immunoglobulin given for immune support What else? Doppler US showed patient’s anterior and posterior cerebral circulation which corresponded to the diagnostic criteria for brain death Nov 15 Outcome - patient proceeded to develop multiple organ failure & couldn't tolerate spontaneous breathing - patient's guardian stopped treatment Nov 17 Lab Tests Differential Diagnosis - Herpes and pulmonary edema - High pathogenic influenza virus infection - Fulminant myocarditis Let's Discuss! What is the relevance? RSV RSV is the major cause of lower respiratory tract illness in children mostly <2 y/o - Causes up to 80% in infants <1 y/o - In most cases, virus not fatal - Most severe infections & well-defined high-risk groups: infants with - a history of premature birth - chronic lung disease - congenital heart disease - cystic fibrosis - immunodeficiency Most children with RSV infection were previously healthy, and it is often difficult to predict deterioration of RSV infection Mechanism In this case RSV-related encephalitis usually develops within 1-2 days after onset of clinical symptoms, such as high fever, cough, & fatigue. However, the mechanism underlying the rapid progression of related encephalitis remains unclear. Possible causes: -CNS infection -coinfection with bacteria -dysfunction of host immune system

Report template

Transcript: Boxes which need to be modified: -Professor/a: Depending on the gender modify it and just add your name. Watch out! There are two boxes!! -Nivell ( level) : Write down the level they are doing. -Participant: You have to write down name and surnames. -Terms: Fill in the correspondent term. It is really easy, you just have to follow certain steps. If you do not follow them, we will send back your student's reports for you to modify them. -There are two main parts: Term evaluation and comments. Every term you will have to fill in with their marks, leaving the previous ones. - Interacció ( interaction): if the participant interacts / participates . There are 4 possibilites: Ok, Good, Very Good or Excellent. -Writings: Pass or Not pass. -There is no average mark! Therefore, participants will see how they are doing in each skill. They are adults. In the comments section is where you have to write down your opinion. Report templates Acadèmia Formate -Reports have to be sent to the language school in advance. We have to check for spelling mistakes, appropiate comments and translation. - Send a whole group in a file. -Every year , we have to modify reports and Ferran and myself have to rush up because teachers do not pay attention. That is why, we will send back anything not been appropiately filled. - Translations have to be done for minors. So, their feedback must be in English and Catalan/ Spanish. -First / advanced students do not have reports! -Write down as well when we are coming back in the comment!!! At the bottom of the sheet, modify: Professor o professora (depending on the gender) and date. -Once we print the reports, you will have to sign them. -Exams have to be handed in in reception as well. Children's template: The format is different. -You grade your pupils according to their abilities and evolution throughout the term.

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