LTCtyphon

CC: “I think I had a mini stroke” HPI: 77 y/o female with PMH of HTN, CAD s/p stents 2017, hypothyroid, anxiety, glaucoma, and mitral valve regurgitation presenting with dysarthria x3 days ago. Patient states 3 days ago as she was eating lunch with her family, she suddenly “couldn’t get the words out”. Patient states this lasted for about 15 minutes and she was able to walk and move all extremities during the episode. Patient admits to intermittent heart palpitations which are happening more frequently. Patient states she went to rest afterwards. She attributes her symptoms to exhaustion and pain …

My LTC rotation was located at St. Francis Hospital. Each morning, I would meet with my preceptor whose medicine service consisted of nearly 60 patients. He would assign me 4 to 5 patients daily, and I would conduct my own history and physical examinations, and create my assessment and plan. Since I had note writing ability on EPIC, I was able to type a full H&P, which was then reviewed by my preceptor and cosigned by him. This allowed me to gain great experience with EPIC and being comfortable writing notes as a future certified PA. The patients I saw …

Worsening Physical Function during Hospitalization is Associated with Poor Outcome in Patients with Acute Decompensated Heart Failure article Gait speed (GS) is a simple assessment of physical function and a predictor of cardiovascular events in the elderly population with heart failure. In this study, 445 patients diagnosed with congestive heart failure were chosen to undergo exercise during hospitalization. Physical examinations and a 10 meters walking test was conducted to evaluate gait speed at the beginning of training and before discharge. Patients were evaluated after discharge on poor outcomes, hospital readmissions, and mortality. At both time points, NT-proBNP and nutritional status …

During my site evaluations, I presented 3 H&Ps, 10 drug cards and an article. One of the patients I presented was a elderly female presenting with dysarthria and heart palpitations lasting 15 minutes 3 days prior to being evaluated in the emergency department. Upon evaluation, she was completely asymptomatic and showed no signs of stroke. Her head CT was negative, however, the head MRI was consistent with a posterior lobe ischemic stroke. This patient was also diagnosed with paroxysmal atrial fibrillation on evaluation, which I learned most likely caused her blood clot. After presenting this case, my site evaluator was …