Name: Anna Jones
Pt. Encounter Number: 5663
Date: 9/13/22
Age: 54
Sex: Female
SUBJECTIVE
CC:
“low back pain radiating to left leg”
HPI:
54 yo female presents to the office today c/o lower back pain radiating down L buttock, down the left leg through the calf. Began 3 days ago, with sudden onset while she was at work, following lifting and turning a patient.. She reports feeling a “pop” followed immediately by this pain. States the pain is constant and worsening and rates severity as 7/10. Describes the pain as throbbing, with stinging and tingling down the left leg and calf and reports she “feels crooked”. She has tried rest and Ibuprofen to treat the pain but has gotten no relief. She reports sitting worsens the pain and she is unable to walk without pain. Denies history of similar symptoms. No recent trauma. No previous treatment or testing related to this problem.
Medications: Ibuprofen 400mg as needed for back pain
Allergies: NKDA
Medication Intolerances: none reported
Past Medical History: Uterine fibroids
Chronic Illnesses/Major traumas: denies
Hospitalizations/Surgeries: 3 live births, partial hysterectomy due to uterine fibroids
Preventive: Immunizations up to date .Tdap 2015, Flu 2019, COVID #1 Jan 2020, COVID#2 Feb 2020. Yearly dental exam. Mammogram March 2020.
Family History
Mother deceased due to COVID with history of asthma and smoking. Father living, age 86, HTN-controlled, smoker, depression.
Social History
Pt attended tech school and is working full time as a nursing assistant. Married and monogamous with husband. She has 3 children. Owns home and feels safe there. Denies smoking, tobacco or recreational drug use. Reports occasional use of wine.
ROS Student to ask each of these questions to the patient: “Have you had any…..”
General
Denies weight change, fatigue, fever, chills, night sweats, or change in energy level
Cardiovascular
Denies chest pain, palpitations, edema.
Skin
Denies rashes, bruises or bleeding, or change in skin lesions.
Respiratory
Denies cough, SOB.
Eyes
Denies visual changes
Gastrointestinal
Denies abdominal pain, N/V/D, constipation, eating disorders or ulcer
Ears
Denies ear pain or hearing loss.
Genitourinary/Gynecological
Denies dysuria or incontinence. Reports last PAP 2010, normal. 3 live births.
Nose/Mouth/Throat
Denies congestion or sinus problems. Denies nosebleed. Denies dental disease. Denies sore throat or hoarseness
Musculoskeletal
Reports throbbing lower back pain, radiates to Left buttock and down to left leg/calf for 3 days. Worsening and causing pain when ambulating. Not relieved by rest, position change or Ibuprofen. Denies history of similar problems. Denies joint swelling or history of arthritis.
Breast
Reports regular SBE, Denies lumps or mass. Last mammogram March 2020
Neurological
Alert and oriented x 4. Denies syncope, seizures. Reports stinging a ...
Cardiovascular history taking is an important skill that is often assessed in bedside teaching . It’s important to have a systematic approach to ensure you don’t miss any key information. The guide below provides a framework to take a thorough cardiovascular history.
CONCISE PRACTICAL GUIDE TO HISTORY TAKING AND WORKUP IN OPD BASED SETTINGSNavroz Khosla
A CONCISE GUIDE FOR STUDENTS, INTERNS (FRESH LEARNERS)
ALL MEDICAL PROFESSIONALS EITHER INVOLVED IN TEACHING ,TRAINING OR PRACTICING SENIOR DOCTORS COULD ALSO USE IT FOR QUICK REVISION.
DUE TO LACK OF A CONCISE PRACTICAL GUIDE FOR HISTORY TAKING I PRESENT UNDER GUIDANCE OF DR.N.K. GOEL (HEAD OF THE DEPARTMENT)
AND ALL RESPECTED FACULTY
DEPARTMENT OF COMMUNITY MEDICINE
GOVERNMENT MEDICAL COLLEGE & HOSPITAL
CHANDIGARH
DR. KHOSLA NAVROZ
History Taking
1.Name, age, sex, marital status, occupation, address (Demographics)
2. Presenting complaints
3. History of present illness
4. Systemic inquiry
5. Past history
6. Menstrual history
7. Treatment history
8. Family history
9. Personal and social history
10. Occupational history
Diagnosis of inflammatory arthritis - Dr Louise Warburtonpcsciences
Co-host of the 2017 Musculoskeletal Education Day, Dr Louise Warburton helps healthcare professionals understand the difficulties in diagnosing inflammatory arthritis
History taking (History of Physical Examination)pankaj rana
A History of Physical Examination Texts and the Conception of Bedside Diagnosis. ... Throughout this paper we construct a difference between a “bedside diagnosis,” made when the physician and patient are in each other's presence, and a “remote diagnosis,” made when the patient and physician are separated.
Name: Anna Jones
Pt. Encounter Number: 5663
Date: 9/13/22
Age: 54
Sex: Female
SUBJECTIVE
CC:
“low back pain radiating to left leg”
HPI:
54 yo female presents to the office today c/o lower back pain radiating down L buttock, down the left leg through the calf. Began 3 days ago, with sudden onset while she was at work, following lifting and turning a patient.. She reports feeling a “pop” followed immediately by this pain. States the pain is constant and worsening and rates severity as 7/10. Describes the pain as throbbing, with stinging and tingling down the left leg and calf and reports she “feels crooked”. She has tried rest and Ibuprofen to treat the pain but has gotten no relief. She reports sitting worsens the pain and she is unable to walk without pain. Denies history of similar symptoms. No recent trauma. No previous treatment or testing related to this problem.
Medications: Ibuprofen 400mg as needed for back pain
Allergies: NKDA
Medication Intolerances: none reported
Past Medical History: Uterine fibroids
Chronic Illnesses/Major traumas: denies
Hospitalizations/Surgeries: 3 live births, partial hysterectomy due to uterine fibroids
Preventive: Immunizations up to date .Tdap 2015, Flu 2019, COVID #1 Jan 2020, COVID#2 Feb 2020. Yearly dental exam. Mammogram March 2020.
Family History
Mother deceased due to COVID with history of asthma and smoking. Father living, age 86, HTN-controlled, smoker, depression.
Social History
Pt attended tech school and is working full time as a nursing assistant. Married and monogamous with husband. She has 3 children. Owns home and feels safe there. Denies smoking, tobacco or recreational drug use. Reports occasional use of wine.
ROS Student to ask each of these questions to the patient: “Have you had any…..”
General
Denies weight change, fatigue, fever, chills, night sweats, or change in energy level
Cardiovascular
Denies chest pain, palpitations, edema.
Skin
Denies rashes, bruises or bleeding, or change in skin lesions.
Respiratory
Denies cough, SOB.
Eyes
Denies visual changes
Gastrointestinal
Denies abdominal pain, N/V/D, constipation, eating disorders or ulcer
Ears
Denies ear pain or hearing loss.
Genitourinary/Gynecological
Denies dysuria or incontinence. Reports last PAP 2010, normal. 3 live births.
Nose/Mouth/Throat
Denies congestion or sinus problems. Denies nosebleed. Denies dental disease. Denies sore throat or hoarseness
Musculoskeletal
Reports throbbing lower back pain, radiates to Left buttock and down to left leg/calf for 3 days. Worsening and causing pain when ambulating. Not relieved by rest, position change or Ibuprofen. Denies history of similar problems. Denies joint swelling or history of arthritis.
Breast
Reports regular SBE, Denies lumps or mass. Last mammogram March 2020
Neurological
Alert and oriented x 4. Denies syncope, seizures. Reports stinging a ...
Cardiovascular history taking is an important skill that is often assessed in bedside teaching . It’s important to have a systematic approach to ensure you don’t miss any key information. The guide below provides a framework to take a thorough cardiovascular history.
CONCISE PRACTICAL GUIDE TO HISTORY TAKING AND WORKUP IN OPD BASED SETTINGSNavroz Khosla
A CONCISE GUIDE FOR STUDENTS, INTERNS (FRESH LEARNERS)
ALL MEDICAL PROFESSIONALS EITHER INVOLVED IN TEACHING ,TRAINING OR PRACTICING SENIOR DOCTORS COULD ALSO USE IT FOR QUICK REVISION.
DUE TO LACK OF A CONCISE PRACTICAL GUIDE FOR HISTORY TAKING I PRESENT UNDER GUIDANCE OF DR.N.K. GOEL (HEAD OF THE DEPARTMENT)
AND ALL RESPECTED FACULTY
DEPARTMENT OF COMMUNITY MEDICINE
GOVERNMENT MEDICAL COLLEGE & HOSPITAL
CHANDIGARH
DR. KHOSLA NAVROZ
History Taking
1.Name, age, sex, marital status, occupation, address (Demographics)
2. Presenting complaints
3. History of present illness
4. Systemic inquiry
5. Past history
6. Menstrual history
7. Treatment history
8. Family history
9. Personal and social history
10. Occupational history
Diagnosis of inflammatory arthritis - Dr Louise Warburtonpcsciences
Co-host of the 2017 Musculoskeletal Education Day, Dr Louise Warburton helps healthcare professionals understand the difficulties in diagnosing inflammatory arthritis
History taking (History of Physical Examination)pankaj rana
A History of Physical Examination Texts and the Conception of Bedside Diagnosis. ... Throughout this paper we construct a difference between a “bedside diagnosis,” made when the physician and patient are in each other's presence, and a “remote diagnosis,” made when the patient and physician are separated.
USING AUDIO DIARIES FOR RESEARCH AND EDUCATION.pptxAgabaSaphan
Audio diaries are an underutilized but important tool in longitudinal qualitative research
This PPT summarizes guidelines on how to approach Audio-diaries as a research method
This is a compilation guiding nursing students and nurses on how to best taking history of the the patients and be able to identify nursing concerns as practicing nurses or for gaining knowledge as students.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. INTRODUCTION
• History taking skills are an essential
component in a nursing curriculum and
practice
• Forms the base for reaching a correct
diagnosis
3. Definition
•A patient narrative facilitated by a health
professional to obtain specific information about
the patient to aid in formulating a diagnosis and
decision making
4. KEY PRINCIPLES IN HISTORY TAKING
• Always listen to the patient
• Privacy and confidentiality loosen up the patient
• 80% of the diagnoses are through history taking alone
• Always use a systematic approach
• Never forget IPC protocols
• Rapport is significant. You are not a robot
• Patient comfort (physical and emotional) is critical
• Patient has rights
• Summarize each stage of History before the next
• Clear, legible and accurate documentation
5. First Impression
“You never get a
second chance to
make a first
impression”-unkown
• MAKE A POSITIVE
FIRST IMPRESSION
• Appearance
• Body language
• Confidence
• Demeanor
6. STADARD FORMAT FOR HISTORY TAKING
1. Bio-data
2. Presenting/chief
complaint
3. History of Presenting
complaint
4. History of past
illnesses –medical &
Surgical.
5. Drug/ Medication
History
6. Family History
8. Social History
9. Review of systems
7. 1. Bio-data
•Name
•Age & DOB
•Address
•Sex
•Tribe
•Religion
•Occupation
•Next of kin
•Contact information
•Who gave the
information (Primary
Vs Secondary source)
8. 2. Chief complaint
• The single most critical concern to the patient
• What brings you to the hospital today?
• What seem to bother you today?
Critical Thinking?
Have I clearly understood the patient’s chief complaint?
What system could be affected?
Patient uses his own words to describe their reason for visiting the hospital
Record this complaint with its onset and duration
If patient has many complaints, you can ask… If I could make one thing better
for you today, what would it be?
9. 3. HISTORY OF PRESENTING COMPLAINT(s)
SYMPTOM ANALYSIS
Details of the current complaint are expounded further.
How does the complaint affect Activities of daily living
SOCRATES
Site-Onset-Character-Radiation-Associated symptoms-Timing-
Exacerbating factors-Severity
PQRST
OLDCARTS
12. Sample Hx of PI
• Patient reports having been well at least 2 days before admission
when the patient fell off a motorcycle and injured his right foot. 3
hours after the incident, the foot got swollen and patient couldn’t
step on his right foot. On the same day, the patient attended the
nearby clinic where he received an injection unknown to him to
relieve the pain. However, patient reports no improvement was
realized.(dose) but doesn’t feel this pain anywhere else.
13. 4. Past medical history
• Past Illnesses
• Any chronic illness
• Hospitalizations
• Operations
• Any past illnesses that could be related to today’s complain
• Any history of similar complaints in the past?
• Any allergies?
14. 5. Medication History
• Current prescriptions and any other for longstanding illness
• An accurate medication history provides a foundation for assessing
the appropriateness of a patient’s current therapy and directing
future treatment choices.
15. 6. FAMILY HISTORY
•Some illnesses are familial while
others are genetic
•Parents and siblings suffer from the
same?
For example: Patient with anemia,
does anyone else at home
experience these symptoms ???
Sickle cell Anemia?
16. 7. Social History
•Smoking History: Type,
amount, Frequency, duration
•Alcohol use: Type, amount,
Frequency, duration
•Any addictions?
•Sexual History
•Risk for Occupational hazards?
17. 8. REVIEW OF SYSTEMS. Main Points
SYSTEM GUIDING SAMPLE QUESTIONS
General health How do you feel compared to normal? How is your appetite?
Have you lost/gained weight? Do you feel more tired than
normal?
Respiratory (Resp) Any breathlessness? Colds, coughs, wheezing? Sputum?
Colour?
Cardiovascular (CVS) Any chest pain or breathlessness? Palpitations or dizziness?
Any oedema?
Nervous system (CNS) Any headaches or visual disturbance? Numbness or tingling?
Any fits? Balance problems? Tremors? Any (new) speech or
hearing problems?
Gastrointestinal (GI) Any episodes of D&V? Any abdominal pain? Any change in
bowel habit, or blood in stool? Weight loss/gain
18. 8. REVIEW OF SYSTEMS. Main Points
SYSTEM GUIDING SAMPLE QUESTIONS
Genitourinary (GU) Any change in frequency of urination? Burning or stinging sensation?
Blood in urine? Discharge? Last menstrual period? Any risk of
pregnancy? Any unprotected sexual contact? (If appropriate to ask)
Bones/muscles/joints (BMJ) Any new joint pain? Any stiffness or aching? Decreased mobility?
Other Endocrine problems —excessive thirst, sweating? Intolerance to heat or
cold? Bleeding or bruising? Rashes? Any swollen lymph nodes?
Note: This is not an exhaustive list
19. CONCLUDE THE HISTORY TAKING EXERCISE
•Give a summary to the patient
•Ask/check if you understood the information
correctly
•Any other information you would like me to
know? Ask the patient
•Advise on what the plan will be or next step
•Involve patient in planning
20. Common Pit falls
• Difficult patient
• Using a tone of voice that sends a wrong message..
What is your problem today, why did you come here
today?
Poor choice of words – Using jargons
