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Clinical Case Presentation

Transcript: Technique Conclusion Patient Response 2010 Prominent leukoencephalopathy with multiple differential considerations as discussed above. 2006 MRI Following having a cavity filled, pt. experienced acute facial pain radiating down arm. Admitted to the hospital for 3 days. CAT scan. Discharged. Repeat MRI Again noted are multiple areas of increased T2 weighted signal throughout the hemispheric white matter which have progressed somewhat since the prior MRI of 2006. Some of these lesions are periventricular in location. There is no associated restricted diffusion and enhancement pattern is normal. A differential diagnosis exists. Possibilities would include small vessel scheming changes the patient has severe hypertension or diabetes. Another possibility would be demyelinating disease such as MS. No hemorrhage or mass lesions is present. Periventricular hyperintensities Diagnostic Criteria Impression Expanded Disability Status Scale Kurtzke, 1985 Impression Composed of 8 functional assessments: Visual Brainstem Pyramidal Cerebellar Sensory Bowel/Bladder Cerebral Other 2006 Dx: Multiple Sclerosis Relapsing/Remitting form Tx: Copaxone - daily Sub-Q injection Prognosis: Patient is maintaining functional status. EDSS = 3.5 She has had one exacerbation since starting DMD. Adherence to tx regime difficult due to pt's thinness. Considering switching to Tysabri (monoclonal antibody given once-a-month by IV infusion) Referral to Neurologist for workup following an acute loss of vision in both OS/OD, increased fatigue, weakness and headache. MRI: The examination is abnormal and reveals prominent rather symmetric regions of leukoencephalopathy in the deep white matter tracts, primarily in the subcortical portions of the centrum semiovale and adjacent to the lateral ventricular surfaces. A few of these regions are associated with diffusion restriction; no abnormal enhancement or mass effect is seen. These changes are suspicious for either prominent demyelinating disease such as multiple sclerosis or perhaps exuberant chronic microvascular disease for age. Other considerations such as vasculitis would seem reasonable as well. 2010 MRI Extensive signal abnormality within the white matter which has progressed since previous studies White Matter Hyperintensities "Please call pt. MRI brain & orbits was essentially the same as in 2006." Patient: M.S. Age: 59 Gender: Female Race/ethnicity: White, non-Hispanic Chief Complaint: 20+ year history of temporary bilateral vision loss, headache/migraine, eye pain, balance impairment, vertigo, peripherial neuropathy (feet), weakness, and fatigue. Clinical Case Presentation Janet Morrison RN, MSN, MSCN Clinical Case Presentation of Multiple Sclerosis At 1.5 Tesla, appropriate pulse sequences were employed in multiple planes both before and after the IV administration of a gadolinium contrast agent. 1983 - Age 30 Abrupt onset bilateral vision loss lasting 10 days. H/O spousal abuse. Diagnosis: Atypical Migraine Ongoing symptoms - retrobulbar pain when looking up or down, Intermittent vision & balance problems, Peripheral neuropathy (feet). Hospitalized 5+ times. Dx: Viral Labyrinthitis. Tx: Ativan, Compazine. 1993 - Age 40 Neurologist consulted. EEG. Electromyelogram. Dx: Migraine & Vertigo. Tx: Depakote 1995 - Age 42 MVA Concussion, Seat belt trauma. 2006 - Age 53 Fell down stairs due to weakness. Fractured 3 thoracic vertebral bodies and coccyx. Relevant Past History Patient called radiology group requesting her MRIs from 2006 and 2010. Read radiologist's reports. Sought opinion from another neurologist. Diagnosis: Multiple Sclerosis Self-referred to university-based MS Neurology Clinic in a large urban health science center. Workup included repeat MRI, opthalmological exam, spinal tap, evoked potentials. Dx: Confirmed MS Tx: Copaxone Expanded Disability Status Scale EDSS "Tell pt. it showed some white spots which is common in migraines" Spoke with pt. 8/16/06

Ancillary GCP

Transcript: Identifying Data Objectives Name: A.B.V Age/Sex: 32/Male Status: Single Religion: Nationality: Filipino Address: Bacolod, Lanao del Norte Chief Complaint: Abdominal pain General Objectives To present a case of a patient who unexpectedly developed thyroid storm during an exploratory laparotomy. Specific Objectives Explore the diagnostic considerations for a patient presenting with persistent intraoperative tachycardia; Discuss the pathophysiology and potential complications of thyroid storm during a nonthyroid surgery; Present the perioperative anesthesia management of thyrotoxicosis. abdullah-alonto-cosme-esmail-lambong-lucman-luna-macadato-maruhom-pansar-sanchez-sangcopan History of Present Illness 1 day PTA 3 days PTA Referred to our instituiton for surgical intervention ABDOMINAL PAIN WEATHERING THE STORM: Abdominal Xray: Partial Bowel Obstruction sought consult at a local hospital admitted managed as a case of complicated UTI diffuse abdominal pain Associated Symptoms: (+) altered bowel habits (+) increasing abdominal girth (+) tympanitic (+) loss of appetite (-) vomiting (-) gross hematuria (-) changes in bowel habits acute epigastric area eventually migrated to right lower quadrant dull, nonradiating Associated Symptoms: (+) right flank pain (+) dysuria (+) undocumented moderate-grade fever (+) nausea (+) loss of appetite. (-) vomiting, (-) gross hematuria (-) changes in bowel habits Admitted Persistent Tachycardia During Exploratory Laparotomy GRAND CASE PRESENTATION IN ANCILLARY MEDICINE Past Medical History - Completed vocational training - tricycle driver (+) alcoholoic beverage drinker, occasional (+) smoker, 10 pack years (+) Nephrectomy (NMMC, 2022) (-) Hypertension (-) Diabetes Mellitus (-) Asthma (-) Thyroid Diesease (-) no known allergies Personal- Social History COURSE IN THE WARDS (+) Goiter, maternal side (-) Hypertension (-) Diabetes Mellitus (-) Malignancy (-) Heart disease Family History Hospital Day 2 Post-OOp Hospital Day 0 Operation Day CBC WBC: 13.85 RBC: 5.0 Hgb: 129 Hct: 0.397 Platelet COunt: 142 Differential Neutrophils: 0.847 Lympho: 0.079 Mono: 0.072 Eo: 0 Baso: 0.002 SERUM ELECTROLYTES Na: 131.1 K: 3.68 BUN: 16.50 Crea: 0.81 URINALYSIS Protein: +1 Pus cells: 6-7 RBC: 4-6 Bacteria: Moderate Epithelial: few Mucus: few Assessment: Acute Abdomen secondary to ruptured appendicitis; S/P Donor nephrectomy, left Plan: Admitted NPO >Medications: Started Paracetamol 300mg IVTT Started Omeprazole 40mg IV Started Cefuroxime 1.5mg IVTT 1 hour prior to OR then 750mg IVTT every 8 hours ANST Started Metronidazole 500mg IVTT > For Emergency Appendectomy, possible exploratory laparotomy > NGT inserted and opened to drain > FBC inserted with urobag Assessment: Acute Abdomen secondary to ruptured appendicitis; S/P Donor nephrectomy, left Plan: Admitted NPO >Medications: Started Paracetamol 300mg IVTT Started Omeprazole 40mg IV Started Cefuroxime 1.5mg IVTT 1 hour prior to OR then 750mg IVTT every 8 hours ANST Started Metronidazole 500mg IVTT > For Emergency Appendectomy, possible exploratory laparotomy > NGT inserted and opened to drain > FBC inserted with urobag S: (+) abdominal pain O: (+) guarding (+) distended abdomen (+) board like rigidity (+) hypoactive bowel sounds (+) generalized tenderness Vital Signs BP 110/80 HR 100 RR 30 T 37.4 I/O: 800cc / 415cc S: (+) abdominal pain O: (+) guarding (+) distended abdomen (+) board like rigidity (+) hypoactive bowel sounds (+) generalized tenderness Vital Signs BP 110/80 HR 100 RR 30 T 37.4 I/O: 800cc / 415cc REVIEW OF SYSTEMS Hospital Day 1 Assessment: Acute Abdomen secondary to ruptured appendicitis; Distal small bowel obstruction; S/P Donor nephrectomy, left Plan: "E" Explaratory Laparatomy NPO > Medications: Shifted Cefuroxime to Ceftriaxone 2g IV drip OD Started Salbutamol 1 neb Metoclopramide 10mg IVTT tranexamic Acid 1 g IV every 8 hours S/O: (+) bilious NGT outcome Hgt: 116 Hgb: 122 Na: 139.6 K: 3.30 TSH: 0.06 FT4: 68.9 Vital Signs: BP: 160/90 HR: 93 RR: 20 T: 36.5 I/O: 2,310cc / 1,561cc Anesthesia Complications Anesthesia complications were minimal, with a single incidence of postoperative nausea and vomiting, which was managed effectively. Monitoring protocols and patient responses were closely documented to improve future anesthetic care. (+) weakness, (-) fever, (+) loss of appetite, (-) weight loss (-) pallor, (-) rashes, (-) itching, (-) skin lesions (-) headache, (-) dizziness, (-) double vision, (-) blurring of vision, (-) hearing problems, (-) earache, (-) colds, (-) nose bleed, (-) difficulty in swallowing, (-) sore throat (-) stiffness, (-) lumps (-) cough, (-) tachypnea, (-) dyspnea, (-) hemoptysis (-) chest pain, (-) palpitation (+) abdominal pain, (+) nausea (-) vomiting, (-) loose bowel movement, (-) constipation, (-) bleeding (-) dysuria, (-) hematuria, (-) urinary frequency (-) Seizures, (+) muscle pain and weakness, (-) joint pains, (-) cramps (-) numbness, (-) tremors (-) altered sensorium, (-) loss of sensation, (+)

Clinical Case Presentation

Transcript: Funding Cognitive/Perceptual (Carpenito-Moyet, 2010) i. Knowledge deficit related to new condition as evidenced by verbalizing having “a new heart”, being “good as new”, and wanting to resume normal ADLs Health Perception/Management Nutrition/Metabolic Health Perception/Management i. “New heart” ii. Feels able to return to normal and more iii. Does not feel tired with exertion but vitals increase significantly Nutrition/Metabolic i. “Whole ingredients” ii. Bacon iii. Temporary versus permanent diet change Cognitive/Perceptual i. Did not finish college ii. New self iii. Surgeon: “Good as new” Procedure Physical Assessment/Charting by Exception Strong heartbeat, not +4 bounding pulse 18 cm sternal wound, approximated, scabbing, no significant erythema/exudate 1-2.5 cm wounds approximated, scabbing, no significant erythema/exudate Medial aspect of right leg Medial aspect of right popliteal Medial aspect of right inguinal Medicare Railroad United Health Care a. The patient will verbalize 2 reasons why he is on restricted activity by the end of the home visit. i. The objective will be met when the patient verbalizes 2 reasons why he is on restricted activity by the end of the home visit. b. The patient will verbalize 2 reasons why he is on a cardiac diet by the end of the home visit (next week). i. The objective will be met when the patient verbalizes verbalize 2 reasons why he is on a cardiac diet by the end of the home visit (next week). c. The patient will collaborate with the health care team and his wife to create a favorite dish that is appropriate with his cardiac diet by the end of the month. i. The objective will be met when the patient successfully prepares a favorite dish with his wife that is appropriate with his cardiac diet by the end of the month. Plan Carpenito-Moyet, L. (2010). Nursing diagnosis: Application to clinical practice (12th ed.). Philadelphia, PA: Lippincott, Williams, & Williams. National Public Radio. 2013. Behind the ever-expanding American dream home. Retrieved from http://www.npr.org/templates/story/story.php?storyId=5525283 Photos Best Clip Art Blog. (2005). Heart health. Retrieved from http://bestclipartblog.com/clipart-pics/health-clip-art-2.gif Can Stock Photo. (2011). Thumbs team. Retrieved from http://ec.l.thumbs.canstockphoto.com/canstock6304481.jpg Clip Art Heaven. (2013). Real estate house. Retrieved from http://www.clipartheaven.com/clipart/real_estate/house_38.gif Clip Art Stock Photo. (2012). Image 2423. Retrieved from http://clipartstockphoto.com/images/doctor-clip-art.jpg Family and Friends. (2013). Clip arts. Retrieved from http://familyandfriends.phillipmartin.info/grandparents.gif PBTPNG. (2010). The doctor is in. Retrieved from http://www.pbtpng.org/the-doctor-is-in QACPS. (2012). Carlson clip art. Retrieved from http://www.qacps.k12.md.us/ces/clipart/Carson%20Dellosa%20Clipart/Carson%20Dellosa%20Learning%20Themes/Images/Color%20Images/Community%20Helpers/BLOOD_PRESSURE_CUFF.jpg Wordpress. (2011). Clip art 0002. Retrieved from http://maryanncp.files.wordpress.com/2009/06/clip-art0020.jpg Word Fitness (2013). Heart rate monitor. Retrieved from http://www.mumsthewordfitness.com.au/wp-content/uploads/2012/02/heart_rate_monitor.gif Clinical Case Presentation NUR 412 Home Health Nursing Jamie Mones Objectives and Planned Evaluation Durable Medical Equipment Resources Interdisciplinary Team i. Cardio-surgeon ii. Home Health Nurse iii. Physical Therapy iv. Occupational Therapy Teaching Required for the Patient/ Family i. See Gentiva Cardiac Journal ii. Documentation 1. Vitals 2. Diet 3. Activity iii. Diet iv. Activity v. Post-Operative 1. Normal/abnormal incision 2. Sleeping position 3. Breathing/brace/spirometer Procedure Bacon Lifestyle alterations Sphygmomanomenter Open Heart Quintuple Bypass Surgery Gentiva Sun City West D.L. 53 years old Hispanic Male 1 week S/P open heart quintuple bypass surgery (9/19/13) Used right great saphenous vein Main diagnosis: stroke Culture, Ethics, and Spirituality Introduction Family 1. Wife 2. Sister 3. No children Culture 1. Hispanic 2. Traditional cooking 3. “Whole” ingredients 4. Gender role: patriarchal Culture i. Diet ii. Gender roles Ethics i. Autonomy ii. Beneficence v nonmaleficence 1. Patient’s outcome versus frustration/depression/stress 2. Catch-22 Skills/Physical Interventions Ordered i. Cardio-pulmonary (with peripheral pulses) ii. Wounds iii. Monitored activity (PT) iv. Breathing exercises (PT/OT) v. Energy conservation (OT) Complementary Therapies i. None ii. Culture-specific support group Summary Environmental factors 1. Sun City West 2. Property 2,500-3,000 sq ft +/- outside amenities 3. Average, borderline high average size (NPR, 2013) 4. No pets Resources and Referral Environment Banner Boswell Medical Center, Sun City Banner Del E. Webb Medical Center, Sun City West Homewatch Caregivers, Sun City Priority Nursing Diagnoses Significant Functional Health Patterns (FHPs)

Clinical Case Presentation

Transcript: Service to Date Language Goals Toilet Training Parent Coaching Behavior Reduction Social Skills Cardiac Evaluation Case History Coronary angiography revealing a significant blockage in the left anterior descending artery. Diagnosed with ASD in late 2023 at the age of 3 Has a younger brother Her mother is a full-time stay-at-home parent Receives in-home ABA services for 4 hours per week Underwent VBMAPP Assessment in June 2023, followed by a specialized educator Critical Examination Challenges: Father not always present, mom can't do it all (inconsistencies in program). How to improve treatment fidelity in this family situation? Mix of in-person and hybrid parent coaching sessions? Basic ABA principles training? Can parents spend 10-15 minutes, 2x a day on teaching 1 skill? One positive: Mom's high motivation to help her daughter be more independent and ready for school. References Clinical Case Presentation Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis, 4(2), 89-99. https://doi.org/10.1901/jaba.1971.4-89 Bass, J.D. and Mulick, J.A. (2007), Social play skill enhancement of children with autism using peers and siblings as therapists. Psychol. Schs., 44: 727-735. https://doi.org/10.1002/pits.20261 Beirne, A., & Sadavoy, J. A. (Eds.). (2022). Understanding ethics in applied behavior analysis: practical applications (2nd ed.). Routledge. Dabney, H. A., DeVries, J., & Jimenez‐Gomez, C. (2023). Caregiver‐implemented toilet training procedures for children with autism spectrum disorder. Behavioral Interventions, 38(3), 804–821. https://doi.org/10.1002/bin.1940 Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2013). Teaching practitioners to conduct behavioral skills training: A pyramidal approach for training multiple human service staff. Behavior Analysis in Practice, 6(2), 4–16. https://doi.org/10.1007/BF03391798

Clinical Case Presentation

Transcript: Priority Nursing Diagnosis Taylor Laboratory Values ARB Fetopathy Nursing Diagnosis Gain weight get to 10kg to get on kidney transplant list! Strengthen muscles to reach developmental milestones Songs of Love Foundation Detroit Specialty Center -> Outpatient Therapy Complications were more severe and more frequently noted in children prenatally exposed to ARBs throughout the entire pregnancy. Women of childbearing age should be educated on the effects of these drugs during pregnancy and they should only be used if absolutely necessary. Quality of life patient will have to continue dialysis until she can get a kidney transplant QOL will be greater with a transplant Affect her growth and development Palliative care Beneficence -> to do good Non-maleficence -> to do no harm Truthfulness -> be truthful about the pts condition and treatments Autonomy -> respect the grandparents wishes Legal Guardianship -> grandparents Midnight Temp: 36.9 HR: 153 Resp: 32 BP: 112/61 O2: 99% Spiritual & Cultural QUESTIONS? Vaccines -> Rates of vaccination against influenza in the pediatric ESRD population have improved, but remain below recommended levels (Carson, 2012). Clinical Case Presentation Risk for electrolyte imbalance r/t end stage renal disease. Patient Assessment Medications Plan of Care Outcomes: 1.) By the end of the shift, pt will remain free from s/s of infection 2.) By discharge, caregivers will be able to identify s/s of infection and demonstrate how to take the pt's temperature Interventions: Assess temperature and observe skin for redness & warmth Hand hygiene Cluster nursing care to decrease number of contacts with pt Educate caregivers on the importance of hand hygiene in preventing infections Educate caregivers how to monitor the pt's temperature Encourage vaccinations Evaluation: 1.) Outcome met -> pt remained afebrile and free from s/s of infection throughout the shift. 2.) Outcome met -> Caregivers verbalized s/s of infection and exhibited how to monitor the pt's temperature Economic & Social Factors Delayed growth and development r/t effects of chronic disease (ESRD) & long periods of hospitalizations since birth AEB difficulty in performing skills typical of age group and altered physical growth. Anemia in Chronic Kidney Disease (2014). In National Institute of Diabetes and Digestive and Kidney Disease. Retrieved March 19, 2016, from http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/anemia-in-kidney-disease-and-dialysis/Pages/facts.aspx. Bullo, M., Tschumi, S., Bucher, B., Bianchetti, M., & Simonetti, G. (2012). Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists: A systematic review. Hypertension, 60, 444-450 Carson, R. (2015). 2015 USRDS annual data report. In United States Renal Data System. Retrieved March 19, 2016, from http://www.usrds.org/2015/view/v2_08.aspx. Cho, M. (2013). Clinical approach to quality of life in children with end-stage renal disease. Korean Journal of Pediatrics, 56(8), 323-326 End stage renal disease (ESRD) in the pediatric patient (2015). In Carolinas HealthCare System. Retrieved March 20, 2016, from http://www.carolinashealthcare.org/documents/ACEModules/ACE_ERSDPediatricPatient_FINAL.pdf. Hyperparathyroidism (2016). In Mayo Clinic. Retrieved March 20, 2016, from http://www.mayoclinic.org/diseases-conditions/hyperparathyroidism. Plazanet, C., Arrondel, C., Chavant, F., & Gubler, M. (2014). Fetal renin-angiotensin-system blockade syndrome: Renal lesions. Pediatric Nephrology, 29, 1221-1230. Richards, C. (2016). Pediatric renal transplantation. Nephrology Nursing Journal, 43(1), 35-37. 8:00 p.m. Temp: 36.4 HR: 159 Resp: 42 BP: 120/70 O2: 96% Social Work Nephrology Nutrition PT/OT Medicare Smoking -> Grandfather smokes outside the house Mom Dad is not in the picture No siblings Grandparents are the legal guardians Referrals & Community Resources Diagnostic Tests M.W. has hemodialysis M, W, F & some Saturdays No wet diapers, but regular BM On room air She has a G/J Tube placed G tube to dependent drainage J tube is for medications & feedings of special pm 60/40 formula at 44 mL/hr She is on continuous pulse ox and CR monitoring, as well as strict I&O's Risk for infection r/t chronic disease, presence of central venous catheters, & hemodialysis. CBC: WBC 24.8 ( ) RBC 2.63 ( ) Hgb 7.2 ( ) Hct 24.0 ( ) Platelets 228 Na, K, and Phosphorous are within normal limits. Ca level increase could be attributed to her hyperparathyroidism (too much PTH secondary to the kidney failure). The kidneys are damaged, so they are not making enough Erythropoietin, which stimulates the bone marrow to make red blood cells. As a result, the bone marrow makes fewer red blood cells, causing anemia -> This is why the patient is receiving Epoetin alfa. BUN and Creatinine are normally removed by the kidneys, but since the kidneys are not functioning, these levels in the blood increase. References Community of Residence

CLINICAL CASE PRESENTATION

Transcript: CLINICAL CASE PRESENTATION Concha, Maria Luisa A. Cornejo, Joanne Rowena Cortes, Marc Lois To present a case about Sciatica To discuss the history and PE of the patient thoroughly To discuss about three differential diagnosis in relation to the case To iscuss about the different management and treatment of Sciatica OBJECTIVES E.E 25 years old Male Works as a messenger Born on Dec. 8, 1992 Consulted for the first time at FM OPD on July 12, 2018 General Data Pain on Left Buttock Chief Complaint

Clinical Case Presentation

Transcript: David not only experienced a sudden loss but also a significant rupture in the family system. Brief Strategic Family Therapy Psychiatric Social Worker Conduct intakes with the youth and family Complete psychosocial assessments Facilitate social work psycho-educational and psychotherapy groups Assess the appropriate level of follow-up care to effectively coordinate discharge plans Brief, pragmatic, behavioral process rather than content Define and resolve the problem Establish clear, achievable, and measurable goals Initial Session is key component to therapy Brief Therapy Stage Problem Stage Interactional Stage Goal-Setting Stage Task-Setting Stage 2. Family Therapy Triage: What to address first? Structual/ Strategic Family Therapy Theory Behaviors reflect maladaptive family interactions Every behavior is a form of communication - no such thing as no communication Family rules - not what's supposed to be but what is References Modeled after the following values Connectedness vs. Individual Autonomy Present vs. Past Theory BSFT Model Short-term (~12 sessions) Youth with behavioral problems Decreases youth problems, improves functioning in families MRI Model David P. Bitter, J. R. (2014). Theory and practice of family therapy and counseling (2nd ed.). Belmont, CA: Brooks/ Cole/ Cengage. Nichols, M.P. (2009). Inside family therapy: a case study in family healing (2nd ed). Boston, MA: Allyn & Bacon. ISBN 978-0-205-61107-2 Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior.Couple and Family Psychology: Research and Practice, 1(2), 134 Walter, C. A., McCoyd, J. L., & Walter, P. C. A. (2015). Grief and loss across the lifespan: A biopsychosocial perspective. Springer Publishing Company. 11 y/o male admitted due to suicide attempt via attempting to hang self As per youth, admitted due to becoming aggressive at home with primary guardian Aunt J. Admitted for 13 days (average length of stay ~ 6) Adjustment disorder with disturbance of conduct As per family, youth was admitted due to out of control, defiant, and oppositional behaviors School refusal Lack of communication Manipulation Destructive and aggressive outbursts Aunt J. Tracking & Diagnostic Enactment Discussion 1. The "Opening the Wound" Dilemma Maternal Aunt is primary guardian Adult sister resides in Atlanta, GA Mother passed away from cancer (5 y/o) Father incarcerated (6 y/o) Monmouth Medical Center CCIS Treatment and stabilization for those in crisis, ages 5-17 Primary treatment goal is to stabilize the acute phase and identify the emotional and behavioral needs of the youth BSFT 3 Core Principles 2. Habitual/ repetitive patterns influence behaviors of each family member 3. Should interventions be modified when working with families such as David's? If so, how? BSFT 4 Intervention Domains Agency Background Focuses on diagnosing family interactional patterns and restructuring the family interactions associated with the adolescent behaviors "David P." Clinical Case Presentation Melissa Genovese CSW II February 25, 2016 3. Interventions are problem-focused and targeted Family Context 1. Family-systems approach Joining Reframing Restructuring

Clinical Case Presentation :

Transcript: Clinical Examination Physical Examination Anthropometry: 90kg, 1.60m, BMI: 35.1 (obesity type 1), abdominal circumference: 90cm. General Exam: Afebrile, hydrated, without cyanosis or jaundice. Posterior neck hyperpigmentation (possible acanthosis nigricans) Cardiac: HR: 90 bpm, BP: 120/80 mmHg. Pulmonary, neurological, gynecological exams: Normal. Clinical Case Complementary Tests HbA1c: 7.2% (elevated). Fasting glucose: 198 mg/dL (elevated). Creatinine: 1.2 mg/dL (moderately high). Lipid Profile: Total cholesterol: 170 mg/dL, HDL: 51 mg/dL, LDL: 100 mg/dL, Triglycerides: 130 mg/dL. (acceptable levels) Urine analysis: Glucose (2+/4+) protein (1+/4+), no bacteria. Clinical Case Presentation : Type 2 Diabetes Mellitus A 60-year-old patient presents with complaints of polyuria, polydipsia, hyperpigmentation in the posterior cervical region, and recurrent urinary infections. Her father passed away at 54 years old from an acute myocardial infarction, and her mother has systemic arterial hypertension and Type 2 Diabetes Mellitus. She reports a sedentary lifestyle but maintains a balanced diet with nutritious and low-fat foods. Laboratory findings indicate several altered parameters. Medical History Diagnosis Conclusion Presenter : Eric Gabriel Serpa Brunhara Personal: Denies chronic degenerative diseases and allergies. Occasional ciprofloxacin use for UTIs. Family: Father died at 54 from myocardial infarction; mother has Type 2 Diabetes and hypertension; brother died of prostate cancer at 50. Lifestyle: Sedentary but follows a balanced diet; denies alcohol, smoking, or drug use. Type 2 Diabetes Mellitus was confirmed based on the following factors: Fasting blood glucose ≥ 126 mg/dL and HbA1C ≥ 6.5%. Acanthosis nigricans in the posterior cervical region, an indicator of insulin resistance. Symptoms of polyuria, polydipsia, and recurrent urinary infections, which are also common in uncontrolled diabetes." Patient Identification This case illustrates that Type 2 Diabetes Mellitus is a manageable condition through effective treatment and lifestyle adjustments. Prevention strategies should focus on adopting healthy habits, including a balanced diet, regular physical activity, and weight management. Regular follow-up visits are crucial for early detection of signs of insulin resistance, ultimately improving prognosis and quality of life. Chief Complaint History of Present Illness (HPI) Patient Identification: M.A.C, a 60-year-old female Occupation: Teacher Color: brown Location: Fortaleza, Brazil Dark spot around the neck was noticed three weeks ago. Treatment Outcome and Prognosis Over the last 3 months, the patient experienced dysuria and low-grade fever for 3 consecutive days. Diagnosed with a urinary tract infection (UTI) and treated with ciprofloxacin. The UTI recurred twice in the following months despite completing the prescribed medication. Over the past month, she developed symptoms of polyuria and polydipsia, especially disturbing at night. Noticed hyperpigmentation around the posterior neck region and sought medical help. Lifestyle Modifications: Increased physical activity and a healthy, balanced diet. Medications: Metformin (first line): Inhibits hepatic glucose production, increases insulin sensitivity. Monitoring: Frequent glucose testing (pre- and post-prandial) to adjust therapy. No evidence of chronic complications Vigilant monitoring for retinopathy, neuropathy, and nephropathy. The patient has a good prognosis with proper lifestyle modifications and adherence to medication. A follow-up appointment will be scheduled within 1 to 3 months.

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