DIAGNOSTIC DATA: Laboratory: The patient's preoperative laboratory evaluation was done as an outpatient. It was all within normal limits. Cultures of her hip showed no growth. Urinalysis showed no growth. Her post-operative electrolytes showed a slightly decreased sodium of 132 due to dilution. Her hemoglobin was 10.9, hematocrit 32.2, with a white count of 10,300. The protime was 13.5 with an INR of 1.1. On the second post-operative day, her hemoglobin was 9.2, hematocrit 26.5 with a white count of 10,000 and protime of 24 with an INR of 2.1.…
Based on the follow-up examination report by Dr. Burszlyn dated 12/11/15, the patient presents for reevaluation of her left knee. She is a week and half status post left knee arthroscopy. She is complaining of postoperative pain.…
Pat Donelson is a 67-year-old female who presented today with complaints of pain in her left lower calf. The pain started about 3-4 months ago as an “aching/cramping” pain that she described as mild in nature. She noticed the pain while walking and with adequate rest the pain subsides. Mrs. Donelson discontinued use of Lipitor because she thought it might be causing her leg pain. She also presented with complaints of recurrent headaches, a morning cough, and loss of hair on her effected leg. Mrs. Donelson has a history of periodic angina and heart palpitations; however, at the present time she is asymptomatic.…
INDICATIONS: The patient is an 87 year-old male admitted with hematochezia associated with over anticoagulation. The patient has history of fecal incontinence after surgery for anorectal fistula. His hematocrit has remained around 34%-35%. No further bleeding since admission has been identified.…
I will continually assess for peripheral circulation and monitor for pain associated with his right leg DVT. I would also monitor for swelling, redness, excess warmth, and discoloration in comparison with unaffected limb.…
Hospital course: On March 27, the patient underwent exploratory laparotomy, left partial salpingectomy, evacuation of hemoperitoneum, and lysis of adhesions. Blood loss was approximately 1000cc, was replaced with transfusion of two units of red blood cells. Her blood type was noted to be O RH- and RhoGAM was provided.…
HISTORY OF PRESENT ILLNESS: The patient is an elderly mail who fell 4 days prior to admission. He noted immediate pain and swelling in the area just below his left elbow. He was presented to the emergency room for treatment.…
PHYSICAL EXAMINATION: VITAL SIGNS: Afebrile, blood pressure 155/98, heart rate 69. GENERAL: He is in no acute distress, alert and oriented x4. HEENT: mucous membranes moist no facial asymmetry. Left ear WNL, right ear with profound hearing loss. LUNGS: Clear to oscultation and percussion bilaterally, CV normal, S-1 S-2 without murmurs or rubs. GI: Soft, non-tender, non-distended no HSM. Positive bowel sounds. GENITALIA: deferred. EXTREMETIES: No edema. Has been admitted for left ankle surgery. UROLOGIC: Intact with the exception of cranial nerve ink on the right. LABS: CVC within normal range. Pre-op glucose 239, BUN 8, creatinine 0.5.…
GENERAL: The patient is a well-developed, well-nourished male who appears to be in moderate distress with pain and swelling in the upper left arm. Vital signs: Blood pressure 140/90, temperature 98.3 degrees Fahrenheit, pulse 97, respiration 18.…
comes to the ED with abdominal pain that is rated as a “9” on a 0to-10 scale. Physical assessment shows that she is grimacing and…
Mary Helen Adams, Physiotherapy Barbara Berg Troyer, Nursing Dr. R.B. Bourne, Orthopaedic Surgeon Hazel Celestino, Clinical Educator Orthopaedics Laurie Flodrowski, Occupational Therapy Bob Harris, Nurse Practitioner Dr. J. Howard, Orthopaedic Surgeon Donna Kalman, Manager Orthopaedics Dr. S. MacDonald, Orthopaedic Surgeon Lina Martins, Nurse Educator George Moogk, Graphic Artist Allan Murray, Physiotherapy Steve Newman, Nursing Tia DiPasquale, Occupational Therapy Ravi Rastogi, Clinical Specialist, Physiotherapy Sylvia Simon, Coordinator Orthopaedics Michelle Smart, Physiotherapy Cheryl Talbot, Nurse Practitioner Marg Vaz, Clinical Specialist, Physiotherapy…
At the medical leadership camp I attended, we watched footage of a knee replacement surgery where the surgeons took the damaged cartilage and bone out of the knee joint, and replaced it with a prosthetic joint. After watching, I discovered I no longer had any intention or desire to become a doctor or surgeon. Despite the opportunity to save lives, being a doctor suddenly felt limiting, and I realized it was not the person conducting the procedure I wanted to be, but rather the person developing the technology and creating the opportunity for operations such as these to occur.…
PHYSICAL EXAMINATION: The patient is a well-developed, well-nourished male who appears to be in moderate distress with pain and swelling in the upper left arm. VITAL SIGNS: Blood pressure 140/90, temperature 98.3 degrees Fahrenheit, pulse 97, respiration 18.HEENT: Head normal, no lesions. Eyes, arcus senilis, both eyes. Ears, impacted cerumen, left ear. Nose, clear. Mouth, dentures fit well, no lesions. NECK: Normal range of motion in all directs. INTEGUMENTARY: Psoriatic lesion, right thigh, approximately 1 mL in diameter. CHEST: Clear breath sounds bilaterally. No rales or rhonchi noted. HEART: Normal sinus rhythm. There is a holosystolic murmur. No friction rubs noted. ABDOMEN: Normal bowl sounds. Liver, kidneys, and spleen are normal to palpitation. GENITALIA: Tests normally descended bilaterally. RECTAL: Prostate 2+ and benign. EXTREMITIES: Pain and swelling noted above…
[Aim]Total knee arthroplasty(TKA) in valgus knee deformity is a rare case. Post-operative physical therapy program has not been established until now. The aim of this case report describe post-operative physical therapy program of Total knee TKA in valgus knee deformity.…
eeTOTAL KNEE REPLACEMENT (T.K.R.) PHYSIOTHERAPY PROTOCOL PRE-OPERATIVE Patients should be evaluated prior to surgery, including: • Assessment of joint range of motion, muscle strength, mobility and general function • Respiratory assessment and treatment if necessary • Explanation of post-operative physiotherapy management, including respiratory and circulatory exercises • Teaching patient independence with bed mobility and transfers • Pre-operative activity and exercise programme to include quadriceps strengthening – there is evidence that this improves function post-operatively (McHugh et al, 2008) • Neuromuscular stimulation (NMT) if appropriate - there is evidence that this improve quadriceps function pre-operatively (Walls et al, 2008) • Education - pre-operative education can reduce anxiety and improve post-operative outcomes, especially with respect to pain, functioning and length of hospital stay (McDonald et al, 2007). In Cappagh this is achieved through attendance at a multi-disciplinary pre-assessment clinic. POST-OPERATIVE • Check operation notes and post-operative physiotherapy and mobility instructions. Day 1 • Assess respiratory status and treat if necessary • Encourage circulatory exercises • Correct position in bed – knee extended in Robert Jones bandage to minimise swelling (no pillows under knee). +/- heel raise. • Review bed transfers mobility…