Here is a prioritized list of the patient's problems:
1. Constipation r/t obstruction
2. Acute Pain r/t obstruction
3. Acute pain r/t surgical incision
4. Altered comfort secondary to pain
5. Fatigue r/t post-operative experience
6. Impaired Skin Integrity r/t surgery
7. Altered Health Maintenance r/t choice of health practices
8. Health-Seeking Behavior r/t concern for health status
9. High Risk for Injury r/t developmental age
10. Readiness for enhanced ability to eliminate waste products r/t post-operative experience
Palliative Care and Acute Oncology IntegrationRecoveryPackage
Dr Catherine O'Doherty, Consultant in Palliative Medicine, Trust Acute Oncology Lead and Lead Cancer Clinician, Basildon and Thurrock University Hospitals NHS Foundation Trust
Karen Andrews, Head of Nursing for Macmillan/Acute Oncology and EOL services, Basildon and Thurrock University Hospitals NHS Foundation Trust
Avoiding errors in diagnosing abdominal painDr Varun Patel
Diagnosing Abdominal pain is Emergency department is a tough task. This presentation covers all possible causes of Abdominal pain. As an Emergency Physician you need to look through all these causes of Abdominal Pain in order to not miss a diagnosis.
OBSTRUCTED LABOR is an emergency that poses significant risk to the life of both mother and fetus. A condition usually associated with low socioeconomic status puts much burden on the fragile health care delivery in subsaharan Africa
STARR Surgery for ODS | Defecography in Pune | Healing Hands Clinic Punehealinghandsclinic Pune
Healing Hands Clinic is a unique and speciality clinic for constipation,piles, hernia & prevention of Lifetstyle diseases. Apart from its heart of the city location, expert consultation, state of the art technology and well qualified staff are few of its assets. It is the first clinic in the city to deliver facility of Defecography for constipation. Our focus, dedication and inner feeling of curing or treating the patients with care have given us many satisfied patients.
Constipation due to difficulty in passing stools once it has reached rectum as a result of Rectorectal Intussusception (Internal Rectal Prolapse) or Rectocele.
SOAP NOTE
Name: J.D.
Date: 03/26/2020
Time: 2:00 pm
Age: 25 y/o
Sex: F
SUBJECTIVE
CC:
” I have a lot of pain on my left side, in my lower belly”
HPI: J.D. is a 25-year-old white female that came to the office today complaining of pain in her lower abdomen. The patient has always had painful cramps with her periods but this time it is much worse being described as a 6 out of 10 and lasting up to 5 hours. The pain started 2 days ago. The pain is described as more painful cramps. It is debilitating and prevents the patient from performing most daily activities. It is localized in the lower abdominal area, and sometimes radiates down her legs, and to her lower back. The patient uses hot compresses to relieve the pain as Tylenol does not work. The patient also states that she has been feeling nauseous ever since the pain started. She also urinates more frequently and pain on urination. Denies fever, vomiting, or chills.
Medications:
2 Tylenol as needed for her pain
PMH (include-immunization status including Gardisil, GTPLA).
Current or past illnesses: No current or past illnesses
Immunizations: All vaccines updated including flu vaccine and Gardasil.
Allergies: NKDA
Medication Intolerances: None.
Chronic Illnesses/Major traumas: None.
Hospitalizations/Surgeries (include delivery of pregnancies here)
No hospitalizations.
G0P0
Family History
Mother: 49 years old, no significant health problems
Maternal Side: No significant health problems
Father: 50 years old, hypertensive
Paternal Side: no significant health problems
Social History
Patient works full-time as a research assistant at a local university. A full-time student seeking a master’s degree in biochemistry at a local university. Married. Sexually active only with husband. Always uses male condoms as contraceptive device. Does not use recreational drugs, tobacco, or electronic cigarettes. Devout follower of Christianity. Denomination: catholic.
ROS
General Patient denies fever or chills, no weight changes.
Cardiovascular Denies chest pain, or discomfort. Denies palpitations, dyspnea, or orthopnea.
Skin: Denies presences of moles, rash, or itching.
Respiratory: Denies dyspnea, cough, hemoptysis, or pleuritic pains.
Eyes Denies problems or changes in her vision; denies double or blurred vision.
Gastrointestinal Positive for nausea.Denies hemorrhoids, constipation, or diarrhea. No variation in bowel habits. Denies vomiting.
Ears Denies difficulty or changes in his hearing. Denies tinnitus, or discharges.
Genitourinary/Gynecological Menarche 11 years old. Regular menstrual periods starting around the 3rd week of every month. LMP: 03.
Similar to Sample Gordon's Functional Health Pattern: Intestinal Obstruction Powerpoint Presentation (20)
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2. A. Health Perception and Management
Prior to admission:
•Can only recall being immunized with BCG and DPT
•Rarely visits a doctor to have a check-up and seek for
medical assistance
•Uses herbal medicines such as oregano, guava, bitter
gourd, and ginger
•Buys and takes over the counter drugs such as Solmux,
Neozep, Biogesic, Mefenamic acid, Diatabs, and
Loperamide.
•Stopped taking multivitamins Enervon
•When sick, goes to the manghihilot or just waits for
the sickness to heal
3. •Practices healthy lifestyle and depends on fruits and
vegetables
•No vices since young such as drinking alcoholic
beverages and smoking cigarette
•After experiencing difficulty in defecating, she
decided to see a physician
During hospitalization:
•Oriented
•Conscious and coherent
•Concerns for her surgical site after incision and repair
•Willing to accept and listen to health teachings
•Shows interest to recover easily and fast
•Always prays to God
4. B. Nutrition/ Metabolism
Prior:
•Eats more of fruits and vegetables
•Eats her meals 3x a day with snack in between
•Can drink up to 1.5L of water or 4-5 glasses a day
•Drinks coffee in the morning and in the afternoon
•Claimed to be allergic on shrimps and claimed to have
good appetite
5. During:
•Weight: 41 kg
•Height: 4 ft and 10 in
•Normal Body Mass Index; BMI = 18.89 kg/m2
•Average Body Temperature is 360 C
•Able to fast in preparation for surgical procedure
•Before operation, being infused with an IVF of D5NM 1L x
160 hooked at her left cephalic vein
•After operation, being infused with an IVF of PLR 1L x 8
hours as main line hooked at her left cephalic vein with a
side drip of PNSS 500mL + 2 ampules Voltaren at 20cc/hr
and an IVF of PNSS 1L x KVO hooked at her right cephalic
vein with a side drip of 2units PRBC
•On NPO
6. C. Elimination
Prior:
•She voids 4-5 times a day
•Her urine color is yellow which is dark most of the times
•There is no burning sensation/ pain felt during urination
•She usually moves her bowel every morning
•With brown and formed stools. But recently, she is having
difficulty in defecating
•The impression to the result of the ultrasound of her whole
abdomen is to consider ileus; partial obstruction and fecal
stasis
7. During:
•No pain or burning sensation during urination
•Before operation, she experienced vomiting with
yellowish vomitus and hasn’t move her bowel all
throughout the 8 hour shift
•After undergoing the surgical procedure, a nasogastric
tube is used which is attached to a drainage bottle; a
colostomy is present attached to a colostomy bag
•After operation, a foley catheter was used which is
attached to the uro bag draining well with dark yellow
urine with an output of 175 cc was taken after the shift
8. D. Activity/Exercise
Prior:
•The patient ambulates within the house
•She does household chores
•She takes a walk at their subdivision to visit the
neighbors and buy at the store
•She does simple exercises on the upper and lower
extremities by means of shaking and stretching
•Able to bathe herself
9. During:
•Reaction to stimuli are slower
•Decreased strength; becomes weak in prolonged activities
•Decreased speed of movement
•Limited range of motion
•Radial pulse rate easily palpable and heard
•PR: 70 bpm
•RR:18 cpm
•BP: 110/80 mmHg
•Before operation, patient can turn to sides with slight
discomfort and can ambulate with assistance
•After operation, patient is on bed rest; flat on bed and
shows evidence of weakness
•Steady and in deep sleep for 4 hours
10. E. Sexuality/ Reproductive
•Married
•A mother of 4 children
•Menarche was on the year 1938 when she was 11 years
old
•On her menopausal stage
•She has no history of Sexually Transmitted Disease or
any disease affecting her genitals
11. F. Cognitive/Perceptual
Prior:
•No sensory deficits but functions are diminished due to age
•Oriented to people, time, and place
•Responds to stimuli verbally and physically
•Pain felt radiating on the abdomen
During:
•Pre-operative Phase
•Before operation, she verbalized, “Sakit kaayo akong tiyan
tapos butod ko. Magbalik-balik ang sakit.”
12. •She rated pain as 8, from a pain scale of 1-10, 10 as the
highest possible pain perceived
•She claimed that pain starts at the right upper quadrant
and radiates all throughout the abdomen
•Claimed pain to be intermittent
•In normal thought process
Post-operative Phase
•“Akong tahi, nagasakit pa.”, as verbalized
•Felt pain around the surgical site
•Slight facial grimacing
•Can respond to stimuli verbally and physically with
weakness noted
•Believes that pain felt is due to post-operative experience
13. G. Roles/Relationship
Prior:
•Married
•With 4 children
•Lives with the youngest child
•Close to her grandchildren
•Loves her family so much
•Well – supported and loved by her family with close
relationship
During:
•Well – supported by the family
•Still plays the role of a mother despite condition by means
of reminding important matters to her children
14. H. Self-Perception/Self-Concept
Prior:
•Manages to practice healthy lifestyle so as not to seek medical
assistance
•Recently, she believed that admission will be helpful to assist her in her
needs, to alleviate the pain she felt, and to correct her bowel
•Hopeful to be relieved and treated
During:
•Though weak, she still manages to appear calm and relaxed
•Agreed to be operated and undergo surgery and gives her trust to the
surgical team
•Hopeful and positive to have a successful operation
•Before operation, she prays all the time
•She desires that no complications will arise after the surgery
•Major concern is her recovery
15. I. Value/Belief
Prior:
•A Roman Catholic
•Have strong faith in God
•She always brings with her the rosary and always prays at
night
•She goes to the church with her youngest child and her
grandchildren to attend the mass every Sunday
During:
•No restrictions in the procedure brought by religion
•The admission and surgery don’t interfere with spiritual
practices
16. J. Coping/Stress
Prior:
•Copes up with stress by doing household chores and by
taking a nap or sleep
•Copes up with problems by talking about it with the family
and finds ways to resolve it together
•No traumatic events experienced before
•Reason for admission is to alleviate the pain and correct
her bowel
•Went to hospital and sought for medical assistance after
experiencing inability of defecating
During:
•Takes a nap and rests when tired
•Verbalizes desires to recover
•Able to accept situation by cooperating with the medical
advices and procedures
17. K. Sleep/Rest
Prior:
•Can sleep for 7-9 hours per night
•Straight hours of sleep
•Her earliest time in going to sleep is at 9:30 PM
•Latest time in waking up is at 6:30 AM
•She sometimes takes a nap at noon for about 1-3 hours
•No difficulties in going to sleep
•Doesn’t uses any medication to promote sleep
During:
•Sleeps at 8:00 PM
•Wakes up at 6:00 AM
•Can consume 10 hours of sleep
•Sometimes, she is distracted and sleep is interrupted due
to pain, administration of medication and visitors
•With rest intervals, usually naps for 4 hours
18. L. Medication History
Prior:
•Took Bentyl and Loperamide
During:
•Pre-operative Phase
•IVF of D5NM 1L x 160
•Completed 6 doses of Kalium Durule 1 tab TID
•Completed 3 doses of Senokot Forte 2 tabs BID
•Administered with Motillium 10 mg 1 tab TID
•Nexium 40 mg 1 tab OD
•Lactulose 30 cc
19. Post-operative Phase
•IVF of PLR 1L x 8 hours as main line with a side drip of
PNSS 500mL + 2 ampules Voltaren at 20cc/hr
•PNSS 1L x KVO with a side drip of 2units PRBC
•On NPO
•Administered with Cefuroxime 750 mg q80 IVTT
•Metronidazole 500 mg q80 @ am
•Omepron OD 40 mg IVTT
•Voltaren 20 cc/hr
•2nd dose of 12 doses Nalbuphine 5 mg q60 IVTT
•Nebulized with Convibent q80
20. Problem List
Problem Date Time Date
Identified Resolved
1. Constipation r/t obstruction 12-13-10 8:30 AM 12-13-10
as manifested by difficulty
and inability to defecate,
abdominal distention, result
of diagnostic test, and
vomiting
2. Acute Pain r/t obstruction as 12-13-10 8:35 AM 12-13-10
manifested by pain rate of
8, from a pain scale of 1-
(Monitori
10, 10 as the highest ng)
possible pain perceived,
claims of intermittent
radiating pain on the
abdomen, and abdominal
distention
21. 3. Altered Health Maintenance 12-13-10 9:30 AM 12-13-10
r/t choice of health
practices as manifested by
not seeking medical
assistance if ill
4. Health-Seeking Behavior r/t 12-13-10 9:35 AM 12-13-10
concern for health status as
manifested by healthy lifestyle
and desire to be treated and to
recover
5. High Risk for Injury r/t 12-13-10 10:00 AM 12-13-10
developmental age as
manifested by decreased
strength, weakening, and
limited range of motion
6. Acute pain r/t surgical 12-14-10 8:30 AM 12-14-10
incision as manifested by
verbalization of perceived pain (Monitorin
around the surgical site, and g)
slight facial grimacing
22. 7. Altered comfort secondary to 12-14-10 8:35 AM 12-14-10
pain as manifested by frequent
sighing and complaints of pain
8. Fatigue r/t post-operative 12-14-10 9:00 AM 12-14-10
experience as manifested by
evidence of weakness and
deep sleep
9. Impaired Skin Integrity r/t 12-14-10 9:15 AM Not yet
surgery as manifested by resolved
presence of surgical incision
and colostomy
10. Readiness for enhanced 12-14-10 10:30 AM 12-14-10
ability to eliminate waste
products r/t post-operative
experience as manifested by
proper management and
cooperation