In crisis interventiоn, which technique is mоst cоmmonly used in the initiаl phаse to help individuаls gain a sense of control and stability?
Cоnvert frоm pоunds to kilogrаms, rounding to the neаrest tenth. 44 lb = __________ kg
Belоw is а cоpy оf the informаtion provided to you аs supplement to the door chart: Part 2 – Door Chart/Note & Learner Instruction Setting (place/time) OB/GYN Office Arrived via private car with spouse Patient Name: Geannie Tambola Age: 44 y/o Chief Complaint: “I’d like to try a new birth control.” Vital Signs: (if applicable) Temperature: 98.8oF/ 37.1oC Heart Rate: 82 beats per min Blood Pressure: 138/84 Respiratory Rate: 16 breaths per min Pulse ox: 99% on RA Weight: 198 lb / 89.8 kg Height: 5’7” (67”) / 170 cm Instructions to Learners: OBJECTIVES: Review the patient history provided below. Revisit and confirm all details relevant to birth control selection with the patient during the encounter. Develop and communicate a treatment plan and provide corresponding education on family planning with the patient. OTHER INSTRUCTIONS: 20 min patient encounter – with 5 min warning DO NOT COMPLETE A PHYSICAL EXAM. Be sure to discuss your reasoning/justification for your proposed treatment to the patient (in order to receive full credit). Past Medical History (PMH): HPI: Geannie is a 44 y/o F who presents for discussion of birth control options, stating “I’d like to try a new birth control.” She reports that she lost her husband (of eightee45DYU89089n years) to cancer 5 years ago and feels that she is ready to begin a sexual relationship with a new partner she met. She denies being sexually active since her husband’s passing and reports a hx of HSV-2 with infrequent genital breakouts (two times per year). She previously used a hormone-based oral contraceptive pill, but she cannot recall the name of that medication. She has been off this OCP for years because her ex-husband had a vasectomy. Although she already has two children, she would not like to close the door on the possibility of having one more child in the future before menopause. She reports occasional irregular menstrual periods, but most recently has had normal interval periods. She denies hx of abnormal Pap smear in the past. She denies any abnormal vaginal discharge or bleeding at this time and notes her LMP was 3 weeks ago. Of note, since her husband’s passing, Geannie reports gaining some weight and expresses concern that she wants to ensure that whichever option she chooses, it will help promote her goal of weight loss this year. Illnesses/Injuries: -Breast Cancer (Type: Early-stage DCIS (Ductal carcinoma in situ). This was found in time to do breast-conserving therapy and radiation. Underwent R breast lumpectomy 3 years ago. No recurrence since on subsequent evaluation.) -Complicated grief (diagnosed after her husband’s death, now resolved) -Hypertension -HSV-2 (infrequent genital herpes breakouts, 1-2 per year) -Obesity (BMI = 31 at present) OB-GYN History: -G2P2002. Normal spontaneous vaginal delivery of children. Normal Pap smears with most recent pap smear being 6 months ago. Menarche 14 yrs old. Menstrual periods reported to vary and have been 4-5 days in length as of lately. Hospitalizations: For the birth of two children only (9 and 11 years ago) Surgical History: Right breast lumpectomy (tumor removal) – 3 years ago at age 41. Screening/Preventive (if relevant): No reported abnormal pap smears in the past. HPV testing negative. Medications (Prescription, Over the Counter, Supplements): -Escitalopram 10 mg PO daily -Lisinopril 10 mg PO daily -Valacyclovir 500mg PO once daily -Tamoxifen 20mg PO once daily (for breast cancer recurrence reduction) Allergies (e.g. environmental, food, medication and reaction): -NKDA Family Medical History: Family history: -Father: alive, 78 years old. Known hx of hypertension, DM, and obesity. -Mother: alive, 75 years old. Known hx of HTN, cholesterol problems, obesity. -Sister: alive and well, age 42 -Children (2): Sons (2), ages 9 and 11, both alive and healthy Social History: Substance Use (past and present) Drug Use: Denies Tobacco Use: Pt was a former tobacco smoker and quit 15 years ago, but pt admits use of “a few” cigarettes per day for stress relief since her husband’s passing (less than a pack per week). Alcohol Use: Drinks occasional alcohol, at 2-3 glasses of wine across each weekend. Home Environment Living in a rental home with her children west of La Jolla Occupation Management level employee at Sea World Leisure Activities Pt enjoys watching reality TV, cooking, and walking in her spare time Diet No specific diet followed. Eats fast food often due to her busy schedule Exercise Walks 30 min 2-3 times per week Religious Practices Christian Sleep 6-7 hours a night Sexual History Pt recently widowed, not currently sexually active currently, but wishes to be in the near future. Laboratory Orders: b-HCG / pregnancy testing - Result: negative Urine dipstick - Result: unremarkable, all findings within normal limits STI testing offered (gonorrhea, chlamydia, Wet mount- yeast/BV, trichomoniasis, HIV, RPR, Hep B/C) - Result: all negative Physical Exam: Gen: Pt is well-developed, well-nourished, pleasant with normal affect Cardiac: RRR, S1/S2, no murmurs Pulm: CTAB, no crackling, wheezing, rales Abdomen: Soft, nontender, +BS X 4 Extremities: No edema, no palpable cords, negative Homan’s bilaterally Pelvic Exam: Multiparous cervix, anteverted, no adnexal masses or tenderness External genitalia: Normal; no lesions or masses Vagina: Pink, moist, well rugated; no blood or abnormal discharge present Cervix: Multiparous, no lesions, no discharge or bleeding present