Andrew Rider of Michigan Insurance Company referred this file for medical case management. Instructions were given to meet with John Pero and assist with coordination of appropriate and related medical care, and identify needs to facilitate recovery.…
D-Client arrived on time for his scheduled appt. with this writer. The client was alert and engaging throughout the session. During the course of the one hour session, he was aware about completing his first initial tx plan, at which he was open to discuss and complete. The client reported that he participated at HOI prior – 15 years ago for heroin. He relapses in 2009 due to his liver transplant surgery in December of 2008. When asked by this writer about happen during his relapse. According to the client, he relapses on RX medication-oxycodone. He’s been abusing his Rx medication for 6 years. This writer asked the client about how his relapse affects his livelihood. According to the client, he affected him greatly financially whereas he spent his entire $150,000 inheritance on RX medication on the street. The client further mentioned that he spend $5,000 a week on daily Rx medication of 30 capsules of oxycodone. The client expressed his disappointment in himself because he was doing well, but since his surgery, at which the client recognized as a blessing, caused his addiction to pain killers. The client continues to say, “I cannot blame anyone, but me.” The client had a desire to open up his own Bar/Restaurant…
SOCIAL HISTORY: Patient admits to alcohol ingestion nightly and on weekends. Denies tobacco use. Denies illicit drug use. He is married.…
SOCIAL HISTORY: Patient admits alcohol in jesting on nights and weekends. Denies tobacco use, denies illicit drug use. He is married.…
D-The patient arrived on time for her counseling session. Reported that the she is unstable on her dose and requested for an increase of 5mg to due to withdrawals symptoms: sweats, nausea, body aches, and also, craving. This writer completed the dose change request form. Alternatives were then discussed about her recent relapse- Heroin-1/2 bundle by inhalation & Cocaine-1-2 lines by inhalation. This writer addressed the patient recent hospitalization as she define as the worst and unethical experience. The patient felt Rockville Hospital did a poor job with assessing the patient's well-being and judged her for receiving methadone and, as an addict. Please note, the patient provided her discharge summary and it's documented in the record by…
A-Based on this writer's assessment, the patient appears to be alert and oriented. There was no evidence of SI/HI. At this time the patients appear to be under the preparation stage of change as she wants to change behavior in her recovery process, but yet did not resolve her ambivalence behavior for her ongoing use of illicit drugs. The patient needs more convincing and encouragement for her recovery.…
There are many factors fused together that affect the health of communities and individuals. Whether individuals are healthy or not, is determined by their environment and circumstances. These factors include where we live, the condition of our genetics, environment, our education and income level, and our relationships with family and friends all have considerable impacts on health, considered that the more widely known factors such as availability and use of health care services often have less of an influence( World Health Organization (2010).…
late. In order to aid nursing home residents in an effective manner, one must not only integrate preferences and options, but also refine nursing home environments (Choi et al., 2008, p. 545). The changes in the nursing home facilities may range from no longer including structured activities to making residents feel at home. In addition, adding complex tasks to residents daily life may help with feelings of unworthiness. According to Bhar & Brown (2012) reestablishing problem solving in nursing home residents produces feelings of worthiness, proficiency and significance (p. 121). Restoring problem solving in residents may be a key to preventing suicide. However, further research is necessary to effectively aid nursing home residents. Further…
At the time of assessment I was referred, by Dr. Blue, in the emergency room for an evaluation on the patient mention above for her suicidal ideation and homicidal ideation with a plan to harm self and others. She reports for the past two weeks experiencing relational issues with her boyfriend and attempted to call him 32 times today, however was unable to get in contact with him. The patient reports that he was afraid of being physically harmed by her, which she admits to assaulting him in previous relational conflict. The patient expresses due to her pasted exposer to domestic violence and abuse throughout her youth, she does not know any other way of coping with situation conflict in her mind. She reports history of practicing cutting behavior when feeling overwhelmed with anxiety from relational conflict with her boyfriend. She expresses thought of…
John is a 30 year old White unmarried male addicted to opiates. He states he has a 15 year history of marijuana, alcohol, and IV heroin use. John has 3 brothers. He states his youngest brother is in prison for murder, and his two oldest brothers have no substance addiction. John states that both his parents are deceased and alludes to the connection of his mother’s death to his brother’s incarceration, but declines to go further into the story. He states that his father died of alcoholism. John has so far declined giving any information of mother’s substance or mental health issues. John displays two tear drops from the corner of his right eye. When questioned about this, because in jail terms the display of tear drops has meaning that this person murdered the number of tear drops, John states they are in memory of his parents. John states that a ‘crew’ of friends would make a weekly drive of 5 hours one way to a neighboring state to obtain heroin for personal use. When asked why he was seeking treatment at this time, he stated he was tired of…
Mr. Brown has been doing test all day and to find out what is going on with him. His test results come back and says triglycerides 145 mg/dL and his cholesterol is 210 mg/dL and his HDL 33 mg/dL and his LDL 160 mg/dL. As I sit with him trying to explain what the results are can be difficult. He ask what are triglycerides me being the physician that I am I explain that triglyceride is an ester formed from glycerol and three fatty acid groups. Triglycerides are the main constituents of natural fats and oils, and high concentrations in the blood indicate an elevated risk of stroke. Cholesterol is the compound of the sterol type found in most body tissues, including the blood and the nerves. It is the fat in the body. The LDL means low-density lipoprotein and the HDL is the opposite which means it is high.…
The main focus of patient care was to control the patient’s pain. Also the patient experienced nausea, vomiting, and constipation .These symptoms were unwanted side effects of the opioids he was taking. During my placement the condition of the patient worsened. Pain increased, along with the side-effects of the medication taken by the patient. Some of the activities that the patient was able to perform independently became difficult, such as getting to the toilet and maintaining personal hygiene. The patient became restless at night time due to the increase of pain. At this point the amount of opioids taken by the patient was increased by the doctor, so that as well as the medication in the syringe driver the patient could take a set amount of strong opioids when required by mouth to relieve the pain. I will relate this care issue to the research article I have chosen to critique and discuss. These oral opioids where always administrated by his wife. The patient was unable to do it himself due to his physical deteriorated condition. However was always the patient that asked to take the medication when he felt he needed it. I have chosen…
Knowing Edward’s past mental issues and suicide attempt a few years back there are many things that I would need to take note of before and during the evaluation process. First I would want to obtain information from Edward’s previous doctors, specifically the one who first…
The writer met with the patient to immediately address his non-compliance with his counseling sessions since last week and his multiple AWOLs. According to the patient, he said, " It's a lot that is going on, Charlene...Like, I don't know what to do." The patient went into detail that his "wife" whom he claimed even though they are engaged is currently incarcerated for identify theft and robbery. She's sentenced for 6 years and the patient informed the writer that he is done with the relationship. The patient appeared sadden and frustrated with the most recent events. In addition to this, the patient reports that his "wife" stole $15,000 from him and only left him with $800. Please note, the patient was teary-eye and was preventing himself from showing his emotions. Denies any recent relapses.…
The first thing to do is build rapport with the patient. As a nurse, I must assess the patient’s age, cultures, level of understanding and readiness to learn. The age of my patient can make a difference. When dealing with a young mother, there is a lot of teaching to be done especially if she is a first-time mother. I want to be able to level my teaching with my patient’s age level, in a way that she can feel being respected and acknowledge accordingly. When it comes to being a mother, cultures have some effect on teaching a patient as well because some might prefer for their own mother to teach them on how to care for the newborn. Another way to assess is to check the level of understanding of the patient maybe there is a language barrier…