Study Tаble 8 "The Chаnging Cоmpоsitiоn of Federаl Spending" on page 107 and answer the following questions 1. What does Table 8 represent?
Histоry оf Present Illness: 78 yо mаn who wаs in the hospitаl 3 weeks ago with chest pressure. He had intermittent chest pressure for 10-12 days prior to admit. Pt ruled in for a MI with an initial troponin of 0.89 ng/ml. Patient underwent a cardiac catheterization and was found to have severe left main coronary artery disease and RCA stenosis. Patient underwent CABG x 3 with bilateral endoscopic vein harvest from his LEs. His post-op course was complicated by anemia, paroxysmal atrial fibrillation, and acute renal insufficiency. Pt was admitted to a SNF after his hospital stay for rehabilitation 6 days later. Labs on admit to SNF: WBC 6.0 RBC 3.60 Hgb 12.1 HCT 34.6 BUN 33 Cr 1.3 Medications: Metroprolol (beta blocker), plavix, amiodarone (antiarrhythmic), nitroglycerin (patch), terazosin (for enlarged prostate), baby aspirin, simvastatin (for cholesterol tx), spiriva, advair, albuterol (bronchodilator), citalopram (SSRI for depression), prilosec, Percocet for back pain PMH: Depression, anxiety, mild-mod COPD, asthma, L bundle branch block, benign prostate hypertrophy, hyperlipidemia, diverticulitis, L heel plantar fasciitis, basal cell carcinoma of R eyebrow, GERD, degenerative disc disease (lumbar) PSH: Left inguinal hernia repair (1990), right inguinal hernia repair (1995), benign neoplasm under L great toenail (2001), R cataract (2002), L cataract (2003), excision of keratosis L face (2003) Family History: Mother: pancreatic cancer, died at age 89, Father: stroke and asthma, died at age 88 Social History: The patient is English speaking and R hand dominant. He denies tobacco, alcohol or illicit drug use. He is divorced and his primary social supports are his 2 daughter in laws (out of state), friends nearby and his cousin is health care proxy. He is retired and is involved in his church and community activities (assists the chaplain in the Alzheimer’s unit of his retirement home). He enjoys walking, playing cards and listening to music. Living Environment: Lives alone in senior retirement community. He has no stairs and the facility has elevator access. Prior Level of Function: Patient was independent with all mobility, ADLs, and IADLs prior to admit. He drove. No regular exercise program but does walk around his retirement community at time, has no DME. Patient Goal: Return to his independent living in his apartment in the senior retirement community Chief Complaint: Chest pain (resolved) shortness of breath with any activity Systems Review Last Vitals: Blood Pressure (BP) : Supine 122/54 Sitting 118/54 Standing 118/56 Tests and Measures Aerobic Capacity: Ambulating 100’ with RW and CGA with following hemodynamic response RESTING DURING WALKING 3 MIN RECOVERY HR (beats/min) 64 86 69 O2 (room air) 96% 96% 97% BP RR 118/54 18 124/56 34 116/52 28 BORG RPE SCALE N/A 15 N/A Balance: Berg Balance Scale 38/56 Practical Examination: Patient is in Skilled Nursing Setting, and is due for their 1-week reassessment, proceed with your evaluation/assessment/interventions/education. I have read the above case and am prepared for the practical exam:
Histоry оf Present Cоndition: 65-yeаr-old femаle with obesity аnd complaints of shortness of breath for approximately 2 years, worsening over the last 4 months. She has had an extensive workup and the etiology of the shortness of breath appears multifactorial. She has referral for home health PT for a progressive activity program. PMH/PSH: Hypothyroidism, Melanoma of nose 2 years ago, Polymyositis 20 years ago, Raynaud’s syndrome, Glaucoma, Mastectomy 12 years ago, Hysterectomy, Bil. THR due to Avascular Necrosis 1 year ago and 2 years ago, Spinal fusion L5S1 Medications: Noroxin, lasix, naproxen, norvasc, benadryl, xalatan eye drops Social History/Habits: Retired psychiatric nurse; married and lives with husband in split entry home , 5 steps to enter; bathroom and bedroom on upper level; laundry on lower level; pt rests on landings 2˚ to SOB. Smoked 1ppd x 40 years, quit 11 years ago. No ETOH. Does not drive. Functional Status/Activity level: Independent with basic ADL; shops with a cart to lean on; difficulty walking beyond that. Systems Review: Alert, oriented x3, good historian. Learns by verbal instruction and demo Ht 63.5 inches Wt 247 lbs BMI 43.1 Vitals: HR 80 and regular (see telemetry strip) RR 16, BP 156/76 R, SpO2 98% on room air. Labs/Tests: PFT’s: recent tests reported mild restrictive abnormality, TLC 81% predicted; normal FEV1/FVC ratio Stress Echo: Normal function in all segments, mildly hypertrophied L ventricle, estimated LVEF 60%, no outflow tract gradient or AR, mild MR, PA pressure > 58 mmHg. Dobutamine Stress: (1 month ago) Peak HR 133, BP 142/86, RR 38 Sinus rhythm, occasional premature atrial contractions (PAC) Aerobic Capacity and Endurance: Performed 6 minute walk test, covering 910 feet; rested x 3 for less than 20 seconds each time; notes chest pressure at peak of walk. HR RR BP SpO2 (RA) Dyspnea Rating (0-10 scale) Rest 84 16 150/80 98% 2/10 Peak 130 32 170/74 99% 8/10 Practical Exam: You are the assigned physical therapist arriving for the patient’s first home health physical therapy appointment, proceed with your evaluation/assessment/interventions/education. I have read the above case and am prepared for the practical exam: