Jorge ELoy Perez Acosta
Registered Nurse
Optum Infusion Services
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Clinicals / Clerkships / ExternshipsUpdated: 02-16-20
200216113306_6440_Verification_of_Clinical_Hours_1.pdf (.pdf) 0.22mb
200216113132_NSG6440_Verification_of_Clinical_Hours_Log1.pdf (.pdf) 0.21mb
200216111904_NSG6440_Verification_of_Clinical_Hours_Log2.pdf (.pdf) 0.19mb
Competency AssessmentsUpdated: 02-16-20
200216111236_Student_Final_Evaluation_6440.docx (.docx) 0.03mb
200216110859_Preceptor_Evaluation_NSG_6440.docx (.docx) 0.01mb
Verification Hours Log NSG6440 Primary Care 12-04-2019 to 12-30-2019
200216113306_6440_Verification_of_Clinical_Hours_1.pdf (.pdf) 0.22mb
Verification Hours Log NSG6440 Primary Care 01-02-2020 to 01-24-2020
200216113132_NSG6440_Verification_of_Clinical_Hours_Log1.pdf (.pdf) 0.21mb
Verification Hours Log NSG6440 Primary Care 02-03-2020 to 02-12-2020
200216111904_NSG6440_Verification_of_Clinical_Hours_Log2.pdf (.pdf) 0.19mb
Case Log - Use as of 7/11/2019
| Date: | 02/05/2020 |
| Rotation Type: | NSG6440 |
| Comments: | HPI. A patient is a 48-year-old male with a previous history of repeated, purulent respiratory tract infections in the least five months treated with antibiotics. The patient complains of a primary physician because he continues with persistent and recurrent cough with purulent sputum production. Sputum is always mucopurulent and on this occasion, he reports copious, foul-smelling, purulent sputum with blood. Blood in sputum is red in small quantity and with cough and taste of blood. The patient refers shortness of breath, wheezing, fatigue, with chest pain that increases during breathing and weight loss. |
| Diagnostic Codes: | J47.9 | Bronchiectasis, uncomplicated |
| Patient Age: | 48 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 55 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough with blood sputum" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN (Kassutto &Weinberger, 2019). Referral patient to be admitted into Hospital. Registration of pulse-oximetric oxygen saturation (SpO2), respiratory and circulatory function (non-invasive blood pressure measurement; assessment of risk involved in interventional procedures and medicinal treatment. Patients should be placed in the lateral decubitus position with the affected lung in a dependent position to avoid pooling of blood in the unaffected lung. Annual vaccination against influenza and vaccination against S. pneumoniae. Patients that are breathless will benefit from pulmonary rehabilitation as is the case with other respiratory disorders, and patients should be encouraged to exercise. Spirometry Airway clearance Teaching patients of symptom monitoring. Chest physiotherapy/respiratory therapy Ciprofloxacin 750 mg twice daily for 14 days p/o. Follow up. Daily. Consult with Pulmonologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Spirometry in office Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 02/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-year-old woman with a previous history of health that visits the primary physician because she has intermittent inflammation in the inferior portion or either labium minus with tenderness and purulent discharge. |
| Diagnostic Codes: | N75.8 | Other diseases of Bartholin's gland |
| Patient Age: | 25 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 37 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 50% |
| Chief Complaint: | "I have inflammation in the inferior portion of either labium minus |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Count blood cells with leukocytosis and left deviation. C reactive protein is positive Chlamydia test Culture of discharge. Marsupialization (in the absence of an abscess), incision and drainage with the insertion of an indwelling Word catheter, or laser treatment will establish a new duct opening. Ibuprofen 200mg twice per day. Avoid physical activities. Follow up: By primary physician Education: Fundamental to the treatment of bartholinitis. Do not return to school for 3 weeks Emphasized to patient the importance of completing the full course of rest and symptomatic treatment. PREVENTION: Avoid physical activities. PROMOTION: Educate caregiver about. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Pelvic Exam |
Case Log - Use as of 7/11/2019
| Date: | 02/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-year-old female with a previous history of health that in the last three weeks she had changes in the work and problems with her husband. He started with intense fear and discomfort associated with palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and a fear of impending doom or death. Patient reports sensation of numbness in both extremities, and feelings of unreality. The patient reports he is sadness, indifference, apathy, or irritability. |
| Diagnostic Codes: | F41.8 | Other specified anxiety disorders |
| Patient Age: | 25 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 42 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have intense fear" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Psychiatric evaluation. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Count Blood Cells. Thyroid Function Test. Fasting Glucose, Insulin and Hemoglobin A1C. Blood tests of Vit B12 Plan Treatment planning requires coordination of short-term strategies to induce remission combined with longer term maintenance designed to prevent recurrence. The most effective intervention for achieving remission and preventing relapse is medication, but combined treatment, incorporating psychotherapy to help the patient cope with decreased self-esteem and demoralization. A short course of a benzodiazepine is usually indicated, preferably lorazepam 10 mg one tab daily p/o. Sertraline (Zoloft) 50 mg daily p/o. Behavior therapy (exposure plus response prevention) and cognitive behavior therapy |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 02/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 47-year-old female with a previous history of upper respiratory infection one week ago. She complains of a primary physician because two days ago he started with a fever and green nasal discharge. Also, the patient refers to nasal congestion and cough that worsens when lying down. |
| Diagnostic Codes: | J01.90 | Acute sinusitis, unspecified |
| Patient Age: | 47 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 100% |
| Chief Complaint: | "I have fever and green nasal discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Diagnosis is usually made through history and physical. Consider sinus x-ray films, which show air-fluid level and thickening of sinus mucous membranes with sinusitis for chronic or recurrent sinusitis or complicated cases. Computed tomography (CT) of sinuses indications include chronic sinusitis, recurrent sinusisits, allergic fungal sinusisits, or osteomeatal complex occlusion. Plan A. General Interventions 1. Teach patient to avoid smoking and secondhand smoke. 2. Drinking extra fluids helps to loosen secretions and hydrate the body. 3. Encourage patient to use medications as prescribed. OTC medications such as antihistimines and decongestants should be used with caution. 4. Application of warm, moist compresses to the face several times a day will help with discomfort. 5. Humidifiers should be used daily. 6. Nasal saline to the nares three times a day will help to keep nasal passages moist. Augmentin 500 mg orally three times a day or 875 mg orally twice daily for 10 days. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 02/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 47-year-old man with a previous history of health. He complains primary physician because in the least three months he started with cutaneous lesions with itching that appear on the trunk, upper arms, neck, and groin. The lesions are white that varies from 45 mm in diameter to large confluent areas. The patient reports extensive skin discoloration lesions in the trunk. |
| Diagnostic Codes: | B36.0 | Pityriasis versicolor |
| Patient Age: | 47 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 38 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 100% |
| Chief Complaint: | "I have cutaneous lesions" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. Wet prep/KOH B. Woods lamp: Woods light is useful in examining skin to determine the extent of infection. Inspection of fine scales with Woods lamp reveals scales with a pale yellow-green fluorescence that contains the fungus. Culture lesion: When obtaining sample scraping, obtain sample from edge of lesion for best sample of hyphae. (Hyphae and spores have a spaghetti and meatball appearance.) General interventions: Apply medication as directed. Pharmaceutical therapy 1. Selenium sulfide 2.5% (Selsun Blue) a. Apply to skin at bedtime one time. Shower off in the morning. 2. Other medications used a. Clotrimazole 1% cream twice daily for 4 weeks b. Ketoconazole (Nizoral) cream daily for 14 days c. Ketoconazole (Nizoral) 200 mg by mouth once daily for 3 days, for adults only. Follow-Up A. None is required if resolution occurs. B. Monitor LFTs every 6 weeks if patient is on ketoconazole. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 02/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | HPI: A patient is a 40-year-old female with a previous history of bronchial asthma using frequent steroid treatment with 20 mg prednisone daily p/o. He complains of a primary physician because he started with increase abdominal circumference (truncal obesity) progressively also the primary physician diagnosed arterial hypertension three months ago without treatment. The patient reports fatigability and weakness. He also refers to the deposition of adipose tissue in characteristic sites, notably the upper face (producing the typical "moon" facies), the interscapular area (producing the "buffalo hump"), supraclavicular fat pads, and the mesenteric bed (producing "truncal" obesity). He also refers to generalized bruising. |
| Diagnostic Codes: | E24.2 | Drug-induced Cushing's syndrome J45.20 | Mild intermittent asthma, uncomplicated |
| Patient Age: | 40 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "Fatigability and weakness" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Laboratory test: Plasma and urine cortisol levels are decreased. Hypokalemia, hypochloremia, and metabolic alkalosis are present. PLAN (Nieman, 2018). Magnetic resonance scanning. Measuring blood or urine cortisol levels in a basal state Gradual withdrawal of prednisone. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 47-year-old woman with a previous history of health. She complains of a primary physician because in the least three months and after sexual relations without protection she started with lower abdominal pain, fever with chills and she reports increased vaginal discharge that is yellow with a foul smell. She refers to nausea and vomiting. Also, low back pain with abnormal vaginal bleeding out of the menstrual cycle. |
| Diagnostic Codes: | A56.11 | Chlamydial female pelvic inflammatory disease |
| Patient Age: | 47 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 40 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have lower bleeding out my menstrual cycles" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | CBC with differential; WBC greater than 10,500 cell/mm3. Sedimentation rate or Creactive protein. Quantitative beta HCG D. RPR, hepatitis B surface antigen, and HIV E. Cultures for gonorrhea and chlamydia. Endometrial biopsy. Transvaginal ultrasonography. Laparoscopy, by referral. Early treatment with the use of antibiotics of an upper genital tract infection is imperative. Other causes of lower abdominal pain, such as irritable bowel syndrome and endometriosis are not likely to be impaired by empiric antibiotic therapy. Antibiotic therapy should be instituted promptly, based on clinical diagnosis without awaiting culture results, to minimize the risk of progression of the infection and risk of transmission of the organisms to other sexual partners. Pharmaceutical therapy. Ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg orally twice a day for 14 days Follow-Up A. B. Hepatitis B immunization should be initiated in previously unvaccinated persons. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Pelvic Exam STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 78-year-old female with a previous history of smoked one pack of cigarettes a day for 20 or more years before she started with dyspnea, cough, and sputum. She visited a physician who ordered Ventolin 2 puff daily inhaler but the patient did not improve. The patient complains of a primary physician with chronic cough and colorless sputum, that usually worse in the morning. She reports that dyspnea with exertion is progressing and she noted blue discoloration on his fingers and mouth. The patient also refers to wheezing and generalized weakness. |
| Diagnostic Codes: | J44.9 | Chronic obstructive pulmonary disease, unspecified |
| Patient Age: | 78 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have dyspnea and blue discoloration on my fingers" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Pulse Oximertry. PO2. 86% Spirometry is the gold standard for diagnosing COPD. PFTs are used to diagnose, determine severity, and follow the disease progression of COPD. Spirometry before and after using bronchodilator. FEV1 is used as an index to airflow obstruction and evaluates the prognosis in emphysema. FVC. FEV1/FVC ratios less than 0.70 B. CXR (not required to diagnose COPD but rules out other diagnoses) CBC-evaluate polycythemia due to chronic hypoxia Sputum specimen for culture Arterial blood gas (ABG) EKG: Note sinus tachycardia, atrial arrhythmias. Two-dimensional echocardiogram is used to evaluate secondary pulmonary hypertension. Chest CT is an alternative imaging study for emphysema; however, it is not required as a diagnostic tool. Perform a PPD test if TB is suspected. Brain natriuretic peptide (BNP). A. General interventions 1. Educate and encourage active participation in the plan of care, including medication adherence. 2. Smoking cessation plan is an essential part of a comprehensive treatment plan. Develop a smoking cessation plan; assess readiness to quit. Set a quit date; encourage a group smoking cessation program. Discuss smoking at every subsequent visit. 3. Advise to stay away from secondhand smoke and limit exposure to other pulmonary irritants, including extreme temperature changes. 4. Advise exercise with physician approval. 5. Educate and counsel patients regarding advance directives. 6. Consider pulmonary rehabilitation for all stages of COPD. 7. The selection of inhalers is dependent on the patients age and ability to use the inhaler. Patients should be evaluated as to their coordination and inspiration abilities necessary to use inhalers; otherwise aerosol medication via nebulizer is the best delivery method. 8. Have patients bring in their medication/spacers to demonstrate correct use. 9. Consider group visits for teaching sessions. Dietary management 1. About 25% of COPD patients are malnourished because of coexisting medical conditions, depression, and inability to shop for or prepare food. 2. Suggest a low-carbohydrate diet. High carbohydrate intake may increase respiratory work by increasing CO2 production. Long-term oxygen has been shown to increase survival in patients with severe resting hypoxemia. Target oxygen saturation is 88% to 92%. Long-acting β agonist as salmeterol (Serevent) with concomitant inhaled corticosteroids Budesonide DPI (Pulmicort Flexhaler) 180540 mcg. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 50-year-old male with a previous history of arterial hypertension. He uses Amlodipine 10mg p/o daily as antihypertensive treatment. The patient complains of a primary physician because three months ago started with fatigue, palpitations, and shortness of breath. Initially, dyspnea and palpitations were observed only during exertion |
| Diagnostic Codes: | I50.20 | Unspecified systolic (congestive) heart failure |
| Patient Age: | 50 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fatigue and shortness of breath" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | HF patients should be advised to stop smoking and to limit alcohol consumption to two standard drinks per day in men or one per day in women. It is equally important to educate the patient and family about HF, the importance of proper diet, as well the importance of compliance with the medical regimen. Furosemide 20 mg qd p/o. Low salt diet, low carbohydrates diet and low fat. Losartan 12.5 mg qd p/o Aspirin 81 mg daily p/o. Prevention Control body weight. Patient encounter: Patient with previous history of arterial hypertension that complains primary physician with fatigue and shortness of breath and orthopnea, The risk factor is arterial hypertension and the primary diagnosis is Congestive heart failure. Use healthy diet. Adequate control of arterial hypertension. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation EKG Interpretation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 55-year-old man with a previous history of health. He visits primary physician because he started suddenly with right eye pain that describes as sharp, dull, and deep with extreme sensitivity to light. The pain is permanent and the patient does not identify any factors that improve the pain. The patient reports eyelids tenderness with a sensation of foreign body and the eye which is redness with swelling in eyelid and mild burning sensation. |
| Diagnostic Codes: | H44.131 | Sympathetic uveitis, right eye |
| Patient Age: | 55 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have eye pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. A.Fluorescein stain B. Measurement of intraocular pressure (IOP). B.Slit-lamp test: reveals cells in the anterior chamber and flare, representing increased aqueous humor protein. Inflammatory cells, called keratic precipitates, can collect in clusters on the posterior cornea. C.Penlight examination: Flashlight examination shows a slightly cloudy anterior chamber in the uveitic eye. Plan. General interventions 1. The initial task is to be sure that there is no threat to vision. 2. Treatment modality depends on the underlying cause of eye pain. Pharmaceutical therapy: Medication depends on the underlying cause. Provide immediate referral to an ophthalmologist due to possible complications of cataracts and blindness. Uveitis and colitis often flare simultaneously; oral steroids are effective for both. Follow-Up A. The patient with uveitis needs a follow-up with an ophthalmologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Exam of Eye for Foreign Body Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 65-year-old man with a previous history of health. He complains of a primary physician because he started suddenly with cough, high fever and chest pain on the right side that increase with breathing. Patient reports fever with shaking chills and shortness of breath. The patient refers to rust-colored sputum and generalized body weakness. |
| Diagnostic Codes: | J15.9 | Unspecified bacterial pneumonia |
| Patient Age: | 65 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough and fever" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Administer acetaminophen (Tylenol) for fever 500mg tid p/o Azithromycin: oral (Zithromax). 500 mg loading dose then 250 mg daily on days 25 p/o. Encourage rest during acute phase. Encourage patients to avoid smoking/secondhand smoke. A vaporizer may be used to increase humidity. Encourage good hand washing or use of hand sanitizer. Dietary management: Encourage a nutritious diet with increased fluid intake. Follow-Up A. Patients/parents should know the signs of increasing respiratory distress and seek immediate medical attention. Chest X Ray. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 49-year-old man with a previous history of health. The patient complains of a primary physician because in the last six months she started with an increase of appetite and a lot of thirsts. He reports abnormally large quantities of urine, accompanied by a need to urinate frequently. |
| Diagnostic Codes: | E11.9 | Type 2 diabetes mellitus without complications |
| Patient Age: | 49 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 50 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 100% |
| Chief Complaint: | "I have a lot of thirst" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. Glycosylated hemoglobin (Hgb A1c) of 6.5% or higher. B. Fasting plasma glucose C. Random plasma glucose D. Oral Glucose Tolerance Test (OGTT). 2. Center goals on normal metabolic control and the prevention and delay of complications while maintaining a flexible, normal, high- quality life. a. Exercise plan i. Develop a consistent, individualized exercise plan with the patient to improve insulin sensitivity, blood sugars, weight reduction, and reduction of cardiovascular complications. c. Psychosocial support: It is important from the beginning of treatment to give the patient a sense of control. i. Consistent involvement of family members will influence compliance. ii. Assess and discuss psychosocial issues at each visit. Topics in the educational plan include the pathophysiology of diabetes, procedures for SMBG and medication therapies, recognition and treatment of hypoglycemia, and instructions for special situations such as illness and traveling. 4. Smoking cessation and avoidance of all tobacco products should be advised to all patients. Counseling regarding smoking/tobacco cessation methods and classes should be offered. C. Dietary/physical activity management 1. Nutritional plan: The patient should meet with a dietitian who has experience with diabetes nutritional therapy. 2. Eating patterns and ideal percentage of calories from protein, carbohydrates, and fat should be individualized for each patient and determined along with a dietician. D. Pharmaceutical therapy Type 2 diabetes is dependent on the severity of disease at diagnosis. If the glucose is less than 300 mg/dL, treatment is usually begun with an exercise program and nutrition plan. If glycemic goals are not reached in 2 or 3 months, monotherapy of medications is considered. a.Monotherapy for type 2 diabetes: Metformin is the preferred oral medication for type 2 diabetes. B. A glycosylated hemoglobin determination every 3 months can assist the provider in measuring control. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Diabetic Foot Care Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 43-year-old man with a previous history of health. He complaints primary physician because in the least three weeks he started with abdominal pain He reports constant aching pain in the right upper part of the abdomen and in the right subcostal region, with radiation to the back and right shoulder. |
| Diagnostic Codes: | K81.0 | Acute cholecystitis |
| Patient Age: | 43 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. Amylase CBC with differential. Alkaline phosphate Bilirubin AST ALT Urinalysis to rule out pyelonephritis and renal calculi . Stool for occult blood to rule out bleeding. Radiography Ultrasonography: Study of choice and can often establish the diagnosis. General interventions: Patients with a single episode of biliary colic are reasonable candidates for expectant management, as long as they continue to be free of recurrent pain. Encourage the patient to avoid fasting and starvation diets, which make the bile even more lithogenic. D. Surgical management 1. Cholecystectomy may be recommended for symptomatic patients. The standard of care is the laparoscopic cholecystectomy. Antibiotics, such as ampicillin or cefazolin (Ancef), flagyl, may be used for mild attacks. Follow-Up A. See the patient at next pain attack to reevaluate. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 24-year-old young female complaint, primary physician because in the past two days he started with cough, fever, and shortness of breath that began suddenly. The patient reports cough that is productive of mucoid, purulent sputum. |
| Diagnostic Codes: | J18.9 | Pneumonia, unspecified organism |
| Patient Age: | 24 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough, fever and shortness of breath" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: Blood Cultures: The yield from blood cultures, even those obtained before antibiotic therapy. Antigen Tests: Two commercially available tests detect pneumococcal and certain Legionella antigens in urine. Polymerase chain reaction (PCR) tests are available for a number of pathogens, including L. pneumophila and mycobacteria. Serology: A fourfold rise in specific IgM antibody titer between acute- and convalescent-phase serum samples is generally considered diagnostic of infection with the pathogen in question. Pharmacologic treatment a macrolide or azithromycin (500 mg PO twice, first day and continues with 500 mg daily per 6 days. Count Blood Cells: Increase in white blood cells with shift deviation. Eritrosedimentation rate is elevated. PCR is elevated. Chest X Ray. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/24/2020 |
| Rotation Type: | NSG6440 |
| Comments: | HPI. A patient is a 65-year-old male with a previous history of arterial hypertension and hyperlipidemia that started 12 years ago using metoprolol 20mg daily p/o. He complains of a primary physician because two months ago, he started with chest pain, typically located in the substernal region or sometimes in the middle region of the abdominal area that radiates to the neck, left shoulder, and left arm. The patient reports that chest pain started with physical activities and worsen with exercises. And usually is 8-10 in pain scale. The pain improves with the rest and use of one-tab sublingual of nitroglycerine, the duration is less than 30 minutes This discomfort is usually severe enough to be considered painful. The patient denies diaphoresis, pale cool skin, and tachycardia. |
| Diagnostic Codes: | I20.8 | Other forms of angina pectoris I27.2 | Other secondary pulmonary hypertension |
| Patient Age: | 65 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 56 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | " I have chest pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN. (Brown, 2019). Exercise ECG testing A radioactive tracer such as thallium. Angiography. Echocardiogram. Troponin. Chest X Ray. Pharmacology treatment (Chest Pain Treatment, 2019) Isosorbide: 20 mg twice daily p/o Metoprolol 100 mg daily, given in a single dose p/o. Aspirin 81 mg daily p/o Nitroglycerin 0.5mg as needed. 1 tab sl. PREVENTION; Prevention of Angina Making Lifestyle Changes Healthy lifestyle choices can help prevent or delay angina and heart disease. To adopt a healthy lifestyle, patient quit smoking and avoid secondhand smoke Avoid angina triggers Follow a healthy diet Be physically active Maintain a healthy weight Learn ways to handle stress and relax. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 21-year-old female with a previous history of health that complains primary physician because today suddenly started with abdominal discomfort. The pain is located in the periumbilical region initially and after it is located in the right lower part of the abdominal region. The patient refers to abdominal pain as severe 8/10 in scale pain. |
| Diagnostic Codes: | K35.80 | Unspecified acute appendicitis |
| Patient Age: | 21 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 35 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal discomfort" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN Count Blood cells. Urine test. Abdominal ultrasound. Abdominal X Ray. Refer to Emergency department for Surgery to remove the appendix (appendectomy). Avoid strenuous activity at first. Follow up : two weeks after appendectomy. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-year-old man with a previous history of health. He complained of a primary physician because one month ago, he started with severe itching in all the body. The itching is worsening with an irritant such as alcohol and soaps and it improves with antihistaminic. |
| Diagnostic Codes: | L20.9 | Atopic dermatitis, unspecified |
| Patient Age: | 25 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 33 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have itching in my both hands and trunk" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests: Radioallergosorbent tests (RASTs) or skin tests may suggest dust mite allergy Eosinophilia Serum IgE levels may be present. General Measures: Promotion and Education Atopic patients have hyperirritable skin. Avoid anything that dries or irritates the skin. Adults with atopic disorders should not bathe more than once daily. Washcloths and brushes should not be used. After rinsing, the skin should be patted dry (not rubbed) and then immediatelywithin three minutescovered with a thin film of an emollient such as Aquaphor, Eucerin, Vaseline, or a corticosteroid as needed. Atopic patients may be irritated by scratchy fabrics, including wools and acrylics. Cottons are preferable, but synthetic blends also are tolerated. Other triggers of eczema in some patients include sweating, ointments, hot bathing, and animal danders. To determine the potential effect of foods, the patient may eliminate one food at a time for several months and monitor the severity of the disease. Pharmacological treatment Local Treatment: Triamcinolone 0.1% tid. Acute weeping lesions: Use water or aluminum subacetate solution or colloidal oatmeal (Aveeno); dispense one box, and use as directed on box) as soothing or astringent soaks, baths, or wet dressings for 1030 minutes two to four times daily. Maintenance treatment Oral prednisone 60 mg daily for adults p/o. Diphenhydramine 25 mg twice-daily p/o. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old female with a previous history of health. She visits the primary physician with cutaneous lesions there may be mild soreness, pain, or itching. The lesions are mainly over the face, neck, upper chest, back, and shoulders. |
| Diagnostic Codes: | L70.0 | Acne vulgaris |
| Patient Age: | 26 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 34 |
| Consult with Preceptor (minutes): | 2 |
| Student Participation: | 75% |
| Chief Complaint: | "I have scar face with itching" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Treatment: Benzoyl Peroxide, apply once a day. The addition of tretinoin 0.025% cream or 0.01% gel at night may be effective, since it works via a different mechanism. EDUCATION: Education of the patient When scarring seems out of proportion to the severity of the lesions, clinicians must suspect that the patient is manipulating the lesions. It is essential that the patient be educated in a supportive way about this complication. It is wise to let the patient know that at least 46 weeks will be required to see improvement and that old lesions may take months to fade. Therefore, improvement will be judged according to the number of new lesions forming after 68 weeks of therapy. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 19-year-old female with a previous history of health that she visits the primary physician with burning and stinging in superior and inferior lips. She noted small grouped vesicles on an erythematous base, especially in the orolabial region. |
| Diagnostic Codes: | B00.9 | Herpesviral infection, unspecified |
| Patient Age: | 19 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 41 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesions in inferior lip" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Direct immunofluorescent antibody slide tests offer rapid, sensitive diagnosis. Viral culture may also be helpful. Specific HSV 2 serology by Western blot assay or enzyme-linked immunosorbent assay (ELISA) can determine who is HSV-infected and potentially infectious. Such testing is very useful in couples in which only one partner reports a history of genital herpes. Acyclovir 5% Apply to the affected area 5 times a day for 4 days. Therapy should be started as early as possible following onset of signs and symptoms (i.e., during the prodromal phase or when lesions appear). Cool compress, soothes painful muscles or joints and may help reduce inflammation. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 55-year-old man with a previous history of health. Patient complains primary physician because in the least three weeks he started with painful swallowing and difficult for swelling solid foods. The patient refers to nausea and upper abdominal pain with a burning sensation in the retrosternal region. The symptoms get worse at bedtime. Also, the patient refers to hoarseness and globus sensation |
| Diagnostic Codes: | K21.9 | Gastro-esophageal reflux disease without esophagitis |
| Patient Age: | 55 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have painful swallowing" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Dietary management 1. Weight loss is advised for overweight or obese patients with GERD symptoms. 2. At present, there is no supporting data for special dietary precautions; however a dietary Elimination of foods helps to identify triggers. Omeprazole 20 mg twice daily p/o. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is an 18-year-old female with a previous history of health that visits primary physician because in the least three days she started with cough with phlegm also, the patient has ocular and/or nasal pruritus, sneezing, and rhinorrhea. Nasal symptoms are often accompanied by eye irritation, which causes pruritus, erythema, and excessive tearing |
| Diagnostic Codes: | J30.89 | Other allergic rhinitis |
| Patient Age: | 18 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have nasal discharge and cough" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Treatment: ibuprofen 200 mg / 5ml 10 ml every 8 hr as needed. Nasal washing Rinsing the inside of the nose with warm salt water to flush out irritants and excess mucus Evaluation: Follow up in a week, if symptoms increase, return and see the doctor Patient to follow-up with primary care provider in one week after finishing treatment. Told to return if patient begins to complain more nasal discharge, or increasing discharge. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 20-year-old with a previous history of health that visits primary physician with red both eyes also, moderate to copious discharge with mild pain. His mother refers that his brother has bacterial conjunctivitis acquired in the daycare. |
| Diagnostic Codes: | H10.30 | Unspecified acute conjunctivitis, unspecified eye |
| Patient Age: | 20 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 100% |
| Chief Complaint: | "I have red eyes with itching" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Short term goal: Complete course of local antibiotic therapy to resolve acute bacterial conjunctivitis. Intervention: Plan of Care: Gentamicin Sulfate Ophthalmic Solution, USP 0.3% . Instill one or two drops into the affected eye(s) every four hours for seven days Wear protective eyewear to protect the eyes from injury. Maintain good hygiene, especially when a cut or skin problem is present Education is important. Mother educated on promoting hygiene It is necessary to educate the mother promoting adequate hygiene in home. The boy should avoid social activities in order to avoid the contagious. |
| Skills/Procedures (Select All That Apply): | Exam of Eye for Foreign Body Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 41-year-old man with a previous history of health that started with episodic or chronic attacks of headache separated by pain-free periods lasting a month or longer. Patient refers that headache is provoked by alcohol. The patient reports severe unilateral pain in the upper part of the right eye lasting 15180 minutes if untreated. The patient reports the headache is accompanied by right eye lacrimation with right nasal congestion and right eyelid edema. |
| Diagnostic Codes: | G44.019 | Episodic cluster headache, not intractable |
| Patient Age: | 41 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have headache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. A. Sinus films to rule out sinusitis or a lesion. B. Sleep studies for obstructive sleep apnea. C. CT scan or MRI: Needed if headache is severe, no results are achieved with drug therapy, and/or aura is present. Sumatriptan 20mg intranasal, and zolmitriptan five mg intranasal are effective in the acute treatment of cluster headache (RCT). Three doses of zolmitriptan in twenty-four hours are acceptable. Preventive agents include gabapentin (up to 3600 mg daily). |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 28-year-old man with a previous history of health. He complains of a primary physician because three days ago started with cough without sputum. The patient refers to a sore throat which is permanent and nasal congestion with white nasal discharge. |
| Diagnostic Codes: | J20.9 | Acute bronchitis, unspecified |
| Patient Age: | 28 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan A. General interventions 1. Tell the patient to increase fluid intake. 2. Suggest humidity and mist therapy. 3. Avoid irritants, such as smoke. Pharmaceutical therapy 1. Acetaminophen (Tylenol) for fever and malaise. 325 to 650 mg by mouth every 4 hours; not to exceed five doses in 24 hours. Expectorants such as guaifenesin with dextromethorphan (Robitussin DM, Humibid DM, Mytussin) to treat minor cough from bronchial/throat irritation tid p/o. Albuterol (Ventolin) for patients with wheezes or rhonchi, or for patients with a history of bronchoconstriction. 0.1 to 2 mg/kg by mouth three times daily. Follow up if patient does not improve in 48 hours. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/22/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 40-year-old woman with a previous history of type 2 diabetes mellitus treated with metformin 500mg twice daily. She complains primary physician because two weeks ago, she started with pruritus and abnormal vaginal discharge that is thick white cheesy vaginal discharge. The patient refers itching, mild to intense vulvar pruritus with vaginal or vulvar irritation, red and swollen and discomfort during and after sexual intercourse. |
| Diagnostic Codes: | B37.3 | Candidiasis of vulva and vagina |
| Patient Age: | 40 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abnormal vaginal discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. A. Wet prep with 10% potassium hydroxide and normal saline prep. Yeast hyphae and/or spores are determined by microscopic examination of vaginal discharge prepared with 10% potassium hydroxide or normal saline. A positive whiff test indicates BV. B. Test discharge with nitrazine paper. The pH with candidiasis remains in the normal range of less than 4.5. C. Consider 2-hour glucose testing. D. Consider testing for gonorrhea and chlamydia. E. Herpes culture, if lesions present. F. Urinalysis and culture, if indicated. A. General interventions 1. Although vaginal candidiasis is treated using OTC products, encourage patients with initial presenting symptoms to have an evaluation to rule out other vaginal infections prior to self-treatment. 2. Consider treating partners. While candidiasis is not considered an STI, it can be sexually transmitted. The partner should be treated in cases of recurrent infections, even if the partner is asymptomatic. 3. For recurrent infections, consider fasting and 2hour postprandial glucose tests for chronic yeast infections. 4. Consider testing for HIV for chronic yeast infections. Pharmaceutical therapy 1. Vaginal antifungal creams: Mild cases may respond to 3 days of therapy; severe cases may require 10 to 14 days. Some of these preparations are available in vaginal suppository form for a 1 or 3night regimen with proven efficacy. a. Clotrimazole (GyneLotrimin, Lotrimin, Mycelex, MycelexG) one applicator full at bedtime for 7 days. Follow-Up A. The patient who presents with recurrent candidiasis should be evaluated for HIV and/or other immunocompromised etiologies and diabetes. |
| Skills/Procedures (Select All That Apply): | Cultures/Swabs/Wet Mount Lab Studies Interpretation Pelvic Exam STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old young man who complains primary physician because three days ago started with fever, sore throat, generalized lymphadenopathies which are painful. Patient reports generalized body weakness. |
| Diagnostic Codes: | B27.90 | Infectious mononucleosis, unspecified without complication |
| Patient Age: | 26 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fever and sore throat" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests: Count blood cells the white blood cell count is usually elevated and peaks at 10,00020,000/L during the second or third week of illness. PCR and Eritrosedimentation Rate. Special Tests: CD8+ cells predominate among the atypical lymphocytes. Serologic Testing: Tests for heterophile antibodies are positive. Titers of IgM and IgG antibodies to viral capsid antigen (VCA) are elevated in the serum of more than 90% of patients at the onset of disease. Antibodies to early antigens (EAs) are found either in a diffuse pattern in the nucleus and cytoplasm of infected cells (EA-D antibody) or restricted to the cytoplasm (EA-R antibody). The heterophile test is used for the diagnosis of IM in children and adults Abdominal ultrasound: No intraabdominal adenopathies. Plan/Therapeutics: Therapy for Infectious Mononucleosis (IM ) consists of supportive measures, with rest and analgesia. Excessive physical activity during the first month should be avoided. Prevention The isolation of patients with IM is unnecessary. Vaccines directed against the major EBV glycoprotein have been effective in animal studies and are undergoing clinical trials. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 29-year-old man with a previous history of health that in the last week he had upper respiratory disease. He complains to the primary physician because he started with severe right ear pain and nasal discharge. The patient reports a high fever and generalized body weakness. |
| Diagnostic Codes: | H65.191 | Other acute nonsuppurative otitis media, right ear |
| Patient Age: | 29 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my right ear" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Amoxicillin 80 to 90 mg/kg/d divided into two daily doses for 10 days. Follow-Up A. Check the patient in 2 to 4 weeks or if fever and complaints persist for more than 48 hours after antibiotic is begun. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 40-year-old woman with a previous history of health that complains primary physician because in the last 6 months he started with middle pain in both extremities that worsened, progressively and pain is more severe when standing. Patient reports pain usually dull, aching, or cramping 7/10 in pain scale. |
| Diagnostic Codes: | I83.215 | Varicos vn of r low extrem w ulc oth part of foot and inflam |
| Patient Age: | 40 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I am feeling of heaviness in extremity " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Trendelenburg test. Perthes test. Doppler ankle/brachial index (ABI). Duplex ultrasound. PLAN: Prevention: General Avoid prolonged standing or sitting. Exercise on a regular basis. Encourage smoking cessation, weight loss, exercise. If prolonged standing is required, shift weight from one leg to the other. Do not sit with legs dependent. Extremity elevation. Compression stockings. Exercise. Aspirin: 325 mg tablet p/o daily. Follow-Up A. Follow-up is determined by patients needs, frequency and intensity of symptoms, and the presence of other medical conditions. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 56-year-old man with a previous history of health. He complains of a primary physician because in the last two weeks he started with perianal pain irradiated to the sacral region. Patient complaints pain in the lower abdominal region which is permanent and fever, with a burning sensation during urination. |
| Diagnostic Codes: | N41.0 | Acute prostatitis |
| Patient Age: | 56 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have anal pain and fever " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Therapeutic: 1. Ciprofloxacin 500mg twice daily per 4 weeks. Diagnostic Tests: 1. Complete blood count shows leukocytosis and a left shift. 2. Urinalysis shows pyuria, bacteriuria, and varying degrees of hematuria. 3. Urine cultures will demonstrate the offending pathogen Education: 1. Intake a lot of fluids. 2. If urinary retention develops, urethral catheterization or instrumentation is contraindicated, and a percutaneous suprapubic tube is required. 3. Follow-up urine culture and examination of prostatic secretions should be performed after the completion of therapy to ensure eradication. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Prostate Examination X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 47-year-old man with a previous history of health. He complains of a primary physician because after nasal sports injury he started with severe pain in and around his nose, and blood coming from the right nostril. |
| Diagnostic Codes: | R04.0 | Epistaxis |
| Patient Age: | 47 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have bleeding in right side of my nose" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests Drug screen, if indicated. Hematocrit and hemoglobin. Count Blood Cells CBC with differential Platelets, prothrombin time (PT), and partial thromboplastin time (PTT). Sinus films if recurrent sinus pain, tenderness, and bleeding. X-rays or CT scanning of the nose and/or sinuses would assist in the diagnosis of fracture, infection, tumor, and polyps. A liver profile might be needed to identify a hepatic cause of the epistaxis. Plan. General interventions: Main goal is to control episodes of bleeding. Pharmaceutical therapy/medical/surgical management 1. To control anterior septal bleeding: a. Have patient sit and lean forward, apply pressure to reduce venous pressure, and prevent swallowing of blood. b. Soak a cotton pledget in phenylephrine (Neo-Synephrine), oxymetazoline HCl (Afrin), or epinephrine 1:1,000, and apply with pressure against bleeding site for 5 to 10 minutes. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Epistaxis and Nasal Packing Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 48-year-old with a previous history of the smoker for the last 20 years with the previous history of a chronic cough that started three years ago that initially, the cough was present in the winter months. The patient reports the clinical manifestation at least six months in one year for more than two years. On this occasion patient complaints, primary physician because seven days ago started with a cough and sputum which occurs every day. |
| Diagnostic Codes: | J41.0 | Simple chronic bronchitis |
| Patient Age: | 48 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough and sputum" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Chest X Ray. Pulmonary Functional test Espirometry. Sputum Examination. Oxygen saturation. Count blood cells. Blood gas tests. High Resolution Computed Tomography (HRCT). Budesonide/formoterol (Symbicort): Two puffs by inhalation two times each day. PREVENTION AND EDUCATION. Avoid cigarette smoke. Vaccines: flu annually and a pneumonia every five years. Avoid irritants. Adequate hygiene. Pulmonary Rehabilitation. Regular physical activity. Healthy Diet. Avoid obesity. Follow-up: Two weeks. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 44-year-old man with a previous history of health. He complains of a primary physician because three days ago started with high fever and chills permanent. Fever is persistent and decreases for a few hours using ibuprofen 400mg tid p/o. Patient reports cough that is permanent and productive of mucoid, purulent, or blood-tinged sputum that has progressively increased with shortness of breath without relation with physical activities that worsened with the breathing and is permanent |
| Diagnostic Codes: | J18.9 | Pneumonia, unspecified organism |
| Patient Age: | 44 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fever and cough" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | General interventions 1. Encourage rest during acute phase. 2. Encourage patients to avoid smoking/secondhand smoke. 3. Encourage good hand washing or use of hand sanitizer. C. Dietary management: Encourage a nutritious diet with increased fluid intake. D. Pharmaceutical therapy 1. Azithromycin 500mg first day p/o. Continue 250mg daily per 5 days p/o. 2. Acetaminophen (Tylenol) 500mg tid p/o |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 23-year-old female with a previous history of health. She complained of a primary physician because in the last week she started with a burning sensation during urination and urinate small quantities with difficulty. |
| Diagnostic Codes: | N30.00 | Acute cystitis without hematuria |
| Patient Age: | 23 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have burning sensation with urination " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Intake a lot of fluids. Urinalysis Urine culture. Avoid sexual intercourses Ciprofloxacin 500 mg twice daily per three days |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/20/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 62-year-old with previous history of health. He complaints primary physician because in the least three weeks he started with hypertensive that occurs in the morning and is localized to the posterior region. Patient also, reports dizziness, palpitations, easy fatigability, and ringing in ears. The patient also, complains somnolence, confusion, visual disturbances, and nausea with vomiting when he has stress. |
| Diagnostic Codes: | I11.9 | Hypertensive heart disease without heart failure |
| Patient Age: | 62 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have headache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. Hematocrit B. LFTs (LDH [lactate dehydrogenase], uric acid) C. C. Chemistry profile D. Lipid profile (total and HDL-cholesterol and triglycerides) D. E. Urinalysis for proteinuria E. F. Estimated GFR F. G. EKG. G. H. If history, physical exam, or lab tests indicate the need, obtain the following: 1. Intravenous pyelography (IVP) 2. Renal arteriogram 3. Plasma renin 4. Catecholamines 5. Chest radiography 6. Aortogram 7. Ultrasonography 8. Sleep study Losartan 50mg daily p-o |
| Skills/Procedures (Select All That Apply): | Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 47-year-old female with a previous history of health. She complaints primary physician that pain gets worse with heavy meals and hunger because. According to the patient, the pain usually will decrease or stop when she eats but it comes back after 2-3 hours. |
| Diagnostic Codes: | K26.7 | Chronic duodenal ulcer without hemorrhage or perforation |
| Patient Age: | 47 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 57 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 100% |
| Chief Complaint: | "I have abdominal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Upper endoscopy procedure. H.Pilory test. Omeprazole 20mg twice-daily p/o Sucralfate 1 g qid p/o. Abdominal ultrasound. PREVENTION Avoid smoking. Avoid alcohol. Avoid fatty food. Avoid NSAIDs. Protect from infections by washing hands regularly and consuming foods that have been cooked thoroughly. Follow up: monthly. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 57-year-old man with a previous history of health. He complaints primary physician because in the least three weeks he started with decreased energy and poor appetite, symptoms that were associated with a weight loss of 4.5 kg. The patient reported acute onset of fever, chills, dysuria, urgency and intermittent perineal with low-back pain. |
| Diagnostic Codes: | N41.0 | Acute prostatitis |
| Patient Age: | 57 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 50 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fever and dysuria" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | TEST: prostatic secretion with bacterias and polymorphonuclears cells. PLAN: Prostatic ultrasound. Culture of prostatic discharge. Urinalysis with pyuria and bacterias Urine culture pendent. Count blood cells with leukocytosis and shift deviation. PSA: Prostate-specific antigen (PSA) test, a blood test that measures levels of a certain protein released by the prostate Blood culture, used to see whether bacterial prostatitis has spread to the blood. NO PHARMACOLOGYC: Intake a lot of fluids. PHARMACOLOGYC: Ibuprophen 400mg twice daily for improving fever, back pain. Alpha-blocker therapy should also be considered for acute bacterial prostatitis. Because the bladder neck and prostate are rich in alpha-receptors, alpha blockade may improve outflow obstruction and diminish intraprostatic urinary reflux. Terazosin, 5 mg/d orally for 4-52 weeks, is the usual first choice. Tamsulosin (Flomax), alfuzosin (Uroxatral), and doxazosin (Cardura) are acceptable alternative agents. Ciprofloxacin: 500mg twice daily per 14 days. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Prostate Examination STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 23-year-old man with a previous history of health. He complains of primary physician because yesterday he started with generalized itching which is severe. Scratching the itchy rash can cause eruptions. The patient reports extensive lesions to occur on the scrotum or penis. Pruritus tends to be increased at night. Other friends have similar symptoms. |
| Diagnostic Codes: | B86 | Scabies |
| Patient Age: | 23 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 38 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have generalized itching" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Treatment is aimed at killing scabies mites and controlling the dermatitis, which can persist for months after effective eradication of the mites. Bedding and clothing should be laundered or cleaned or set aside for 14 days in plastic bags. PREVENTION Unless treatment is aimed at all infected persons in a family or institutionalized group, reinfestations will probably occur. Pharmacologic treatment: Permethrin 5% cream is highly effective and safe in the management of scabies. Treatment consists of a single application for 812 hours. It may be repeated in 1 week. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 45-year-old man with a previous history of health that complaints the primary physician because he started with severe pain swollen and red discoloration in the first right toe. |
| Diagnostic Codes: | M10.071 | Idiopathic gout, right ankle and foot |
| Patient Age: | 45 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my first right toe" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | The serum uric acid is elevated (> 7.5 mg/dL) in 95% of patients who have serial measurements during the course of an attack. However, a single uric acid determination is normal in up to 25% of cases, so it does not exclude gout, especially in patients taking uricopenic drugs. During an acute attack, the ESR and white cell count are frequently elevated. Sudden reduction of serum uric acid. Naproxen: 500mg twice daily p/o. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 17-year-old man with a previous history of health. He complains of a primary physician because one day ago, he started with cutaneous lesions characterized for red, swollen, and tender nodules of varying size and at times with an overlying pustule in the left leg. |
| Diagnostic Codes: | L02.92 | Furuncle, unspecified |
| Patient Age: | 17 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 41 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesions" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | adequate hygiene Wash hands Ciprofloxacin 500mf twice daily p-o per seven days. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 19-year-old female with a previous history of health that complaints primary physicians with vaginal irritation and discharge that is white like-cheese. |
| Diagnostic Codes: | B37.3 | Candidiasis of vulva and vagina |
| Patient Age: | 19 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 43 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have vaginal discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Microscopic examination with 10% potassium hydroxide reveals filaments and spores A culture with Nickersons medium is used because Candida is suspected. PLAN (P): Saline wet mount demonstrating Candida Albicans. Vaginal secretions are mixed with 10% potassium hydroxide (KOH) solution. Vaginal secretions are cultured. Topical steroid Micolog/Cortisone is beneficial for decreasing inflammation and relieves itching externally. Fluconazole150mg oral dose. Cervical discharge collected for Gram stain may indicate Neisseria gonorrhoeae or Chlamydia trachomatis. Cervical cytological testing may be positive for HPV. PREVENTION: Nonabsorbent undergarments should be avoided as well as douching. PROMOTION: Underlying metabolic diseases as diabetes should be rule out. Explain the patients that continuous use of antibiotic is one cause of vaginal candidiasis. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 44-year-old woman with a previous history of type 2 diabetes mellitus treated with metformin 500mg twice daily. She complains primary physician because two weeks ago, she started with pruritus and abnormal vaginal discharge that is thick white cheesy vaginal discharge. The patient refers itching, mild to intense vulvar pruritus with vaginal or vulvar irritation, red and swollen and discomfort during and after sexual intercourse. |
| Diagnostic Codes: | B37.3 | Candidiasis of vulva and vagina |
| Patient Age: | 44 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abnormal vaginal discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. A. Wet prep with 10% potassium hydroxide and normal saline prep. Yeast hyphae and/or spores are determined by microscopic examination of vaginal discharge prepared with 10% potassium hydroxide or normal saline. A positive whiff test indicates BV. B. Test discharge with nitrazine paper. The pH with candidiasis remains in the normal range of less than 4.5. 3. For recurrent infections, consider fasting and 2hour postprandial glucose tests for chronic yeast infections. 4. Consider testing for HIV for chronic yeast infections. 5. Preventive care therapies a. Vinegar and water douche may be effective in mild cases: one to two tablespoons vinegar per quart warm water daily for 5 days. Patients should be encouraged to present for evaluation if, after appropriate therapy has been instituted, they continue to have symptoms. C. Pharmaceutical therapy 1. Vaginal antifungal creams: Mild cases may respond to 3 days of therapy; severe cases may require 10 to 14 days. Some of these preparations are available in vaginal suppository form for a 1 or 3night regimen with proven efficacy. a. Clotrimazole (GyneLotrimin, Lotrimin, Mycelex, MycelexG) one applicator full at bedtime for 7 days. Follow-Up A. The patient who presents with recurrent candidiasis should be evaluated for HIV and/or other immunocompromised etiologies and diabetes. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Pelvic Exam STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 66-year-old man with a previous history of viral encephalitis five years ago. He complains primary physician because for the last six months he started with tremor at rest that was intermittent but progresses over time and patient reports the joints are more rigid with slow voluntary movement, especially with daily activities such as cutting food, dressing self, and so forth. |
| Diagnostic Codes: | G20 | Parkinson's disease |
| Patient Age: | 66 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have tremor" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN. General interventions 1. Encourage regular exercise to maintain or improve flexibility. Home safety evaluations are recommended because the symptoms of PD place patients at high risk for falls and accidental injury. Pharmaceutical therapy Polypharmacy is the hallmark rather than the exception with PD. Always comanage with a neurologist. Sinemet is the levodopa and carbidopa combination drug most often used. i. The dose and dosing frequency are very individualized. ii. Patients are often on a combination of sustained release and shortacting preparations. iii. See literature for individual dosing. Titrate dose up every 3 days for adjustments. Follow-Up A. PD requires lifelong management by a neurologist. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/17/2020 |
| Rotation Type: | NSG6440 |
| Comments: | History of Present Illness. Mr. OA is 82 years old man with a previous history of arterial hypertension. Family refers that in the least three days, he started with changes in his mood. Family refers patient has restlessness agitation, rapid mood changes, and refusal to cooperate with care. Other clinical manifestations that family reports are difficulty focusing, maintaining, or shifting attention with inattention. Family refers to consciousness level fluctuates; the patient is disoriented to time and sometimes in place or person. The patient has hallucinations, delusions, and paranoia with agitation. The primary physician referral the patient to the Emergency Department, and he was hospitalized. |
| Diagnostic Codes: | F05 | Delirium due to known physiological condition N39.0 | Urinary tract infection, site not specified |
| Patient Age: | 82 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "Changes in mood and restlessness agitation". (Family arrives as informant). |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Treatment (Grover & Avasthi,2018). Non pharmacologic treatment. Treatment of the cause or precipitating factors General management of the patient with delirium including elimination of other precipitating factors that may exacerbate the delirium. The components of this can be divided into providing support and orientation, providing unambiguous environment, measures at maintaining competence and providing other supportive measures. Haloperidol. 0.250.50 mg 4 hourly for elderly (Grover & Avasthi, 2018). Delirium can often be associated with secondary complications like falls, development of bedsores, hospital acquired infections, functional impairment, problems with bladder and bowel control and over sedation. Started with Ciprofloxacin 500mg twice daily p-o. Adequate environment. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 52-year-old man with a previous history of gallstones that complains primary physician because he started three days ago with abdominal pain in the right side that is described as a sharp, abrupt and severe cramping sensation in right upper quadrant (RUQ) of the abdomen postprandially. He reports nausea, vomiting, and anorexia with the pain. The patient refers to fever and chills. |
| Diagnostic Codes: | C23 | Malignant neoplasm of gallbladder K81.0 | Acute cholecystitis |
| Patient Age: | 52 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 43 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 50% |
| Chief Complaint: | "I have pain in the right side of the abdomen" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Patient teaching 1. No activity restriction is required. Hospitalization and/or surgery may be required depending on the sever ity of the attack. C. Dietary management 1. Counsel the patient to avoid fatty foods. 2. Encourage the patient to avoid fasting and starvation diets, which make the bile even more lithogenic. D. Surgical management 1. Cholecystectomy E. Pharmaceutical therapy 1. Acetaminophen (Tylenol) may be used as needed for pain. 2. Anticholinergics are not helpful. 3. Antibiotics, such as ampicillin or cefazolin (Ancef), flagyl, may be used for mild attacks. Follow-Up A. See the patient at next pain attack to reevaluate |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old man with a previous history of health. He complains of a primary physician because after nasal sports injury he started with severe pain in and around his nose, and blood coming from the right nostril. The patient reports that the nose is likely to be more swollen immediately after trauma. |
| Diagnostic Codes: | R04.0 | Epistaxis |
| Patient Age: | 27 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have bleeding in right side of my nose" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests Drug screen, if indicated. Hematocrit and hemoglobin. Count Blood Cells CBC with differential Platelets, prothrombin time (PT), and partial thromboplastin time (PTT). Sinus films if recurrent sinus pain, tenderness, and bleeding. X-rays or CT scanning of the nose and/or sinuses would assist in the diagnosis of fracture, infection, tumor, and polyps. A liver profile might be needed to identify a hepatic cause of the epistaxis. Plan. General interventions: Main goal is to control episodes of bleeding. Pharmaceutical therapy/medical/surgical management 1. To control anterior septal bleeding: a. Have patient sit and lean forward, apply pressure to reduce venous pressure, and prevent swallowing of blood. b. Soak a cotton pledget in phenylephrine (Neo-Synephrine), oxymetazoline HCl (Afrin), or epinephrine 1:1,000, and apply with pressure against bleeding site for 5 to 10 minutes. c. Remove and check for bleeding after 10 minutes. Follow-Up A. Anterior septal bleeding: Referral to otolaryngologist is recommended for unsuccessful cessation of hemorrhage. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Epistaxis and Nasal Packing Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old young man who complains primary physician because three days ago started with fever, sore throat, generalized lymphadenopathies which are painful. Patient reports generalized body weakness. |
| Diagnostic Codes: | B27.90 | Infectious mononucleosis, unspecified without complication |
| Patient Age: | 26 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fever and sore throat" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests: Count blood cells the white blood cell count is usually elevated and peaks at 10,00020,000/L during the second or third week of illness. Lymphocytosis is usually demonstrable, with >10% atypical lymphocytes PCR and Eritrosedimentation Rate are elevated. Special Tests: CD8+ cells predominate among the atypical lymphocytes. Serologic Testing: Tests for heterophile antibodies are positive. Titers of IgM and IgG antibodies to viral capsid antigen (VCA) are elevated in the serum of more than 90% of patients at the onset of disease. Antibodies to early antigens (EAs) are found either in a diffuse pattern in the nucleus and cytoplasm of infected cells (EA-D antibody) or restricted to the cytoplasm (EA-R antibody). The heterophile test is used for the diagnosis of IM in children and adults Abdominal ultrasound: No intraabdominal adenopathies. Plan/Therapeutics: Therapy for Infectious Mononucleosis (IM ) consists of supportive measures, with rest and analgesia. Excessive physical activity during the first month should be avoided. Prevention The isolation of patients with IM is unnecessary. Vaccines directed against the major EBV glycoprotein have been effective in animal studies and are undergoing clinical trials. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old man with a previous history of previous respiratory disease 10 days ago treated with Tylenol 500mg tid p/o. He complains primary physician because yesterday suddenly he started with severe right ear pain and nasal discharge. The patient reports a high fever and generalized body weakness. |
| Diagnostic Codes: | H65.191 | Other acute nonsuppurative otitis media, right ear |
| Patient Age: | 27 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my right ear" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | General intervention: Pain relief with acetaminophen or ibuprofen. Auralgan may be used for a topical pain relief in children older than 3 years of age. Patient teaching on adherence treatment. Amoxicillin 80 to 90 mg/kg/d divided into two daily doses for 10 days. Follow-Up A. Check the patient in 2 to 4 weeks or if fever and complaints persist for more than 48 hours after antibiotic is begun |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 22-year-old male with a previous arrival with his mother as an informant that complains primary physician because 3 days ago he started with malaise, myalgia, inability to eat, irritability and pain in the right side of the upper lip. Patient denies fever. |
| Diagnostic Codes: | B00.9 | Herpesviral infection, unspecified |
| Patient Age: | 22 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "Pain in right side of upper lip" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | HSV infection is best confirmed in the laboratory by detection of virus, viral antigen, or viral DNA in scrapings from lesions. HSV DNA detection by PCR, when available, is the most sensitive laboratory technique. Acyclovir is the agent most frequently used for the treatment of HSV infections Acyclovir (400800 mg 35 times per day) from 7-14 days. PREVENTION Adequate hygiene Reduced HSV Transmission to Sexual Partners Once-daily valacyclovir (500 mg) has been shown to reduce transmission of HSV-2 between sexual partners Transmission rates are higher from males to females and among persons with frequent HSV-2 reactivation. Serologic screening can be used to identify at-risk couples. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 24-year-old man with a previous history of health. He complains of a primary physician because in the least three months he started with abdominal pain on the left side of the lower abdominal region. He reports back pain. Patient reports flatulence with periodic abdominal distension and borborygmi, or loud. The patient refers to diarrhea with nausea and vomiting. |
| Diagnostic Codes: | K57.92 | Dvtrcli of intest, part unsp, w/o perf or abscess w/o bleed |
| Patient Age: | 24 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have abdominal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | CT scan is becoming the optimal method of investigation for suspected acute diverticulitis. C. CBC with differential: WBC may show leukocytosis with a shift to the left; hemoglobin and Hct may be low with chronic or acute bleeding. CRP Radiography Abdominal ultrasonography to evaluate masses or abscess Proctosigmoidoscopy. Hemoccult: Stool. PLAN. A. Stress the importance of strict adherence to diet. B. Dietary management 1. NPO (nothing by mouth) status for acute treatment. 2. Fullliquid diet or lowfiber diet if not on bowel rest. 3. Longterm dietary management a. Highfiber diet including bran, beans, fruits, and vegetables. b. Bulk agents if unable to tolerate bran. Ciprofloxacin (Cipro) 500 mg orally twice daily and metronidazole (Flagyl) 500 mg orally three times a day for 7 to 14 days |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Microscopy |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old male with a previous history of health. He complains of a primary physician with a marked and persistent fear of objects or situations as fear of closed spaces exposure to which results in an immediate anxiety reaction. |
| Diagnostic Codes: | F40.240 | Claustrophobia |
| Patient Age: | 26 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fear of closed spaces" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Structural clinical interview Beta blockers (e.g., propranolol, 2040 mg orally 2 h before the event) Behaviorally focused psychotherapy. Cognitive-behavioral strategies |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 21-year-old male with a previous history of health. He complains of a primary physician because three days ago he started with oral lesions which are painful in mouths and lips with the burning sensation of the tongue. |
| Diagnostic Codes: | K12.1 | Other forms of stomatitis |
| Patient Age: | 21 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 43 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have painful lesion in my tongue" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Topical corticosteroids (triamcinolone acetonide, 0.1%, or fluocinonide ointment, 0.05%) in an adhesive base (Orabase Plain) do appear to provide symptomatic relief |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/15/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 10-year-old child with a previous history of health that complains primary physician because three days ago started with tender sores around the mouth and nose area in which the lesions continue to spread and worsen. Patient refers the lesions started suddenly. |
| Diagnostic Codes: | L01.00 | Impetigo, unspecified |
| Patient Age: | 10 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have tender lesions near the mouth and nose" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | May perform culture if recurrent or resistant to treatment. A. General interventions 1. Crusted lesions may be removed with thorough, gentle washing with mild soap three to four times daily. B. Patient teaching: Encourage good hand washing and hygiene to reduce spreading infection. C. Pharmaceutical therapy 1. If few lesions noted without involvement of face or cellulitis: Mupirocin (Bactroban) ointment to site four times daily for 10 days. 2. Systemic antibiotics Dicloxacillin 12.5 to 25 mg/kg/d four times daily for 10 days. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 50-year-old man with a previous history of health. He complaints He complains of a primary physician because in the least three days he started with high fever, tachycardia, and generalized muscle tenderness. The patient complains tenderness with urinary frequency or urgency. Patient refers to guarding and urinary frequency, nocturia, hematuria, and dysuria |
| Diagnostic Codes: | N10 | Acute tubulo-interstitial nephritis |
| Patient Age: | 50 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 56 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 100% |
| Chief Complaint: | "I have fever and abdominal pain". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Antiemetics as needed; however, if the patient is not able to tolerate oral fluids, he or she should be hospitalized. Antibiotics: Empiric antibiotic selection should be guided by local antibiotics resistance patterns, allergies, and culture results. Patients with delayed response to therapy should also receive a longer course of antibiotics of 14 to 21 days. Adults i. First-line therapy: Ciprofloxacin (Cipro) 500 mg twice daily for 7 days, or extended release Cipro XR 1,000 mg once a day for 7 days. Follow-Up A.Follow up with the patient in 24 to 48 hours depending on the evaluation of the initial severity of symptoms. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 19-year-old man with a previous history of health that in the least three years he started with excessive tearing in his right eye. Patient reports he is feeling a sensation of a ‶foreign body in the right eye″. |
| Diagnostic Codes: | H00.13 | Chalazion right eye, unspecified eyelid |
| Patient Age: | 19 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 39 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have irritation in my right eye" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Perform visual acuity exam. A. General interventions 1. Small chalazia do not usually require treatment. 2. Warm, moist compresses may be applied for 15 minutes four times a day. Patient teaching: Instruct patient regarding compresses and hand washing. Pharmaceutical therapy Sulfacetamide sodium (Sulamyd) ophthalmic ointment 10%, four times daily, for 7 days. Treat for 5 to 7 days as needed. Follow-Up A. For large infected chalazia, follow up with patient in 1 week and then evaluate the patient every 2 to 4 weeks. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Exam of Eye for Foreign Body Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 47-year-old man with a previous history of health. He complained of a primary physician because started suddenly with red urine (clots may be present). The patient reports back pain as colicky that radiating to the groin. Patient reports frequency in urination, difficulty to urination with urgency, and suprapubic pain with permanent red urine. |
| Diagnostic Codes: | R31.0 | Gross hematuria |
| Patient Age: | 47 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I have red urines " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Urinalysis Hgb or myoglobin with a urine dipstick. Urine culture and sensitivity. Urine cytology. CBC with differential. BUN. Creatinine. Prothrombin time (PT), partial thromboplastic time (PTT) platelet count, and bleeding time. Follow with a 24-hour urine collection for creatinine and protein. Culture for gonorrhea and chlamydia. Urine culture for acid-fast bacillus. CT urography (CTU). Cystoscopy. A CT scan of the abdomen or pelvis. Strep testing. Antinuclear antibody. General interventions 1. Investigate and diagnose cause(s). Repeat urinalysis in 2 weeks. B. Pharmaceutical therapy: None is recommended for hematuria unless an infection is diagnosed. Follow-Up: Evaluate weekly. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Microscopy Prostate Examination |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 35-year-old female with a previous history of health. She complaints primary physician because suddenly yesterday she started with a burning sensation in both eyes, itching, and the sensation of having a foreign body or a grain of sand in the eye. She refers to ropy secretions across their eyes, especially in the morning. |
| Diagnostic Codes: | H16.223 | Keratoconjunct sicca, not specified as Sjogren's, bilateral |
| Patient Age: | 35 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have burning sensation in my eyes" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Laboratory findings include mild anemia, leukopenia, and eosinophilia. Polyclonal hypergammaglobulinemia, rheumatoid factor positivity (70%), and antinuclear antibodies (95%) are all common findings. Antibodies against the cytoplasmic antigens SS-A and SS-B (also called Ro and La, respectively) are often present in Sjgren's syndrome and tend to correlate with the presence of extraglandular manifestations. Useful ocular diagnostic tests include the Schirmer test, which measures the quantity of tears secreted. Lip biopsy, a simple procedure, is the only specific diagnostic technique and has minimal risk; if lymphoid foci are seen in accessory salivary glands, the diagnosis is confirmed. Biopsy of the parotid gland should be reserved for patients with atypical presentations such as unilateral gland enlargement. Treatment is symptomatic and supportive. Artificial tears applied frequently will relieve ocular symptoms and avert further desiccation. The mouth should be kept well lubricated. Sipping water frequently or using sugar-free gums and hard candies usually relieves dry mouth symptoms Follow-up in clinic. If symptoms are worsen, call the on-call physician or go to Emergency Room |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Exam of Eye for Foreign Body Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 62-year-old female with a previous history of health. She visits a primary physician with fever, generalized body weakness, and persistent headache. Other manifestations that the patient reports are: malaise, fatigue, anorexia, weight loss, sweats, and arthralgia. Also, the patient refers to scalp pain and claudication of the jaw and tongue. |
| Diagnostic Codes: | M31.6 | Other giant cell arteritis |
| Patient Age: | 62 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have headache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Normochromic or slightly hypochromic anemia. Liver function abnormalities with increase alkaline phosphatase levels. Increased levels of IgG and complement have been reported. Biopsy of the temporal artery. Ultrasonography of the temporal artery. Follow-up: To see results of biopsy of the temporal artery. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 57-year-old man with a previous history of health. He complains of a primary physician because he started with high fever, pleuritic chest pain, shortness of breath and cough with purulent sputum. |
| Diagnostic Codes: | J84.114 | Acute interstitial pneumonitis |
| Patient Age: | 57 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fever and dyspnea" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Chest X Ray with radiopacity in lower right pulmonary field. Count blood cells with leukocytosis and left deviation Eritrosedimentation rate is elevated. Sputum Gram examination and culture. 1. Intake a lot of fluids 2. Defining an appropriate therapeutic strategy: Ibuprophen 400mg twice per day if the patient has fever 3. Use expectorant syrup 4. Avoid dyspnea using beta agonist medication as Albuterol nebulizer 5. Azithromycin 500 mg PO twice per day the first day continue with 500mg daily per 6 days. 6 . Follow-up in clinic. If symptoms are worsen, call the on-call physician or go to Emergency Room 7. PROMOTION: To explain the patient about the disease in order to avoid complications. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 52-year-old female with a previous history of health. She complains of a primary physician because in the last month he reports weight loss of 20kg with an increase in appetite. She refers to tachycardia. She refers to decreased tolerance to heat. She reports difficulty in sleep. |
| Diagnostic Codes: | E05.90 | Thyrotoxicosis, unsp without thyrotoxic crisis or storm E05.91 | Thyrotoxicosis, unspecified with thyrotoxic crisis or storm |
| Patient Age: | 52 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have unintentional weight loss " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | TSH, free thyroxine (T4), triiodothyronine (T3) B. Radioactive iodine (131I) uptake (RAIU). CBC. 2. Serum ferritin E. An echocardiogram |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 42-year-old female with a previous history of health. She complaints primary physician because in the least three days she started with right eye pain that describes as sharp, dull, and deep with extreme sensitivity to light. |
| Diagnostic Codes: | H20.00 | Unspecified acute and subacute iridocyclitis |
| Patient Age: | 42 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 42 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have right eye pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan. General interventions 1. The initial task is to be sure that there is no threat to vision. 2. Treatment modality depends on the underlying cause of eye pain. Pharmaceutical therapy: Medication depends on the underlying cause. Provide immediate referral to an ophthalmologist due to possible complications of cataracts and blindness. Uveitis and colitis often flare simultaneously; oral steroids are effective for both. Follow-Up A. The patient with uveitis needs a follow-up with an ophthalmologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Exam of Eye for Foreign Body Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/13/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 46-year-old man with a previous history of health. He complaints primary physician because in the least three weeks he started with heartburn. Patient reports regurgitation of fluid or food. Patient reports burning sensation in the chest that gets worsened when the patient lie on the bed. The patient also, reports unintentional weight loss and abdominal pain in the upper abdominal region. |
| Diagnostic Codes: | K21.9 | Gastro-esophageal reflux disease without esophagitis |
| Patient Age: | 46 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have Heartburn" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Dietary management 1. Weight loss is advised for overweight or obese patients with GERD symptoms. 2. At present, there is no supporting data for special dietary precautions; however a dietary elimination of foods helps to identify triggers. Initiation of a PPI should be prescribed once a day, before the first meal of the day. Omeprazole 20 mg administered 30 to 60 minutes before a meal (breakfast and dinner). Follow-Up A. Noncardiac chest pain due to GERD should have a diagnostic evaluation before institution of therapy. B. Empiric treatment with a PPI may be attempted for a short period except for patients presenting with any alarm symptoms. Schedule a return visit in 1 to 2 weeks to evaluate the relief of symptoms. C. Patients have been having frequent relapses; failure to adequately respond or longterm OTC H2 blockers and PPI use should have an endoscopic evaluation. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 57-year-old male with a previous history of hypertension and no clear cardiovascular problems reported by the patient. He complains of a primary physician because he started suddenly with cough, high fever, SOB, and chest pain on the right side that increase with breathing. Patient reports fever with shaking chills and shortness of breath. The patient refers to rust-colored sputum and generalized body weakness. |
| Diagnostic Codes: | J15.9 | Unspecified bacterial pneumonia |
| Patient Age: | 57 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 59 |
| Consult with Preceptor (minutes): | 11 |
| Student Participation: | 100% |
| Chief Complaint: | "I have cough and fever" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Administer acetaminophen (Tylenol) for fever 500mg tid p/o Azithromycin: oral (Zithromax). 500 mg loading dose then 250 mg daily on days 25 p/o. Encourage rest during acute phase. Encourage patients to avoid smoking/secondhand smoke. A vaporizer may be used to increase humidity. Encourage good hand washing or use of hand sanitizer. Dietary management: Encourage a nutritious diet with increased fluid intake. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 62-year-old female with a previous history of health. She complains of a primary physician because in the least three months she started with increase thirst, He reports an increase in the frequency of urination and an increase in appetite thus. He has lost weight. He refers to fatigue and lack of energy levels. The patient refers to visual disturbances with loss of visual acuity. |
| Diagnostic Codes: | E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| Patient Age: | 62 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 100% |
| Chief Complaint: | "I have thirst" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | It is recommended to perform at least 150 minutes per week of moderate intensity physical exercise for at least 3 days a week, with not more than 2 consecutive days of rest. Monotherapy for type 2 diabetes: Metformin is the preferred oral medication for type 2 diabetes 500mg twice daily. Change life style. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Diabetic Foot Care Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 29-year-old man with a previos history of health. He complaints primary physician because in the last week he started with the severe pain I right knee with a sensation of fullness mass, and stiffness. The patient complains of pain that occurs with terminal knee extension. |
| Diagnostic Codes: | M71.21 | Synovial cyst of popliteal space [Baker], right knee |
| Patient Age: | 29 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 50% |
| Chief Complaint: | "I have pain in my right knee" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Pharmaceutical therapy 1. Drug of choice a. NSAIDs to reduce pain and inflammation as Ibuprophen 400mg twice daily. p/o. Follow-Up A. Schedule initial follow-up in 2 weeks to evaluate current therapy or sooner if problems arise. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 32-year-old man with a previous history of health. He complaints primary physician because in the least week he started with cutaneous lesions with itching that appear on the trunk, upper arms, neck, and groin. The patient reports extensive skin discoloration lesions in the trunk. |
| Diagnostic Codes: | B36.0 | Pityriasis versicolor |
| Patient Age: | 32 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 38 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesions in the skin" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | D.Pharmaceutical therapy 1. Selenium sulfide 2.5% (Selsun Blue) a. Apply to skin at bedtime one time. Shower off in the morning. For 12 days, apply Selsun Blue to skin lesions, wait 30 minutes, then shower off. c. Treatment may be needed monthly until desired results are obtained. Encourage use of Selsun Blue on entire body surface except for face and head. 2. Other medications used a. Clotrimazole 1% cream twice daily for 4 weeks b. Ketoconazole (Nizoral) cream daily for 14 days c. Ketoconazole (Nizoral) 200 mg by mouth once daily for 3 days, for adults only. E.When using ketoconazole (Nizoral) as treatment, caution the patient regarding liver damage with toxicity. Follow-Up A. None is required if resolution occurs. B. Monitor LFTs every 6 weeks if patient is on ketoconazole. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 52-year-old man with a previous history of gallstones that complains primary physician because he started three days ago with abdominal pain in the right side that is described as a sharp, abrupt and severe cramping sensation in right upper quadrant (RUQ) of the abdomen postprandially. He reports nausea, vomiting, and anorexia with the pain. |
| Diagnostic Codes: | K81.0 | Acute cholecystitis |
| Patient Age: | 52 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain. " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Referral to surgery services Procedure. Count Blood Cells (CBC). Liver Function Test (LFT). Alanine aminotransferase; Aspartate aminotransferase; Alkaline phosphatase (ALP); Gamma glutamyl transferase (GGT). Chemistry panel Amylase if evidence of pancreatitis. Right upper quadrant abdominal ultrasound usually reveals stones and is considered the diagnostic test of choice. Abdominal CT is less helpful in the diagnosis when compared to US but can assist in ruling out other GI pathology. Urinalysis to rule out pyelonephritis and renal calculi. Stool for occult blood to rule out bleeding. Chest radiography to rule out pneumonia. EKG to rule out myocardial infarction (MI). PLAN Plan A. General interventions: Patients with a single episode of biliary colic are reasonable candidates for expectant management, as long as they continue to be free of recurrent pain. B. Patient teaching 1. No activity restriction is required. 2. Treatment depends on acuteness of attack. Heat may be used as needed for pain. If pain contin ues to worsen, have the patient contact his or her health care provider. Hospitalization and/or surgery may be required depending on the sever ity of the attack. C. Dietary management 1. Counsel the patient to avoid fatty foods. 2. Encourage the patient to avoid fasting and starvation diets, which make the bile even more lithogenic. D. Surgical management 1. Cholecystectomy may be recommended for symptomatic patients. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 19-year-old female with a previous history of health. She complained of a primary physician because in the least six months she started with abundant blood loss by menses that complains to the primary physician with easy fatigability, tachycardia, palpitations, and tachypnea on exertion. Also, the patient reports skin and mucosal changes, as smooth tongue, fragile nails, and cheilosis. The patient refers to craving specific foods like ice and chips. |
| Diagnostic Codes: | D50.0 | Iron deficiency anemia secondary to blood loss (chronic) D50.9 | Iron deficiency anemia, unspecified |
| Patient Age: | 19 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 55 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abundant menses" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | The serum ferritin will become abnormally low. A ferritin value less than 30 mcg/L is a highly reliable indicator of iron deficiency. The serum total iron-binding capacity (TIBC) rises. Bone marrow biopsy for evaluation of iron stores is now rarely performed because of intraobserver variation in its interpretation. Serum iron values decline to less than 30 mcg/dL and transferrin saturation to less than 15%. The MCV falls and the blood smear shows hypochromic microcytic cells. With further progression, anisocytosis (variations in red blood cell size) and poikilocytosis (variation in shape of red cells) develop. Severe iron deficiency will produce a bizarre peripheral blood smear, with severely hypochromic cells, target cells, hypochromic pencil-shaped cells, and occasionally small numbers of nucleated red blood cells. Gynecologic ultrasound shows small uterine myoma. The platelet count is increased. Pharmacological treatment. Ferrous sulfate, 325 mg three times daily, which provides 180 mg of iron daily of which up to 10 mg is absorbed (though absorption may exceed this amount in cases of severe deficiency), is the preferred therapy. Parenteral iron therapy should be used only in cases of persistent anemia after a reasonable course of oral therapy. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 58-year-old female with a previous history of health. She complained of a primary physician because she suddenly started with a severe sore throat and high fever. Throat pain gets worse when he swallows. |
| Diagnostic Codes: | J03.00 | Acute streptococcal tonsillitis, unspecified |
| Patient Age: | 58 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have throat ache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | TASO: elevated Pharyngeal culture Count blood cells with increase leukocytosis and shift deviation. Eritrosedimentation rate is positive. PCR: positive Streptococcal test is positive Penicillin V potassium (250 mg orally three times daily or 500 mg twice daily for 10 days) or cefuroxime axetil (250 mg orally twice daily for 510 days) are both effective. Ibuprophen 400mg twice daily. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old man with a previous history of health. He complaints primary physician because he started three days ago with a swollen and red cutaneous lesion in her right arm. The patient reports yellow discharge for the lesion. |
| Diagnostic Codes: | L02.92 | Furuncle, unspecified |
| Patient Age: | 27 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 39 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesion" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Decolonization usually consists of 5 to 10 days application of mupirocin ointment twice daily in the nostrils and daily body wash with 4% chlorhexidine soap for 5 to14 day. - Trimethoprim-sulfamethoxazole: 2 pills twice daily per 14 days. 2-PROMOTION: To explain the patient about the disease in order to avoid the recurrence of the disease. To explain the patient that furunculosis has a propensity to recur and in such cases they often spread among family members. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/10/2020 |
| Rotation Type: | NSG6440 |
| Comments: | History of Present Illness (HPI): A patient is a 40-year-old male complains primary physician because he started with presence of recurrent and unpredictable panic attacks, which are distinct episodes of intense fear and discomfort associated with a variety of physical symptoms, including palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and a fear of impending doom or death. The patient refers to clinical manifestations that started after a problem in his work. |
| Diagnostic Codes: | F41.0 | Panic disorder without agoraphobia |
| Patient Age: | 40 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have intense fear trembling" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan/Therapeutics (Roy-Byrne, 2017). Fasting glucose level. Thyroid function test SSRIs should be started at one-third to one-half of their usual antidepressant dose (e.g., 510 mg fluoxetine, 2550 mg Flurazepam (Dalmane) 15mg daily. Early psychotherapeutic intervention and education aimed at symptom control enhances the effectiveness of drug treatment. Patients can be taught breathing techniques, educated about physiologic changes that occur with panic, and learn to expose themselves voluntarily to precipitating events in a treatment program spanning 1215 sessions. Homework assignments and monitored compliance are important components of successful treatment. Once patients have achieved a satisfactory response, drug treatment should be maintained for 12 years to prevent relapse. Follow-up: weekly. Referral: Psychiatry. Side Effects Explained X, Continue Same Medications X, Patient Education Verbal X, Written X Health Education YES Nutrition: Diet normal. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 37-year-old male with a previous history of health. He complaints primary physician because he started with abdominal discomfort that can be relieved with defecation and an alteration in bowel pattern that alternate between diarrhea and constipation predominantly diarrhea associated with psychological problems and stress. Symptoms generally were slow in onset, started 2 months ago. |
| Diagnostic Codes: | K58.9 | Irritable bowel syndrome without diarrhea |
| Patient Age: | 37 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 42 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Stool guaiac should be performed on any patient with abdominal discomfort for rule out other gastrointestinal diseases. Stool culture, microscopy and antigen testing: negative. Upper GI and small bowel series Colonoscopy Abdominal ultrasound. MEDICATIONS: Antidiarrheal agents for patients with IBS with predominant diarrhea can be used on an occasional basis. Loperamide HCl (Imodium) inhibits peristaltic activity, thereby prolonging transit time, and it can increase anal sphincter tone (Start: 4 mg after first loose stool then 2 mg after each following stool Range: 416 mg/d). |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 28-year-old man with a previous history of health. He complains primary physician because in the last week he started with fever sore throat, generalized lymphadenopathies which are painful. The patient reports generalized body weakness. |
| Diagnostic Codes: | B27.90 | Infectious mononucleosis, unspecified without complication |
| Patient Age: | 28 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fever and sore ache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Excessive physical activity during the first month should be avoided. Prevention The isolation of patients with IM is unnecessary. Lab Tests: Count blood cells the white blood cell count is usually elevated and peaks at 10,00020,000/L during the second or third week of illness. Lymphocytosis is usually demonstrable, with >10% atypical lymphocytes PCR and Eritrosedimentation Rate are elevated. Special Tests: CD8+ cells predominate among the atypical lymphocytes. Serologic Testing: Tests for heterophile antibodies are positive. Titers of IgM and IgG antibodies to viral capsid antigen (VCA) are elevated in the serum of more than 90% of patients at the onset of disease. Antibodies to early antigens (EAs) are found either in a diffuse pattern in the nucleus and cytoplasm of infected cells (EA-D antibody) or restricted to the cytoplasm (EA-R antibody). The heterophile test is used for the diagnosis of IM in children and adults |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation STD & HIV Screening/Counseling X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 38-year-old man with a previous history of health. He visits the primary physician because in the least three days he reports that it started with gradual onset of swelling and tenderness of the left scrotum. He reports scrotal ‶induration″. He reports localized, unilateral left testicular pain with difficulty for urination and fever. |
| Diagnostic Codes: | N45.1 | Epididymitis N45.3 | Epididymo-orchitis |
| Patient Age: | 38 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my testicles and hard" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete: Lab Tests. Gram stain of urethral secretions. Urinalysis and urine cultures. Urethra swab (before void, after prostate massage) for gonorrhea and chlamydia culture Express prostatic secretions. TB skin test to rule out TB. PLAN Pharmaceutical therapy Ibuprophen 400mg twice daily per 10 days p/o Ciprofloxacin 500mg twice daily p/o per 10 days. Avoid physical activities. Follow-Up A. 7 days |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 35-year-old man with a previous history of health. Yesterday he suffers trauma practicing sport in his left testis and he noted increases in the size of his testis, for this reason, he visits the primary physician. |
| Diagnostic Codes: | N43.3 | Hydrocele, unspecified |
| Patient Age: | 35 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my left testis" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Evaluate factors that indicate surgical repair: as failure to resolve by age; continued discomfort; enlargement or waxing and waning in volume; unsightly appearance; secondary infection. Pharmaceutical therapy: None is recommended. Follow-Up A. Monitor every 3 months. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 54-year-old female with a previous history of health. She complained of a primary physician because in the least three days she started with yellow and green nasal discharge. Patient reports fever and sore throat and difficult to swallow with facial pain in the frontal part. |
| Diagnostic Codes: | J01.90 | Acute sinusitis, unspecified |
| Patient Age: | 54 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have yellow nasal discharge and frontal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Teach patient to avoid smoking and secondhand smoke. Drinking extra fluids helps to loosen secretions and hydrate the body. Application of warm, moist compresses to the face several times a day /local use. Humidifiers should be used daily (once daily) by nasal use. Nasal saline to the nares three times a day by nasal use. Provide patient with teaching guide on Sinusitis. Augmentin. 45 mg/kg/d in twice daily dosing for 10 days p/o Mometasone furoate monohydrate (Nasonex): Two sprays daily nasal use. Next appointment in 1 weeks. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 56-year-old male with a previous history of arterial hypertension, treated with amlodipine and spironolactone. He complains of a primary physician because in the least three months he refers to pain in both breasts and increases the size. |
| Diagnostic Codes: | N62 | Hypertrophy of breast |
| Patient Age: | 56 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have increase in the size of my both breasts" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Prolactin level. TSH. HCG. Serum luteinizing hormone. Testosterone level. Estradiol level. Mammography. Avoid spironolactone. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 52-year-old man with a previous history of arterial hypertension. He complains with the primary physician for blood pressure follow-up. |
| Diagnostic Codes: | I10 | Essential (primary) hypertension |
| Patient Age: | 52 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 36 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I am coming to follow up my arterial hypertension" |
| Reason for Visit (Check at least one): | Follow-up (Consult) |
| Procedure: | Adequate diet Physical exercises Losartan 50mg daily Aspirin 81mg daily. ECG Lipid panel test. |
| Skills/Procedures (Select All That Apply): | Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 42-year-old female with a previous history of health. She complains primary physician because in the least two weeks she started with pain during sexual intercourse as well as vaginal bleeding. |
| Diagnostic Codes: | A54.03 | Gonococcal cervicitis, unspecified |
| Patient Age: | 42 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain during sexual intercourse " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | WBC, if indicated. B. Consider testing for syphilis (rapid plasma reagin [RPR] or Venereal Disease Research Laboratory test). C. Wet prep. D. Cervical cultures for gonorrhea and chlamydia. E. Pap smear. F. Urine culture and sensitivity. G. Herpes culture. Plan. Plan A. General interventions: Patients whose culture is negative generally respond to a round of doxycycline therapy, which is the drug of choice for nonchlamydial, nongonorrheal cervicitis. B. Patient teaching 1. Women should be encouraged to obtain routine, annual Pap smear evaluations. Drug of choice for chlamydia: Doxycycline 100 mg twice daily for 7 days or azithromycin 1 g orally in a single dose. Treat all partners. 2. Drug of choice for gonorrhea: Ceftriaxone (Rocephin) 125 mg by IM injection plus either a single dose of azithromycin 1 g orally or doxycycline 100 mg orally twice a day for 7 days. Follow-Up A. Recommend test of cure: Reculture 1 to 2 weeks following completion of pharmacologic therapy. B. Follow up with Pap smear as mandated by result. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Pelvic Exam STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/08/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 40-year-old female with a previous history of health. She complaints primary physician because in the least three months she started with unintentional weight loss and lack of energy with generalized body weakness. The patient refers to increases in hunger. Patient reports thirst as well as increase the frequency of urination |
| Diagnostic Codes: | E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| Patient Age: | 40 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have lack of energy " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Exercise plan Weight reduction. LDL-C and non-HDL-C laboratory studies. Self-monitoring blood glucose (SMBG) Physical activities. A glycosylated hemoglobin determination every 3 months can assist the provider in measuring control. Metformin 500mg twice daily p/o. Follow-Up. Monthly. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 68-year-old man with a previous history of the smoker for the last 20 years with the previous history of a chronic cough that started three years ago that initially, the cough was present in the winter months. The patient visits the physician who ordered to stop smoking and using albuterol nebulizer, two puff by inhalation three times daily. He did not stop smoking, and he used albuterol one puff by inhalation when he has shortness of breath without improvement. |
| Diagnostic Codes: | E66.9 | Obesity, unspecified F17.203 | Nicotine dependence unspecified, with withdrawal J41.0 | Simple chronic bronchitis |
| Patient Age: | 68 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 41 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough and sputum" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Chest X Ray. Pulmonary Functional test Espirometry. Sputum Examination. Oxygen saturation. Count blood cells. Blood gas tests. High Resolution Computed Tomography (HRCT). Budesonide/formoterol (Symbicort): Two puffs by inhalation two times each day. PREVENTION AND EDUCATION. Avoid cigarette smoke. Vaccines: flu annually and a pneumonia every five years. Avoid irritants. Adequate hygiene. Pulmonary Rehabilitation. Regular physical activity. Healthy Diet. Avoid obesity. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Pulmonary Function Test Interpretation Spirometry in office X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 50-year-old man who complains of a previous history of health that complains primary physician because in the last 6 months he started with middle pain in both extremities that worsened, progressively and pain is more severe when standing. Patient reports pain usually dull, aching, or cramping 7/10 in pain scale. |
| Diagnostic Codes: | I83.893 | Varicose veins of bi low extrem w oth complications |
| Patient Age: | 50 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "Feeling of heaviness in extremity " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Trendelenburg test. Perthes test. Doppler ankle/brachial index (ABI). Duplex ultrasound. PLAN: Prevention: General Avoid prolonged standing or sitting. Exercise on a regular basis. Encourage smoking cessation, weight loss, exercise. If prolonged standing is required, shift weight from one leg to the other. Do not sit with legs dependent. Extremity elevation. Compression stockings. Exercise. Aspirin: 325 mg tablet p/o daily. Follow-Up A. Follow-up is determined by patients needs, frequency and intensity of symptoms, and the presence of other medical conditions. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 74-year-old male, with a previous history of health. He comes to the Emergency Department complaining of pain in his right arm. He sits upon the bed. He holds his right arm to his body with the left hand, and it is externally rotated and slightly adducted. He shows pain when he tries to move his right shoulder in any direction. The pain started three days ago when he was playing with his grandchildren in the garden when he tripped and fell. |
| Diagnostic Codes: | S46.001A | Unsp inj musc/tend the rotator cuff of r shoulder, init |
| Patient Age: | 74 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my right arm" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN The arm should be immobilized in a sling and swathed for 1-3 weeks. Active and passive flexion, extension, abduction, and internal/external rotation begin at about the third week, when the patient comes out of the sling. Rehabilitation is necessary to gently restoring the range of motion over 6-8 weeks. Radiography study (x ray). Ibuprofen 400mg twice daily. Physical therapy. PREVENTION. Rest the injury arm. Avoid fails. Avoiding activities. Rehabilitation and exercises. Good follow-up care. Follow up: two weeks. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old man with a previous history of health. He complains of a primary physician because in the last two days he started suddenly with both red eyes and abundant secretions which are yellow. Patient reports burning, stinging, or gritty sensation in eyes with discomfort in both eyes as mild foreign-body sensation. He refers to crusted eyelids upon awakening, with swelling of eyelids. Patient refers I have ‶beefy red eyesʺ. He denies fever. |
| Diagnostic Codes: | H10.30 | Unspecified acute conjunctivitis, unspecified eye |
| Patient Age: | 27 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 42 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have my eyes red with discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. Diagnostic Test. A. Gram stain testing for discharge/exudate extracted from eyes. B. Culture for chlamydia (Young man that is sexually active) C. Perform fluorescein stain of eye if foreign body is suspected or corneal abrasion/ulceration is suspected. D. Test visual acuity with the Snellen chart. Assess peripheral vision and extra ocular movements (EOMs). PLAN Plan A. General Interventions 1. Distinguish between bacterial, allergic, or viral infection. 2. Consider other diagnoses if eye pain is noted. Cool compresses to affected eye should be applied several times a day. Clean eyes with warm, moist cloth from inner to outer canthus to prevent spreading infection. Encourage good hand washing with antibacterial soap. 4. Instruct on the proper method of instilling medication into eye. Give patient the teaching guide on Teach the patient/parent the difference between bacterial, allergic, and viral infection. Educate according to appropriate diagnosis. 1. Bacterial a. Aminoglycosides: Gentamicin 0.3%: Severe infections: 2 gtts every hour on Day 1, then 1 to 2 gtts every 4 hours for 5 to 7 days. Follow-Up A. If resolution occurs within 5 to 7 days after proper treatment, follow-up is not needed. B. If patient continues to have symptoms or if different symptoms appear, then follow-up with the primary provider is recommended. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 46-year-old man with a previous history of health. He complains of a primary physician because in the least three months he started with abdominal pain on the left side of the lower abdominal region. He reports back pain. Patient reports flatulence with periodic abdominal distension and borborygmi, or loud. The patient refers to diarrhea with nausea and vomiting. |
| Diagnostic Codes: | K57.13 | Dvtrcli of sm int w/o perforation or abscess w bleeding |
| Patient Age: | 46 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain and fever" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. The diagnosis of diverticular colitis is made endoscopically and histologically. B. CT scan is becoming the optimal method of investigation for suspected acute diverticulitis. C. CBC with differential: WBC may show leukocytosis with a shift to the left; hemoglobin and Hct may be low with chronic or acute bleeding. D. CRP E. Radiography: Flat plate and upright films of abdomen to evaluate ileus or obstruction, free air, and perforation. F. Abdominal ultrasonography to evaluate masses or abscess G. Proctosigmoidoscopy. H. Hemoccult: Stool. A. Stress the importance of strict adherence to diet. B. Dietary management 1. NPO (nothing by mouth) status for acute treatment. 2. Fullliquid diet or lowfiber diet if not on bowel rest. 3. Longterm dietary management a. Highfiber diet including bran, beans, fruits, and vegetables. b. Bulk agents if unable to tolerate bran. c. Note foods to avoid such as nuts. 2. Diverticulitis initial attack: Ciprofloxacin (Cipro) 500 mg orally twice daily and metronidazole (Flagyl) 500 mg orally three times a day for 7 to 14 days Chronic disease: Utilize longterm ciprofloxacin but not metronidazole. 6. Avoid laxatives, enemas, and opiates. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Microscopy |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 45-year-old man with a previous history of arterial hypertension treated with Losartan 50mg daily that in the least three months and in relation with changes in the work he started with intense fear and discomfort associated with palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and a fear of impending doom or death. |
| Diagnostic Codes: | F41.8 | Other specified anxiety disorders I10 | Essential (primary) hypertension |
| Patient Age: | 45 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have intense fear" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Psychiatric evaluation. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Count Blood Cells. Thyroid Function Test. Fasting Glucose, Insulin and Hemoglobin A1C. Blood tests of Vit B12 Plan Treatment planning requires coordination of short-term strategies to induce remission combined with longer term maintenance designed to prevent recurrence. The most effective intervention for achieving remission and preventing relapse is medication, but combined treatment, incorporating psychotherapy to help the patient cope with decreased self-esteem and demoralization. A short course of a benzodiazepine is usually indicated, preferably lorazepam 10 mg one tab daily p/o. Sertraline (Zoloft) 50 mg daily p/o. Behavior therapy (exposure plus response prevention) and cognitive behavior therapy |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 60-year-old patient with a previous history of obesity. He complains the primary physician with a headache that is frequent in the morning. He refers to blurring vision and ringing in both ears. The patient reports that the headache worsened in the morning. The patient reports dizziness and palpitations. He visited the physician who ordered check blood pressure. |
| Diagnostic Codes: | I10 | Essential (primary) hypertension |
| Patient Age: | 60 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have headache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Advise overweight patients to lose weight. Loss of as little as 10 pounds reduces BP in many patients. Advise the patient to limit or discontinue alcohol intake. Encourage the patient to stop smoking. Encourage increased physical activity. Encourage some form of relaxation technique. Consider starting antihypertensive and/or inadequate response to initial therapy and no adherence is ruled out. Losartan 25 mg daily. Diagnostic Tests A. Hematocrit B. B.LFTs (LDH [lactate dehydrogenase], uric acid) C. Chemistry profile D. Lipid profile (total and HDL-cholesterol and triglycerides). E.Urinalysis for proteinuria. F.Estimated GFR. G.EKG |
| Skills/Procedures (Select All That Apply): | Cardiovascular Risk Assessment/Management Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 60-year-old female with a previous history of autoimmune thyroiditis treated with levothyroxine 50 μg levothyroxine (T4) daily p/o. He complains primary physician with weakness which is sporadic, and most evident at times of stress; that the patient is continuously fatigued, and bed rest is necessary. The patient refers that family detected changes in the color of skin with diffuse brown, or bronze darkening of parts such as the elbows or wrinkles of the hand and of areas that normally are pigmented such as the areolae about the nipples. |
| Diagnostic Codes: | E27.1 | Primary adrenocortical insufficiency |
| Patient Age: | 60 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 56 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "Weakness and loss of appetite" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. Serum chemistry, electrolytes. Blood urea nitrogen (BUN) Creatinine. Glomerular filtration rate (GFR). Complete blood count (CBC). PPD. Rapid ACTH test: Rapid ACTH stimulation test excludes or establishes adrenal insuffi ciency but does not differentiate between primary and secondary adrenal insufficiency; with abnormal results (plasma cortisol < 1820 mcg/dL), proceed to plasma ACTH levels. Plasma ACTH level Potassium levels. Pharmaceutical therapy Prednisone 20 mg in three doses (every 8 hours). Hyperkalemia: is managed with a low potassium diet in combination with prescribing a loop diuretic such as furosemide. Serum and urinary cortisol and serum ACTH to monitor hydrocortisone dose. Monitor BP and serum electrolytes to determine fludrocortisone dose. Do annual adrenal function studies. Glucocorticoid replacement regimen -Hydrocortisone (1525 mg) or cortisone acetate (2035 mg) in two or three divided oral doses per day; the highest dose should be given in the morning at awakening, the next either in the early afternoon (2 h after lunch; two-dose regimen) or at lunch and afternoon (three-dose regimen). Mineralocorticoid replacement in PAI -All patients with confirmed aldosterone deficiency receive mineralocorticoid replacement with fludrocortisone (starting dose, 50100 μg in adults) and not restrict their salt intake. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/06/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 58-year-old man with a previous history of frequents respiratory diseases and a diagnosis of recurrent pneumonia. The patient complains of a primary physician because suddenly he started with pain on the right side of the abdomen that increased with deep breathing and coughing. The patient refers shortness of breath that has worsened progressively and a dry cough that is persistent. |
| Diagnostic Codes: | J18.9 | Pneumonia, unspecified organism |
| Patient Age: | 58 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 55 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in the right side of my abdomen" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Complete blood count. Ultrasonography. Chest X Ray CBC with differential. Rapid viral tests per nasal swab General interventions 1. Encourage rest during acute phase. 2. Encourage patients to avoid smoking/secondhand smoke. 3. A vaporizer may be used to increase humidity. 4. Encourage good hand washing or use of hand sanitizer. Encourage a nutritious diet with increased fluid intake. Chest physiotherapy is not prescribed for pneumonia. Pharmaceutical therapy 1. Treatment with antibiotics is empirical. Oral therapy should continue 7 to 10 days. Amoxicillin is considered as first-line therapy 500mg tid p/o. Administer acetaminophen (Tylenol) for fever; 500mg tid p/o. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 44-year-old man with a previous history of upper respiratory infection one week ago treated with Acetaminophen 500 mg tid p/o. He complains of primary physician because two days ago he started with a fever and green nasal discharge. He reports a sore throat with facial pain. |
| Diagnostic Codes: | J01.90 | Acute sinusitis, unspecified |
| Patient Age: | 44 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 100% |
| Chief Complaint: | "I have fever and green nasal discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete: 1. Teach patient to avoid smoking and secondhand smoke. 2. Drinking extra fluids helps to loosen secretions and hydrate the body. 3.Humidifiers should be used daily. 4. Nasal saline to the nares three times a day will help to keep nasal passages moist. Augmentin 500 mg orally three times a day or 875 mg orally twice daily for 10 days. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 30-year-old man with a previous history of sickle cell anemia. He complains of a primary physician because today he started with a painful and persistent erection of his penis lasting for seven hours. The patient reports that erection is unrelated to sexual interest or stimulation. |
| Diagnostic Codes: | N48.32 | Priapism due to disease classified elsewhere |
| Patient Age: | 30 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have painful and persistent erection of my penis" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Referral to hematologist and For phenylephrine injections, 1 mL of 1% phenylephrine (10 mg/mL) is added to 19 mL of 0.9% saline to make 500 mcg/mL; 100 to 500 mcg (0.2 to 1 mL) is injected every 5 to 10 min until relief occurs or a total dose of 1000 mcg is given. Before aspiration or injection, anesthesia is provided with a dorsal nerve block or local infiltration. Follow-Up. Weekly. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 40-year-old male with a previous history of health that yesterday suddenly started with severe dizziness (vertigo), last for 1 to 6 h also, he refers ringing in the right ear (tinnitus), hearing loss, and a feeling of fullness or congestion in his left ear. |
| Diagnostic Codes: | H81.09 | Meniere's disease, unspecified ear |
| Patient Age: | 40 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have hearing loss" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests Audiogram and gadolinium-enhanced MRI to rule out other causes. Electronystagmogram (ENG). Vestibular autorotation test. The video-occulography. Hearing testing (audiometry), with tympanometry and OAE. (hearing should be down) ECOG (electrocochleography) -- pressure may be normal or increased. Increased in Meniere's. Videonystagmography (VENG), rotatory chair Video Head Impulse Testing (or VHIT) and Vestibular Evoked Myogenic Potentials (VEMP) testing to document amount of damage. Combining the VHIT and VENG (caloric) test may be sensitive to Meniere's Posturography Blood tests. (Should be normal): these are not always done. CRP and ANA (for autoimmune) Anti-thyroglobulin and anti-TPO antibodies (for Hashimoto's thyroiditis) MRI of brain Anticholinergic Antiemetics (eg, prochlorperazine 25 mg rectally or 10 mg po q 6 to 8 h. Antihistamines meclizine, 50 mg po q 6 h. Hydrochlorothiazide 25 mg po once/day A low-salt (< 1.5 g/day) diet, avoidance of alcohol and caffeine, and a diuretic (eg, or acetazolamide 250 mg po bid) may help prevent or reduce the incidence of vertigo attacks and are commonly used first steps. Follow-up. Weekly |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 45-year-old woman with a previous history of health. She complains primary physician because three days ago, she has fissures of the right nipple. Today she started with severe breast pain 8/10 according to pain scale in the right breast that patient describes as sharp, burning, aching with redness, swelling and increase in local temperature with fever. |
| Diagnostic Codes: | S20.111A | Abrasion of breast, right breast, initial encounter |
| Patient Age: | 45 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my right breast" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. Treatment usually initiated based on symptoms and exam B. CBC: Leukocytosis in peripheral smear C. Ultrasound considered if breast is not responding to treatment to evaluate for breast abscess. Plan A. General Interventions: Encourage self-care and support. Advise the family to assist the patient with self-care and infant care during this acute period. The woman may feel extremely ill for the first 24 to 48 hours of therapy and may find it difficult to continue breastfeeding, self-care, and newborn care activities. B. Patient education Encourage her to eliminate caffeine, if possible, or use in moderation. Pharmaceutical therapy 1. Antibiotics a. Drug of choice: Dicloxacillin 500 mg by mouth every 6 hours for 10 days. Advise the patient to complete the full course of antibiotics even if symptoms are improved sooner. Pain medication as ibuprofen 400 mg twice daily p/o. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 40-year-old man with a previous history of health. He complains primary physician because in the least three months he started with cutaneous lesions with itching that appear on the trunk, upper arms, neck, and groin. The lesions are white that varies from 45 mm in diameter to large confluent areas. The patient reports extensive skin discoloration lesions in the trunk. |
| Diagnostic Codes: | B36.0 | Pityriasis versicolor |
| Patient Age: | 40 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesions" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. Wet prep/KOH B. Woods lamp: Woods light is useful in examining skin to determine the extent of infection. Inspection of fine scales with Woods lamp reveals scales with a pale yellow-green fluorescence that contains the fungus. D. Pharmaceutical therapy 1. Selenium sulfide 2.5% (Selsun Blue) a. Apply to skin at bedtime one time. Shower off in the morning. For 12 days, apply Selsun Blue to skin lesions, wait 30 minutes, then shower off. c. Treatment may be needed monthly until desired results are obtained. Encourage use of Selsun Blue on entire body surface except for face and head. 2. Other medications used a. Clotrimazole 1% cream twice daily for 4 weeks b. Ketoconazole (Nizoral) cream daily for 14 days c. Ketoconazole (Nizoral) 200 mg by mouth once daily for 3 days, for adults only. Follow-Up A. None is required if resolution occurs. B. Monitor LFTs every 6 weeks if patient is on ketoconazole. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 61-year-old man with a long-standing history of alcohol abuse. He presents the primary physician with a 4-day history of a midabdominal ache persistent and severe that radiates to the back and improves when he leans forward. The patient refers to nausea and vomiting. |
| Diagnostic Codes: | C25.3 | Malignant neoplasm of pancreatic duct |
| Patient Age: | 61 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in the upper part of my abdomen" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Abdominal scans for other medical issues. MRI and CT scans are used to help differentiate a pseudo cyst from cancer, but may require additional testing for a conclusive diagnosis. Rectal exam. Count Blood Cells ( CBC ). Electrolytes. BUN/Cr Amylase. Lipase. AST/ALT/ bilirubin/alkaline phosphatase. U/Sabdomen CTabdomen Upper endoscopy. ECG. Liver functions test. Amylase. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 44-year-old woman with a previous history of health. She complains of primary physician because in the least three months and after sexual relation without protection she started with lower abdominal pain, fever with chills and she reports increased vaginal discharge that is yellow with a foul smell. |
| Diagnostic Codes: | A56.11 | Chlamydial female pelvic inflammatory disease A56.11 | Chlamydial female pelvic inflammatory disease |
| Patient Age: | 44 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have lower bleeding out my menstrual cycles" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | CBC with differential; WBC greater than 10,500 cell/mm3. Sedimentation rate or Creactive protein. Quantitative beta HCG D. RPR, hepatitis B surface antigen, and HIV E. Cultures for gonorrhea and chlamydia. Pharmaceutical therapy. Ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg orally twice a day for 14 days Follow-Up A. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy Pelvic Exam STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 55-year-old man with a history of obesity that complains primary physician because in the least six months he reports restless sleep associated with dry mouth and sore throat which are permanent. The patient refers to a lack of physical or mental energy with a decrease in concentration during intellectual activities and cognitive deficits. |
| Diagnostic Codes: | G47.33 | Obstructive sleep apnea (adult) (pediatric) |
| Patient Age: | 55 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have daytime sleepiness" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Patient Teaching Educate patient about modifying controllable risk factors such as keeping diabetes and hypertension under control, diet, exercise, and stopping smoking. 2. Treatment with CPAP and BiPAP is required at all times during the night and during naps. 3. Behavioral strategies include sleeping in a nonsupine position using a positioning device (e.g., alarm, pillow, backpack, tennis ball are used for positional therapy). 4. Give patient teaching sheet on sleep apnea. 5. Dietary management: Even a modest weight loss of 10% to 20% has been associate |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Screen/Manage Sleep Disorders |
Case Log - Use as of 7/11/2019
| Date: | 01/03/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 60-year-old man with a previous history of arterial hypertension treated with amlodipine 10mg daily p/o. According his wife he has abnormal gait because when walking, shorter steps are taken, shuffle step, feeling of unsteadiness with walking. Also, the patient has postural instability. Patient refers to he has tremor at rest which is intermittent but progresses over time. Also, the patient reports the joints are more rigid. |
| Diagnostic Codes: | G20 | Parkinson's disease I10 | Essential (primary) hypertension |
| Patient Age: | 60 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "My husband has abnormal gait" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. There is no definitive diagnostic test for PD. B. Urinalysis to rule out UTI with any urinary symptoms. C. Speech therapy evaluation of dysarthria and dysphagia to assess aspiration risk . D. Brain CT scan or MRI to exclude mass lesion, multiple infarcts, or normal pressure hydrocephalus. E. MRI of cervical spine if there is increased gait disturbance after a fall. PLAN General interventions 1. Encourage regular exercise to maintain or improve flexibility. 2. Emphasize the importance of the nonmotor symptoms being addressed and adequately treated. Encourage the family to notify the provider if these symptoms are not being controlled. Anxiety, depression, fatigue, mood, and behavioral issues need to be addressed and controlled for quality of life for the patient and family. 3. Home safety evaluations are recommended because the symptoms of PD place patients at high risk for falls and accidental injury. Levodopa, combined with a decarboxylase inhibitor, is the mainstay of treatment. Sinemet is the levodopa and carbidopa tid p/o. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 65-year-old man patient with a previous history of obstructive sleep apnea and arterial hypertension treated with amlodipine 10mg daily. He complains of a primary physician because in the least three months he started with difficulties with activities of daily living (ADL) or functional impairment. Also, the patient refers to a lack of interest/inability to tolerate exercise and shortness of breath. He refers to difficulty with personal hygiene on some occasions he reports urinary incontinence. Patient refers he desires to lose weight |
| Diagnostic Codes: | E66.01 | Morbid (severe) obesity due to excess calories G47.33 | Obstructive sleep apnea (adult) (pediatric) I10 | Essential (primary) hypertension |
| Patient Age: | 65 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 38 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 50% |
| Chief Complaint: | "I desire to lost my weight" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Manage obesity as a chronic relapsing disease, including the co-management of other diseases secondary to obesity (i.e., diabetes, hypertension). A. General interventions 1. Reinforce the positive impact that weight loss measures (diet, exercise) can have and the overall health benefits of weight loss. 2. Identify and monitor any cardiovascular complications. 3. Behavior modification: Intensive behavioral therapy has been shown with better success of weight loss and sustainable weight loss for longer periods of time. Behavioral therapy includes weekly meeting with health care professionals for at least 6 to 8 weeks. a. Dietary plan i. Low calorie ii. Increase in fruits and vegetables iii. Eliminate alcohol and beverages containing sugar. iv. Reduction of high-glycemic foods such as candy. v. Reduction in high-caloric foods and drinks. vi. Reduction of fat intake. vii. Reduction of portion sizes viii. Increase in water intake b. Exercise: Both children and adults |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 47-year-old man with a previous history of health. In the least five weeks, he started with abdominal pain in the middle of the abdominal region. Pain is with burning sensation in relation with meals. The patient reports that pain awakes the patient from sleep (between midnight and 3 A.M.). According to the patient is ‶as hunger painʺ. The pain occurs 3 h after a meal and is frequently relieved by antacids or food. The patient refers to a loss of appetite. |
| Diagnostic Codes: | K26.3 | Acute duodenal ulcer without hemorrhage or perforation |
| Patient Age: | 47 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 31 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 50% |
| Chief Complaint: | "I have pain in my stomach" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Diagnostic Tests A. CBC B. Stool for occult blood C. Coagulation studies D. Testing for H. pylori 1. Endoscopy with biopsy is the most accurate test. 2. Urea breath test (UBT) 3. Serum test for H. pylori antibodies 4. Stool H. pylori antigen testing E. Radiography with barium meal F. Mucosal biopsy, after GI consultation, to rule out cancer. G. Fasting gastrin level (screening for ZollingerEllison). A. General Interventions: Goals are to alleviate pain, promote healing, limit complications, and prevent recurrences while minimizing costs and side effects of treatment. Encourage the patient to stop taking NSAIDs, unless medically indicated. Dietary management: Advise the patient to avoid alcohol, coffee, including decaffeinated, and other caffeinecontaining beverages because they stimulate acid secretion. Medical and surgical management 1. Diagnostic evaluation of the ulcer is by means of endoscopy. 2. Test for H. pylori. Pharmaceutical therapy Omeprazole 20mg twice daily. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 68-year-old patient with a previous history of smoked one pack of cigarettes a day for 20 or more years before he started with dyspnea, cough, and sputum. He visited the physician who ordered Ventolin 2 puff daily inhaler but the patient did not improve. The patient complains of primary physician with chronic cough and colorless sputum, that usually worse in the morning. |
| Diagnostic Codes: | J44.9 | Chronic obstructive pulmonary disease, unspecified |
| Patient Age: | 68 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have dyspnea and blue discoloration on my fingers" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Pulse Oximertry. PO2. 86% Spirometry is the gold standard for diagnosing COPD. PFTs are used to diagnose, determine severity, and follow the disease progression of COPD. Spirometry before and after using bronchodilator. FEV1 is used as an index to airflow obstruction and evaluates the prognosis in emphysema. FVC. FEV1/FVC ratios less than 0.70 B. CXR (not required to diagnose COPD but rules out other diagnoses) CBC-evaluate polycythemia due to chronic hypoxia Sputum specimen for culture Arterial blood gas (ABG) EKG: Note sinus tachycardia, atrial arrhythmias. Two-dimensional echocardiogram is used to evaluate secondary pulmonary hypertension. Chest CT is an alternative imaging study for emphysema; however, it is not required as a diagnostic tool. Perform a PPD test if TB is suspected. Brain natriuretic peptide (BNP). A. General interventions 1. Educate and encourage active participation in the plan of care, including medication adherence. 2. Smoking cessation plan is an essential part of a comprehensive treatment plan. 3. Consider pulmonary rehabilitation for all stages of COPD. Dietary management 1. About 25% of COPD patients are malnourished because of coexisting medical conditions, depression, and inability to shop for or prepare food. 2. Suggest a low-carbohydrate diet. High carbohydrate intake may increase respiratory work by increasing CO2 production. Long-term oxygen has been shown to increase survival in patients with severe resting hypoxemia. Target oxygen saturation is 88% to 92%. Long-acting β agonist as salmeterol (Serevent) with concomitant inhaled corticosteroids Budesonide DPI (Pulmicort Flexhaler) 180540 mcg |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Pulmonary Function Test Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 52-year-old man with a previous history of health. He complains of a primary physician because in the least three months he started with increase thirst, He reports an increase in the frequency of urination and an increase in appetite thus. He has lost weight. He refers to fatigue and lack of energy levels. The patient refers to visual disturbances with loss of visual acuity. |
| Diagnostic Codes: | E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| Patient Age: | 52 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have thirst" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. Glycosylated hemoglobin (Hgb A1c) of 6.5% or higher B. Fasting plasma glucose: The baseline should be performed earlier if any predisposing factors exist. A. General interventions 1. Establish, review, and evaluate individual goals with the patient on a routine basis. 2. Center goals around normal metabolic control and the prevention and delay of complications while maintaining a flexible, normal, high- quality life. Psychosocial support: It is important from the beginning of treatment to give the patient a sense of control. i. Consistent involvement of family members will influence compliance. ii. Assess and discuss psychosocial issues at each visit. iii. Dietary/physical activity management 1. Nutritional plan: The patient should meet with a dietitian who has experience with diabetes nutritional therapy. 2. Eating patterns and ideal percentage of calories from protein, carbohydrates, and fat should be individualized for each patient and determined along with a dietician. 3. Involve the family to improve compliance with the individualized meal plan. 4. Overweight/obese patients are encouraged to set a goal of healthy eating strategies to enhance weight loss. It is recommended to perform at least 150 minutes per week of moderate intensity physical exercise for at least 3 days a week, with not more than 2 consecutive days of rest. Monotherapy for type 2 diabetes: Metformin is the preferred oral medication for type 2 diabetes 500mg twice daily. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 48-year-old man with a previous history of arterial hypertension treated with Amlodipine 10mg daily p/o. The patient is obese with a sedentary lifestyle. The patient complains of the primary physician with pain somewhere in the chest that started suddenly after a vigorous physical exercise as rising overweight. He described as the worst pain ever experienced. Patient reports as chest heaviness or tightness with nausea, vomiting and a lot of sweating and indigestion. He reports anxiety. The patient reports chest pain as heavy, squeezing, and crushing. |
| Diagnostic Codes: | I21.02 | STEMI involving left anterior descending coronary artery |
| Patient Age: | 48 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 55 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have chest pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Referral to Emergency department with Lab Tests A. Electrocardiogram (EKG): Shows inverted T waves, ST segment elevation, and Q waves. B. Laboratory testing 1. Cardiac biomarkers/enzymes 2. Troponin levels: A protein that is released when necrosis of the cardiac muscles occurs. 3. Creatine kinase (CK): CK-MB levels increase 3 to 12 hours after the chest pain begins, peaks at 24 hours, and returns to normal in 48 to 72 hours. 4. Myoglobin: Urine myoglobin levels rise 1 to 4 hours after the chest pain begins. 5. Complete blood count (CBC) 6. Chemistry profile. C. Cardiac imaging: Coronary angiogram. Aspirin 325 mg (four 81 mg baby aspirin) chewed or swallowed as soon as possible. Enteric-coated aspirin delays absorption and therefore is not recommended. 2. Instruct the patient on how to take sublingual nitroglycerin tablets and other medications. 3. Nitrates: Nitroglycerin sublingual 0.2 to 0.6 mg every 5 minutes for ischemic chest pain in the absence of hypotension. 4. If pain persists after three doses of nitroglycerin: a. Morphine sulfate IV; 2 to 4 mg IV, repeating every 5 minutes until pain resolves Oxygen therapy: 2 to 4 liters per nasal cannula. Fibrinolytic therapy |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 56-year-old male with a previous history of arterial hypertension treated with amlodipine 10mg daily p/o. He complains of a primary physician because in the last two months he started with perianal pain irradiated to the sacral region also patient reports pain in the lower abdominal region which is permanent and fever, with a burning sensation during urination. The patient refers to some occasions red color of urine. |
| Diagnostic Codes: | N41.0 | Acute prostatitis |
| Patient Age: | 56 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have anal pain and fever " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Therapeutic: 1. Ciprofloxacin 500mg twice daily per 4 weeks. Diagnostic Tests: 1. Complete blood count shows leukocytosis and a left shift. 2. Urinalysis shows pyuria, bacteriuria, and varying degrees of hematuria. 3. Urine cultures will demonstrate the offending pathogen Education: 1. Intake a lot of fluids. 2. If urinary retention develops, urethral catheterization or instrumentation is contraindicated, and a percutaneous suprapubic tube is required. 3. Follow-up urine culture and examination of prostatic secretions should be performed after the completion of therapy to ensure eradication. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Prostate Examination STD & HIV Screening/Counseling X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 38-year-old woman with a previous history of chronic pelvic pain three years ago, which is associated with infertility. The patient complains of a primary physician because in the least three months she started with pain during sexual intercourse and rectal pain with vaginal bleeding without the period. The patient refers to pain worsened with intercourse and bowel movements. |
| Diagnostic Codes: | N80.9 | Endometriosis, unspecified |
| Patient Age: | 38 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan General Interventions: After surgical confirmation, the practitioner may comanage endometriosis with a physician. B. Patient teaching 1. Treatment goals include prevention of disease progression, alleviation of pain, and establishment or restoration of fertility. Treatment options include the following. a. Observation alone. b. Medical therapy or pharmacologic therapy. c. Referral to Gynecologist to consultation for laparoscopic therapy, including laser vaporization and removal of adhesions. a. Combined Oral Contraceptive (COC) pills are considered the first line therapy. If the patient experiences pain during the week of withdrawal bleeding, she may take active pills continuously, omitting the placebo pills of the off week. Follow-up: Weekly. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Microscopy Pap Smear Pelvic Exam STD & HIV Screening/Counseling X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 46-year-old male with a previous history of arterial hypertension using hydrochlorothiazide and labetalol. Patient drinking ethanol daily. He complains primary physician with a history of a sudden onset of acute upper central abdominal pain 8 out of 10 in pain scale which is steady and boring in character, is located in the middle and upper part of the abdomen and periumbilical region and it radiates to the back as well as to the lower abdomen. |
| Diagnostic Codes: | K85.2 | Alcohol induced acute pancreatitis |
| Patient Age: | 46 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Complete Blood Count (CBC). Comprehensive Metabolic Panel. Serum lipase and amylase, interleukins. Serum troponin. AST/ALT. FBC and differential. C-reactive protein (CRP). Hematocrit Arterial blood gas Abdominal plain film CXR Trans abdominal ultrasound Ratio of serum lipase: amylase Further Diagnostics Required CT scan w/ contrast. ECG |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 01/02/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 60-year-old male with a previous history of arterial treated with Amlodipine 10mg p/o daily. The patient complains of a primary physician because three months ago started with fatigue, palpitations, and shortness of breath. Initially dyspnea and palpitations were observed only during exertion. On this occasion, the patient refers that dyspnea as well as palpitations occurring in the recumbent position. |
| Diagnostic Codes: | I27.2 | Other secondary pulmonary hypertension I50.20 | Unspecified systolic (congestive) heart failure |
| Patient Age: | 60 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 56 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have Fatigue and shortness of breath" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Patients should receive immunization with influenza and pneumococcal vaccines to prevent respiratory infections. Furosemide 20 mg qd p/o. Low salt diet, low carbohydrates diet and low fat. Losartan 12.5 mg qd p/o Aspirin 81 mg daily p/o. Prevention Control body weight. Adequate control of arterial hypertension. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 66-year-old man with a previous history of health. The patient complains of a primary physician because in the last six months he started with an increase of appetite and a lot of thirsts. He reports abnormally large quantities of urine, accompanied by a need to urinate frequently. He was passing large volumes of urine throughout the day and night, without difficult for urination. |
| Diagnostic Codes: | E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| Patient Age: | 66 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 55 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have a lot of thirst" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. General interventions 1. Establish, review, and evaluate individual goals with the patient on a routine basis. a. Exercise plan i. Develop a consistent, individualized exercise plan with the patient to improve insulin sensitivity, blood sugars, weight reduction, and reduction of cardiovascular complications. ii. Evaluation by a health care provider, including a complete physical examination and EKG, must precede any exercise program. iii. Generally, the goals for physical activity are to reduce LDL-C and non-HDL-C and to lower blood pressure. The exercise should involve moderate-to-vigorous intensity. C. Pharmaceutical therapy Metformin 500mg tid p/o. If monotherapy at the maximum dose is not achieved after 3 months, a second oral medication should be added. B. A glycosylated hemoglobin determination every 3 months can assist the provider in measuring control. Consultation/Referral A. Refer to the physician if the patient experiences: Severe or frequent hypoglycemia that is unresponsive to conventional pharmaceutical therapy. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 24-year-old man with a previous history of health that started in the least three days with ocular and/or nasal pruritus, sneezing, and rhinorrhea. |
| Diagnostic Codes: | J30.5 | Allergic rhinitis due to food |
| Patient Age: | 24 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have nasal pruritus" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Drinking extra fluids helps to loosen secretions and hydrate the body. Encourage patient to use medications as prescribed. OTC medications such as antihistamines and decongestants should be used with caution. Diphenhydramine 25 mg twice daily. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 45-year-old man with a previous history of health that complains primary physician because five days ago started with yellow and green nasal discharge. Patient reports fever and facial pain that increases with percussion. |
| Diagnostic Codes: | J01.90 | Acute sinusitis, unspecified |
| Patient Age: | 45 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 50 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 100% |
| Chief Complaint: | "I have nasal discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Drinking a lot of fluids OTC medications such as antihistimines and decongestants should be used with caution. Application of warm, moist compresses to the face several times a day will help with discomfort. Humidifiers should be used daily. Nasal saline to the nares three times a day will help to keep nasal passages moist. Provide patient with teaching guide on Sinusitis. Augmentin. 45 mg/kg/d in twice daily dosing for 10 to 14 days. Mometasone furoate monohydrate (Nasonex): Two sprays daily |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old young woman with a history of seasonal rhinitis. She complains of a primary physician because three weeks ago she, started with itching and cutaneous lesions disseminated in all the body which improves with OTC antihistaminic. |
| Diagnostic Codes: | L20.9 | Atopic dermatitis, unspecified |
| Patient Age: | 27 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have generalized itching" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests: Radioallergosorbent tests (RASTs) or skin tests may suggest dust mite allergy Eosinophilia Serum IgE levels may be present. General Measures: Promotion and Education Atopic patients have hyperirritable skin. Avoid anything that dries or irritates the skin. Diphenhydramine 25 mg twice-daily p/o. Photo-therapy Referral: Dermatologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient of 29 years old with a previous history of health. She complains of primary physician because has itching cutaneous lesion as hives disseminated in her body after eating ham. |
| Diagnostic Codes: | L50.0 | Allergic urticaria |
| Patient Age: | 29 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesions" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Avoid irritant Atopic diet Benadryl . 25 mg twice daily |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-year-old female with a history of previous healthy that visits the primary physician with abdominal pain or discomfort and altered bowel habits with diarrhea after intense stress. |
| Diagnostic Codes: | R19.7 | Diarrhea, unspecified |
| Patient Age: | 25 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have diarrhea" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab studies, and . 1.Use adequate diet, intake a lot of fluids. 2. Use medication ANTISPASMODICS (ANTICHOLINERGIC) AGENTS: Dicyclomine, hyoscyamine, methscopolamine ANTIDIARRHEAL AGENTS: Loperamide OSMOTIC 2-PROMOTION: To explain the patient about the disease in order to avoid complications. Continue with the medication. 3-PREVENTION: To educate patient to use complete regimen treatment. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 23- year-old female with a previous history of health. She started two days ago with a burning sensation during urination and low back pain also, the patient complains fever and chills |
| Diagnostic Codes: | N39.0 | Urinary tract infection, site not specified |
| Patient Age: | 23 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have burning with urination" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Intake a lot of fluids Ciprofloxacin 500mg twice daily |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old man with previous history of health. He complains primary physician because he has severe throat ache with difficulty for swallowing and fever. He refers generalized body weakness. |
| Diagnostic Codes: | J02.0 | Streptococcal pharyngitis |
| Patient Age: | 26 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 41 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have throat ache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Intake a lot of fluids Benzatyn penicillin. 1, 200.000 uds IM. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 12/30/2019 |
| Rotation Type: | NSG6440 |
| Comments: | HPI. The patient is a 60-year-old male with a previous history of arterial hypertension. He uses Amlodipine 10mg p/o daily as antihypertensive treatment. The patient complains of a primary physician because three months ago started with fatigue, palpitations, and shortness of breath. Initially, dyspnea and palpitations were observed only during exertion. On this occasion, the patient refers that dyspnea as well as palpitations occurring in the recumbent position. The shortness of breath is worsened with physical activities and improves with rest. The patient reports anorexia, nausea, and early satiety associated with abdominal pain and fullness two weeks without relation to physical activities that worsen after meals. |
| Diagnostic Codes: | E66.9 | Obesity, unspecified I27.2 | Other secondary pulmonary hypertension I50.20 | Unspecified systolic (congestive) heart failure |
| Patient Age: | 60 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 10 |
| Student Participation: | 75% |
| Chief Complaint: | "Fatigue and shortness of breath" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN (Colucci, 2018). Lab Tests Complete blood count, a panel of electrolytes, blood urea nitrogen, serum creatinine, hepatic enzymes, and a urinalysis. Fasting serum glucose or oral glucose tolerance test, fasting lipid panel, and thyroid-stimulating hormone level, T3 and T4, HbA1c). Electrocardiogram (ECG): A routine 12-lead ECG Chest X-Ray Biomarkers: Both B-type natriuretic peptide (BNP) and N-terminal pro-BNP. C Reactive protein. Echocardiogram. Treatment HF patients should be advised to stop smoking and to limit alcohol consumption to two standard drinks per day in men or one per day in women. Education: Patients suspected of having an alcohol-induced cardiomyopathy should be urged to abstain from alcohol consumption indefinitely. Extremes of temperature and heavy physical exertion should be avoided. Patients should receive immunization with influenza and pneumococcal vaccines to prevent respiratory infections. It is equally important to educate the patient and family about HF, the importance of proper diet, as well the importance of compliance with the medical regimen. Furosemide 20 mg qd p/o. Low salt diet, low carbohydrates diet and low fat. Losartan 12.5 mg qd p/o Aspirin 81 mg daily p/o. Prevention Control body weight. Patient encounter: Patient with previous history of arterial hypertension that complains primary physician with fatigue and shortness of breath and orthopnea, The risk factor is arterial hypertension and the primary diagnosis is Congestive heart failure. Use healthy diet. Adequate control of arterial hypertension. IMPLEMENTATION: the healthcare provider must give information about the disease and it is important to instruct the patient continues to take medications and to follow up with the care physician primary. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old male with a previous history of the upper respiratory disease three days ago using ibuprofen tid p/o. The patient complains of a primary physician because he started suddenly with fever, generalized headache and malaise. He refers sore and/or scratchy throat. He reports fatigue and decreased intake of food and fluid. |
| Diagnostic Codes: | J02.9 | Acute pharyngitis, unspecified |
| Patient Age: | 27 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 39 |
| Consult with Preceptor (minutes): | 2 |
| Student Participation: | 100% |
| Chief Complaint: | "I have throat ache " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Penicillin V potassium (Pen-Vee-K): 250 mg four times daily twice daily for 10 days. Follow-Up A. If symptoms do not improve in 3 to 4 days, recheck patient. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 46-year-old man with a previous history of health. He complained of primary physicians because yesterday started with high fever and cough. He refers to generalized body weakness and joints pain. |
| Diagnostic Codes: | J20.9 | Acute bronchitis, unspecified |
| Patient Age: | 46 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 35 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Intake a lot of fluids Azithromycin 500mg daily per three days. Expectorants. Three times daily. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 35-year-old female with a previous history of health. She visits the primary physician because in the least week she started with a burning sensation during urination and difficult for urination. She denies fever. |
| Diagnostic Codes: | N30.00 | Acute cystitis without hematuria |
| Patient Age: | 35 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 100% |
| Chief Complaint: | "I have difficult for urination" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Intake a lot of fluids. Avoid sexual intercourses Ciprofloxacin 500 mg twice daily per three days Urinalysis Urine culture. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 56-year-old female with a previous history of health. She complains primary physician because three days ago she started with Itching in all the body and cutaneous lesions that consist of oval, fawn-colored plaques up to 2 cm in diameter. The centers of the lesions have a crinkled or "cigarette paper" appearance and a collarette scale, a thin bit of scale that is bound at the periphery and free in the center. |
| Diagnostic Codes: | L42 | Pityriasis rosea |
| Patient Age: | 56 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesions" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Pityriasis rosea often requires no treatment. The most effective management consists of daily UVB treatments, or prednisone as used for contact dermatitis. Topical corticosteroids of medium strength (triamcinolone 0.1%) may also be used if pruritus is bothersome. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 45-year-old female with a previous history of health. She complains primary physician pruritic lesions in the face neck, upper trunk, wrists, and hands and in the antecubital and popliteal folds |
| Diagnostic Codes: | L20.9 | Atopic dermatitis, unspecified |
| Patient Age: | 45 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 43 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesions" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Corticosteroids should be applied sparingly to the dermatitis twice daily and rubbed in well as triamcinolone 0.1% or a stronger corticosteroid then taper to hydrocortisone or another slightly stronger mild corticosteroid (Aclovate, Desonide). Doxepin cream 5% may be used up to four times daily and is best applied simultaneously with the topical corticosteroid. Stinging and drowsiness occur in 25%. Diphenhydramine 25 mg p-o three time daily Avoid irritants |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 30-year-old female with a previous history of health. She started two weeks ago, with nasal symptoms as a nasal discharge which is clear and nasal pruritus. She refers that the symptoms are often accompanied by eye irritation, which causes pruritus, erythema, and excessive tearing. |
| Diagnostic Codes: | J30.5 | Allergic rhinitis due to food |
| Patient Age: | 30 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 44 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have nasal and eye discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | chlorpheniramine 4 mg orally every 8 hours. Cetirizine 10 mg orally once daily. Beclomethasone (42 mcg/spray twice daily each nostril) Montelukast (10 mg/d orally). |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 45-year-old man with a previous history of health. He started two weeks ago with right ear pain which is usually unilateral over the maxillary sinus or is toothache-like. The patient reports change of secretions from mucoid to purulent green or yellow. He reports headache, and cough may also be present. |
| Diagnostic Codes: | J01.90 | Acute sinusitis, unspecified |
| Patient Age: | 45 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 43 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 100% |
| Chief Complaint: | "I have hearing loss" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Amoxicillin 1000 mg PO tid Intake a lof fluids Normal saline in both nostrils three time daily. Ibuprophen 400 mf three-time daily p/o |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old man with a previous history of upper respiratory tract infection that suddenly three days ago he started with otalgia in the right ear, aural pressure, decreased hearing, and fever with loss of appetite. |
| Diagnostic Codes: | H65.01 | Acute serous otitis media, right ear |
| Patient Age: | 27 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have otalgia" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Ibuprophen 400mg twice daily Amoxicillin 70 mg per Kg daily. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 72-year-old man with a previous history of upper respiratory viral infection that he started three weeks ago, with aural fullness and fluctuating hearing. |
| Diagnostic Codes: | H69.81 | Other specified disorders of Eustachian tube, right ear |
| Patient Age: | 72 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fluctuating hearing" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Oxymetazoline, 0.05% spray every 8 hours combined with auto inflation by forced exhalation against closed nostrils may hasten relief. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/24/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 40-year-old male with a previous history of health that yesterday he started with otalgia, frequently accompanied by pruritus and purulent discharge. There is a history of recent water exposure or mechanical trauma. |
| Diagnostic Codes: | H60.63 | Unspecified chronic otitis externa, bilateral |
| Patient Age: | 40 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 44 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 100% |
| Chief Complaint: | "I have right ear pain " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | protection of the ear from additional moisture and avoidance of further mechanical injury by scratching. five drops in both ears three times a day |
| Skills/Procedures (Select All That Apply): | NOT APPLICABLE |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | Mr. DF is a 40-year-old man with a previous history of health. He complains of a primary physician because in the least three weeks he started with the loss of appetite, generalized body weakness. He reports tea-colored urine and clay-colored stool and abdominal pain. The patient refers to malaise, anorexia with nausea and low-grade fever. According to the patient, he has a yellow discoloration of the skin. |
| Diagnostic Codes: | B17.9 | Acute viral hepatitis, unspecified |
| Patient Age: | 40 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 50 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 75% |
| Chief Complaint: | "I have yellow discoloration of my skin" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests A. Viral serology for typing HAV, IgG, and IgM. B. Serum IgM presents at onset of illness and disappears within 4 months, generally indicating current or recent infection. C. However, it may persist for 6 months or longer. D. Presence of IgG antiHAV antibodies without virusspecific IgM indicates past infection and immunity. E. Liver function studies, including ALT, AST, LDH, and ALP. F. Bilirubin, direct and indirect G. . CBC H. PT F. I. Urinalysis: Reveals proteinuria and bilirubinuria. J. Imaging studies are usually not indicated for hepatitis A infection. K. An ultrasound may be used to exclude other pathology. PLAN A. General interventions 1. Contact precautions are recommended for diapered and/or incontinent patients for 1 week after onset of symptoms. 2. Children and adults with acute HAV infection should be excluded from school, work, and child care centers for 1 week after onset of illness. 3. Hepatitis is selflimiting and does not require therapy. Treatment is supportive. a. Limit activities secondary to malaise Adults who work as food handlers should not work for 1 week after onset of the illness. Encourage strict hand washing. 2. Teach the patient that major methods for prevention are improved sanitation (e.g., of water sources and in food preparation) and personal hygiene. 3. Food and travel precautions include the following: a. Avoid uncontrolled water resources: Use bottled water, boil water, or add iodine to inactivate the virus. b. Avoid raw shellfish. c. Avoid uncooked foods. d. All fruit should be washed and peeled. C. Dietary management: Encourage optimum nutrition. D. Pharmaceutical therapy 1. IG (Gamastan, GammarP): Preexposure administration is 0.02 mL/kg, two doses IM. HAV vaccine preexposure is preferred in all populations unless contraindicated. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 16-year-old young man complaints primary physician with epigastric pain as heartburn or dyspepsia often associated with indigestion or sour stomach. Also, pain is described as a gnawing or burning sensation and an empty stomach usually causes pain. It is not uncommon for the pain to awaken the patient from sleep from 1 to 2 a.m. Antacids typically offer relief pain which may be episodic, with symptom-free intervals. Pain may radiate to the back. Associated symptoms include bloating, belching, nausea, and loss of appetite. |
| Diagnostic Codes: | K26.3 | Acute duodenal ulcer without hemorrhage or perforation |
| Patient Age: | 16 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 44 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN/TEST: Stool guaiac should be performed on any patient with epigastric pain. Abdominal ultrasound. Upper endoscopy Helicobacter pillory test MEDICATIONS: The American Gastroenterological Association (AGA) cautions against empirical use of antisecretory agents for suspected PUD because such treatment may delay important diagnostic testing and appropriate long-term treatment. Nor does the AGA support treatment of H. pyloriinduced ulcers without serologic or breath test results confirming H. p yloriinduced infection. The Helicobacter test is positive; the treatment is: Clarithromycin 500 mg bid + 714 d amoxicillin 1 g bid + a PPI as omeprazole 40 mg daily per 3 weeks. PROMOTION: Because the most common cause of PUD recurrence after treatment with antibiotics is failure to eradicate H. pylori, several issues should be considered in an attempt to prevent t treatment failures. Patients diagnosed with PUD should be encouraged to eliminate cigarette smoking, NSAID use (if possible), and excessive caffeine and alcohol intake. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 17-year-old male, visits primary physician because the patient started one day ago with dry cough that progressed from dry to productive cough with white sputum. Also patient refers to generalized body weakness. |
| Diagnostic Codes: | J20.8 | Acute bronchitis due to other specified organisms |
| Patient Age: | 17 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough and wheeze" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN/TEST: White blood count elevated lymphocytes. IMAGING: X ray examination of the chest with a mild increase in bronchovascular markings. MEDICATIONS: Patients should be encouraged to drink plenty of fluids to prevent dehydration and decrease the viscosity of bronchial secretions Tylenol; 10 to 15 mg/kg per dose in children or ibuprofen 10 mg/kg per dose in children) administered every 4 to 6 hours can be used as analgesic/antipyretic therapy. The use of nonprescription medications that contain various combinations of antihistamines, sympathomimetic agents, and antitussives can result in dehydration of bronchial secretions. This could lead to further aggravation of symptoms, which prolongs the recovery process. Dextromethorphan, an antitussive agent, is recommended to help treat mild, persistent cough. Severe cough may require more potent cough medications that contain codeine or similar agents. PREVENTION: Maintain adequate hygiene, washing hands frequent. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 14-year-old young male who complains of a primary physician because he refers to productive cough, high fever, and pleuritic chest pain also refers to generalized body weakness. The patient refers to shortness of breath. |
| Diagnostic Codes: | J15.9 | Unspecified bacterial pneumonia |
| Patient Age: | 14 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I am with cough and fever" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Chest radiography may confirm the diagnosis and detect associated lung diseases. It can also be used to help assess severity and response to therapy over time. Radiographic findings can range from patchy airspace infiltrates to lobar consolidation with air bronchograms to diffuse alveolar or interstitial infiltrates (see x-ray). Antimicrobial therapy should be initiated promptly after the diagnosis of pneumonia is established and appropriate specimens are obtained. Macrolides (clarithromycin, 500 mg orally twice a day, or azithromycin, 500 mg orally as a first dose and then 250 mg once a day for 4 days, or 500 mg daily for 3 days). (2) Doxycycline (100 mg orally twice a day). |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 7-year-old male, visits a primary physician with a cough. He was never diagnosed as severely asthmatic. The patient has been coughing intermittently for a week now. When he coughs, it is continuous. He sounds very croupy. He had a fever. Last night, I started with a stuffy nose. The patient takes albuterol p.r.n. and Flovent. For the past few days, mom has been administering both the Flovent and albuterol. |
| Diagnostic Codes: | J06.9 | Acute upper respiratory infection, unspecified |
| Patient Age: | 7 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "cough" ( Patient is accompanied by his mother as informant). |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Numerous over-the-counter antihistamines, such as brompheniramine or chlorpheniramine (4 mg orally every 812 mg orally every 812 hours as a sustained-release tablet) and clemastine (1.342.68 mg orally twice daily) PROMOTION: The first step is to eliminate irritant exposures such as tobacco smoke (primary or secondary) PREVENTION: Maintaining an allergen-free environment by covering pillows and mattresses with plastic covers, substituting synthetic materials (foam mattress, acrylics) for animal products (wool, horsehair), and removing dust-collecting household fixtures (carpets, drapes, bedspreads, wicker) is worth the attempt to help more troubled patients. Air purifiers and dust filters (such as Bionaire models) may also aid in maintaining an allergen-free environment |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 10-year-old male, visits primary physician because patient has had sore throat, dysphagia, and halitosis for about one day. He has had congestion and coryza. There has been fever. |
| Diagnostic Codes: | J02.0 | Streptococcal pharyngitis |
| Patient Age: | 10 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "Sore throat" report mother of the patient. |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN/TEST: Rapid strep test was positive. MEDICATIONS: Penicillin 250 mg p.o. t.i.d. for 10 days. PROMOTION: Change his toothbrush in three days. He will be contagious for 24 hours; though can go back to school in two days if he is feeling well. PREVENTION: Anyone he has been in contact with that has a sore throat should see their physician. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 13-year-old female. She complaints primary physician with sharp pain on the left side of her chest just underneath her breast. She did not have any fever. The pain on her left chest is not associated with any activity. |
| Diagnostic Codes: | M94.0 | Chondrocostal junction syndrome [Tietze] |
| Patient Age: | 13 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I am sharp pain in my chest" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN/TEST: Chest X Ray for rule out respiratory or cardiac disorders in this patient is normal MEDICATIONS: Ibuprofen 200mg twice daily PROMOTION: To explain the patient about the importance to avoid intense physical activities. PREVENTION: To educate about the importance of use medication |
| Skills/Procedures (Select All That Apply): | EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 14 years old young man with a previous history of health. He complains of a primary physician because one week ago he started with severe pain (8-10 in pain scale) in his right knee with limited in the movement and swollen. |
| Diagnostic Codes: | M12.561 | Traumatic arthropathy, right knee |
| Patient Age: | 14 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "Pain in my right knee" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Ibuprophen 200mg tid po Avoid excessive physical activities and appointment with Orthopedic MD. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/23/2019 |
| Rotation Type: | NSG6440 |
| Comments: | HPI. A patient is a 22-year-old man with a previous history of health. He complains primary physician because he reports that yesterday he started suddenly with severe, steady ache or fullness in the upper and media part of abdomen region with frequent radiation to the right scapula, and shoulder following a fatty meal. The patient reports nausea and loss of appetite. The patient also, reports epigastric fullness and eructation. The symptoms are severe with intensity 8/10 in pain scale. The duration is for 30 min to 5 h, and according to the patient diminishing rapidly. |
| Diagnostic Codes: | K80.20 | Calculus of gallbladder w/o cholecystitis w/o obstruction |
| Patient Age: | 22 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 100% |
| Chief Complaint: | "I have abdominal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN (Gallstones, 2019). Medical TherapyGallstone Dissolution Ursodeoxycholic acid (UDCA a dose of 8-10 mg/kg/d PO divided bid/ p/o during 6 months Diclofenac 75 mg IM daily per 3 days. Surgical therapy Prevention Recommending dietary changes of decreased fat intake. Prevention of Gallstones Administration of ursodeoxycholic acid at a dose of 600 mg daily for 16 weeks reduces the incidence of gallstones. Coffee consumption appears to be associated with a reduced risk of gallstone disease. Follow-up. Weekly. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 12-year-old female with history of previous healthy that visits the primary physician with pain or burning when she urinates also she refers to fever , loss of appetite and lower abdominal pain. |
| Diagnostic Codes: | N39.0 | Urinary tract infection, site not specified |
| Patient Age: | 12 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "Burning sensation with urination" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | LAB TEST Count Blood Cells with leukocytosis. Urinalysis with increase the white cells 4-SPECIAL TEST; Renal ultrasound Urine culture. 1. Use adequate diet, intake a lot of fluids. 2. Use medication (antibiotic) Ciprofloxacin 500mg twice daily per 10 days. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old man with a previous history of health. He complains primary physician because in the last week he started with cutaneous lesions in the inferior lip which are painful. |
| Diagnostic Codes: | P35.2 | Congenital herpesviral [herpes simplex] infection P35.2 | Congenital herpesviral [herpes simplex] infection |
| Patient Age: | 27 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesion in inferior lip" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab test with PCR, STD test, CBC with diff, other. Acyclovir ointment three times daily. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 45-year-old woman with a previous history of health that after her mother died she started with intense fear and discomfort associated with palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and a fear of impending doom or death. Patient reports sensation of numbness in both extremities, and feelings of unreality. Also, the patient reports impaired concentration, feeling "on edge" or restlessness, and insomnia. The patient reports she is sadness, indifference, apathy, or irritability. She refers that does not want to continue alive. |
| Diagnostic Codes: | F41.8 | Other specified anxiety disorders |
| Patient Age: | 45 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 50 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have intense fear" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Psychiatric evaluation. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Count Blood Cells. Thyroid Function Test. Fasting Glucose, Insulin and Hemoglobin A1C. Blood tests of Vit B12. Plan Sertraline (Zoloft) 50 mg daily p/o. Behavior therapy (exposure plus response prevention) and cognitive behavior therapy. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 44-year-old man with a previous history of health. He complains of a primary physician because in the least two weeks he started with abdominal pain on the left side of lower abdominal region. The patient complains flatulence with periodic abdominal distension and borborygmi, or loud. The patient refers to diarrhea with nausea and vomiting. The patient reports difficulty for urination and fever of low-grade. |
| Diagnostic Codes: | K57.12 | Dvtrcli of sm int w/o perforation or abscess w/o bleeding |
| Patient Age: | 44 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain and fever" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. CBC with differential: WBC may show leukocytosis with a shift to the left; hemoglobin and Hct may be low with chronic or acute bleeding. CRP Abdominal ultrasonography to evaluate masses or abscess Proctosigmoidoscopy. Hemocult: Stool. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Microscopy X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 22-year-old female young patient with a previous history of seasonal allergic rhinitis that complains primary physician because she refers itching in the throat with pain sensation and itching in the nasal region also, she refers itching in both eyes. The patient reports persistent clear nasal discharge with redness eyes. |
| Diagnostic Codes: | J30.89 | Other allergic rhinitis |
| Patient Age: | 22 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 42 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 100% |
| Chief Complaint: | "I have itching in both eyes" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests: Radioallergosorbent tests (RASTs) or skin tests may suggest type of allergen Eosinophilia Serum IgE levels may be present. General Measures: Promotion and Education . Diphenhydramine 25 mg twice-daily p/o. Referral: Immunologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 28-year-old female with a previous history of health. She complains of primary physician because in the least two days she started with a dry cough, nasal congestion, and headache with generalized body weakness. |
| Diagnostic Codes: | J00 | Acute nasopharyngitis [common cold] |
| Patient Age: | 28 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Intake a lot fluid Paracetamol 500mg tid po |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 23-year-old young man with a previous history of health. He complains primary physician because in the last two days he started suddenly with both red eyes and abundant secretions which are yellow. Patient reports burning, stinging, or gritty sensation in eyes with discomfort in both eyes as mild foreign-body sensation. |
| Diagnostic Codes: | H10.33 | Unspecified acute conjunctivitis, bilateral |
| Patient Age: | 23 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 41 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have my eyes red with discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN B. Patient education: How to Administer Eye Medications. Cool compresses to affected eye should be applied several times a day Clean eyes with warm, moist cloth from inner to outer canthus to prevent spreading infection. Encourage good hand washing with antibacterial soap. C. Pharmaceutical therapy Gentamicin 0.3%: Severe infections: 2 gtts every hour on Day 1, then 2 gtts every 4 hours for 5 to 7 days. Follow-Up A. If resolution occurs within 5 to 7 days after proper treatment, follow-up is not needed. B. If patient continues to have symptoms or if different symptoms appear, then follow-up with the primary provider is recommended. Consultation/Referral A. Consult or refer patient to physician if patient is not responding to treatment. B. Refer if patient is suspected of having periorbital cellulitis. |
| Skills/Procedures (Select All That Apply): | Exam of Eye for Foreign Body Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-year-old a young man with a previous history of health that complaints primary physicians with epigastric pain as heartburn or dyspepsia Also pain is described as a gnawing or burning sensation and empty stomach usually causes pain. Antacids offer relief pain which may be episodic, with symptom-free intervals. Pain may radiate to the back. |
| Diagnostic Codes: | K26.3 | Acute duodenal ulcer without hemorrhage or perforation |
| Patient Age: | 25 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN/TEST: Stool guaiac should be performed on any patient with epigastric pain. Abdominal ultrasound. Upper endoscopy Helicobacter pillory test. The Helicobacter test is positive; the treatment is: Clarithromycin 500 mg bid + 714 d amoxicillin 1 g bid + a PPI as omeprazole 40 mg daily per 3 weeks. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/20/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old man with a previous history of health. He refers that has sedentary lifestyle. He expends the majority of time watching television, computer, and hand-held game more than 3 hours a day. He complains, difficulty staying asleep, also, he reports difficulties with activities of daily living (ADL). He reports difficulty with personal hygiene and he desires to lose weight. |
| Diagnostic Codes: | E66.9 | Obesity, unspecified |
| Patient Age: | 26 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 50 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I desire to lose weight" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Manage obesity as a chronic relapsing disease, including the co-management of other diseases secondary to obesity (i.e., diabetes, hypertension). A. General interventions 1. Reinforce the positive impact that weight loss measures (diet, exercise) 2. Identify and monitor any cardiovascular complications. Dietary plan i. Low calorie ii. Increase in fruits and vegetables iii. Eliminate alcohol and beverages containing sugar iv. Reduction of high-glycemic foods such as candy v. Reduction in high-caloric foods and drinks vi. Reduction of fat intake, viii. Increase in water intake Exercise: At least 60 minutes. At least five times a week of moderate to vigorous exercise is recommended. 1. Keep a food diary to identify food triggers. 2. Counsel about pharmaceutical therapy drug side effects and the lack of long-term safety data. Stress to the patient the temporary nature of the weight loss medication. Typical weight loss is modest, less than 5 kg (1011 lbs) at 1 year. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old young female with a previous history of allergic rhinitis. She used Neosporin for treating infection lesion in his left hand. The patient reports that after using the medication he started with intense itching, she detected dryness skin The patient reports that his skin is thickening. She denies fever. |
| Diagnostic Codes: | L20.9 | Atopic dermatitis, unspecified |
| Patient Age: | 26 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 3 |
| Student Participation: | 100% |
| Chief Complaint: | "I have itching in my left hand" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Diagnostic Tests Culture skin lesions to determine viral, bacterial, or fungal etiology. B. Blood work: Serum IgE is elevated with atopic dermatitis. Diphenhydramine 25mg tid po |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 60-year-old female with a previous history of health. She complains primary physician because she started with joint pain from activity-related. Pain comes on either during or just after joint use and then gradually resolves. Pain included knee or hip pain with going up or downstairs, pain in weight-bearing joints when walking, also pain is episodic, Patient reports that pain becomes continuous. She reports Stiffness of joints that in the morning stiffness is usually brief ( |
| Diagnostic Codes: | M16.11 | Unilateral primary osteoarthritis, right hip |
| Patient Age: | 60 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in joint of both knee and in right hip " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: Education and health promotion: Non-pharmacological treatment. 1) Avoiding activities that overload the joint, as evidenced by their causing pain. Physiotherapy. Acetaminophen (paracetamol) Prescription: 500mg tid p/o. Intraarticular Injections: Glucocorticoids and Hyaluronic Acid if it is necessary weekly. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 63-year-old young man with a previous history of pain in the right knee since 2 years ago that physician-diagnosed as osteoarthritis. He complains of primary physician because in the last two weeks he started with posterior aching and swelling in the left knee. He reports limitation to knee flexion. The patient also refers to severe pain with stiffness and a limited range of motion with the sensation of bruising on the knee and calf. |
| Diagnostic Codes: | M71.21 | Synovial cyst of popliteal space [Baker], right knee |
| Patient Age: | 63 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have discomfort and swelling in the posterior side of my left knee" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN Need to take care of extremity to prevent further damage. C. Pharmaceutical therapy 1. Drug of choice a. NSAIDs to reduce pain and inflammation as Ibuprophen 400mg twice daily. p/o. Follow-Up A. Schedule initial follow-up in 2 weeks to evaluate current therapy or sooner if problems arise. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 58-year-old man with a previous history of recurrent allergic rhinitis since childhood. The patient complains of the intermittent sensation of chest tightness and cough that started three days ago after viral upper respiratory disease. The shortness of breath, and/or wheezing are persistent. The cough is nonproductive and persistent. He reports difficulty in filling their lungs with air. Patient visits the physician two days ago and he ordered OTC: Zyrtec 10mg p/o twice daily but the patient reports that the clinical manifestation was worsened. |
| Diagnostic Codes: | J45.20 | Mild intermittent asthma, uncomplicated |
| Patient Age: | 58 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have chest tightness, and cough" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Spirometry. Peak flow. Chest X ray. Total serum IgE. Budesonide (Pulmicort Flexhaler, Rhinocort).(nebulizer). Inhaled 2 puffs 2 times each day Montlukast (Singulair): 10 mg (single 10-mg tablet) orally once daily in evening. Albuterol spray: Aerosol metered-dose inhaler: 180 mcg (2 puffs) inhaled PO each 4 hr; not to exceed 12 inhalations/24 hr. Education How to use their inhalers correctly. Recognize worsening of asthma and how to step up therapy. Avoid tobacco smoke. Annual influenza vaccine. Maintain adequate hydration with 8 glasses of water per day. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Peak Flow Meter Pulmonary Function Test Interpretation Spirometry in office Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 34-year-old man with the previous history of health. He complains of a primary physician because in the least three days he started with pain in the right testis. The patient refers that the pain reliefs with an elevation of the scrotum, also, he reports urethral discharge and pain during urination. The patient refers to fever and scrotal induration. |
| Diagnostic Codes: | N45.1 | Epididymitis |
| Patient Age: | 34 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 38 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my right testis" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Pharmaceutical therapy. 1. Antibiotic therapy (both partners must be treated for an STI). Treat empirically until laboratory test results are available. For acute epididymitis all patients should receive: Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 10 days. NSAIDs for pain management as Ibuprophen 400mg twice daily p/o. Follow-Up. A.See the patient in 2 to 7 days depending on severity of infection Pain typically improves within 1 to 3 days, but may take up to 2 to 4 weeks. Inadequate treatment can result in abscess formation and decreased fertility. Culture urine at the end of treatment (test of cure). gonorrhea. Consider testing for HIV. Consultation/ referral. Obtain an immediate consultation with a urologist if testicular torsion, scrotal abscess, or failed medical treatment is suspected. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 57year-old male with a previous history of obesity and arterial hypertension treated with 50mg daily of Losartan. The patient complains of a primary physician because in the least two months he started with fatigue, palpitations, and shortness of breath that was observed only during exertion. On this occasion, the patient refers that dyspnea as well as palpitations occurring in the recumbent position. |
| Diagnostic Codes: | E66.9 | Obesity, unspecified I27.2 | Other secondary pulmonary hypertension I50.20 | Unspecified systolic (congestive) heart failure |
| Patient Age: | 57 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 56 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 100% |
| Chief Complaint: | "I have Fatigue and shortness of breath" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN Lab Tests Complete blood count, a panel of electrolytes, blood urea nitrogen, serum creatinine, hepatic enzymes, and a urinalysis. Fasting serum glucose or oral glucose tolerance test, fasting lipid panel, and thyroid-stimulating hormone level, T3 and T4, HbA1c). Electrocardiogram (ECG): A routine 12-lead ECG Chest X-Ray Biomarkers: Both B-type natriuretic peptide (BNP) and N-terminal pro-BNP. C Reactive protein. Echocardiogram. Treatment HF patients should be advised to stop smoking and to limit alcohol consumption Education: Extremes of temperature and heavy physical exertion should be avoided. Patients should receive immunization with influenza and pneumococcal vaccines to prevent respiratory infections. It is equally important to educate the patient and family about HF, the importance of proper diet, as well the importance of compliance with the medical regimen. Furosemide 20 mg qd p/o. Low salt diet, low carbohydrates diet and low fat. Losartan 12.5 mg qd p/o Aspirin 81 mg daily p/o. Prevention Control body weight. Use healthy diet. Adequate control of arterial hypertension. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | H & P. A patient is a 40-year-old man with a previous history of health that started today suddenly with a high fever. The patient complains right chest pain intense 9/10 that increases with deep breathing. Also, he reports dry cough persistent that get worsened at night with generalized body weakness and loss of appetite |
| Diagnostic Codes: | J15.9 | Unspecified bacterial pneumonia |
| Patient Age: | 40 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 100% |
| Chief Complaint: | "I have shortness of breath" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Chest X Ray. CBC with differential. BUN. Rapid viral testing. PLAN: 1. Encourage rest during acute phase. 2. Encourage patients to avoid smoking/secondhand smoke. 3. A vaporizer tid. 4. Encourage good hand washing or use of hand sanitizer. 5. Encourage a nutritious diet with increased fluid intake. 6. Azithromycin 500mg tid p/o first day and continue 500mg daily per 5 days. 7. Intake a lot of fluids. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 62-year-old female with a previous history of health. He complains of a primary physician because in the least three months he started with palpitations of sudden onset unrelated to physical activities. Also, the patient refers to hyperactivity, irritability, weight loss of 30 lbs. he complains that she does not tolerate the heat temperatures. |
| Diagnostic Codes: | E05.90 | Thyrotoxicosis, unsp without thyrotoxic crisis or storm |
| Patient Age: | 62 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have palpitations" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests: TSH level T4 and T3 levels. Thyroid peroxidase antibody (TPO) antibodies Thyroid binding inhibitory immunoglobulin (TBII) Thyroid stimulating immunoglobulin TSI. Count blood cells Platelet count. Thyroid ultrasound. Electrocardiogram. Echocardiogram Treatment Propylthiouracil 100 every 8 h p/o Propranolol 40 mg tid. p/o |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/18/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 27-year-old young male with a history of previous health that complains primary physician because after heavy physical activity he started with sudden low back pain radiating down the buttock and below the knee. Pain is severe 7 /10 and it gets improved during rest |
| Diagnostic Codes: | M54.5 | Low back pain |
| Patient Age: | 27 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have back pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Count blood cells normal. Eritrosedimentation rate is normal. Lumbar radiologist studies MRI Urinalysis. Analgesia can usually be provided with NSAIDs as Ibuprophen 400mg twice daily. All patients should be taught how to protect the back in daily activities for example, it is not to lift heavy objects, to use the legs rather than the back when lifting, To use a chair with arm rests, and to rise from bed by first rolling to one side and then using the arms to push to an upright position. Back manipulation for benign, mechanical low back pain appears safe and as effective as therapies provided by physicians. Follow-up: weekly. Supportive treatment. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 37-year-old man with a previous history of health. He complains of a primary physician because three days ago started with cough without sputum. The patient refers to a sore throat which is permanent and nasal congestion with white nasal discharge. |
| Diagnostic Codes: | J20.9 | Acute bronchitis, unspecified |
| Patient Age: | 37 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cough " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan A. General interventions 1. Tell the patient to increase fluid intake. 2. Suggest humidity and mist therapy. 3. Avoid irritants, such as smoke. Pharmaceutical therapy 1. Acetaminophen (Tylenol) for fever and malaise. 325 to 650 mg by mouth every 4 hours; not to exceed five doses in 24 hours. Expectorants such as guaifenesin with dextromethorphan (Robitussin DM, Humibid DM, Mytussin) to treat minor cough from bronchial/throat irritation tid p/o. Albuterol (Ventolin) for patients with wheezes or rhonchi, or for patients with a history of bronchoconstriction. 0.1 to 2 mg/kg by mouth three times daily. Follow-Up A. Follow up if patient does not improve in 48 hours. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 54-year-old man with a previous history of health that complains primary physician because three days ago started with yellow and green nasal discharge. Patient reports fever and sore throat with facial pain in the frontal part. |
| Diagnostic Codes: | J01.90 | Acute sinusitis, unspecified |
| Patient Age: | 54 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have nasal congestion and green discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: General interventions. 1. Teach patient to avoid smoking and secondhand smoke. 2. Drinking extra fluids helps to loosen secretions and hydrate the body. 3. Encourage patient to use medications as prescribed. OTC medications such as antihistimines and decongestants should be used with caution. 4. Application of warm, moist compresses to the face several times a day will help with discomfort. 5. Humidifiers should be used daily. 6. Nasal saline to the nares three times a day will help to keep nasal passages moist. 7. Provide patient with teaching guide on Sinusitis. Augmentin. 45 mg/kg/d in twice daily dosing for 10 to 14 days. Mometasone furoate monohydrate (Nasonex): Two sprays daily Next appointment in 1 weeks. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 56-year-old man with a previous history of heath. He complains of a primary physician because in the last week he started with severe pain like a burning sensation in the right side of the chest that was worsened without improved with ibuprofen. Yesterday his doctor detected a small cutaneous lesion in the anterior and lateral region of his right chest with vesicles. |
| Diagnostic Codes: | B02.7 | Disseminated zoster |
| Patient Age: | 56 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have severe pain in my right chest. " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | CBC with differential w/ platelet CMP ESR CPR. Adequate hygiene, Acyclovir 100 mg three: time daily per seven days. Ibuprophen 400 mg. Two pill each 12 hours |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 20-year-old young man that complains of the primary physician with fever, generalized body weakness, dry cough, and severe headache. He refers to some classmates have influenza. |
| Diagnostic Codes: | J10.00 | Flu due to oth ident flu virus w unsp type of pneumonia |
| Patient Age: | 20 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fever and dry cough" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Intake a lot of fluids Oseltamivir 75 mg twice daily p-o per five days Education: 1. Use cover month. 2. Increase fluid intake 3. Do not return to school for a full 24 hours |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | Child of an 11-years-old man with a previous history of Seasonal Rhinitis using nasal steroids that arrives in primary physician with her mother as an informant with persistent cough shortness of breath and wheezes which are permanent. |
| Diagnostic Codes: | J45.901 | Unspecified asthma with (acute) exacerbation |
| Patient Age: | 11 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "Shortness of breath and cough' |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan: 1. ALbuterol nebulized 0.083% tid as needed for coughing 2. Budesonine/Formoterol two time per day inhaler. 3. Avoid irritants 2. Continue Nasonex 1 spray at night. Educated mother AND PATIENT for alarm symptoms such as difficulty breathing (air hunger), constant wheezing, changes in the child's color, like bluish or gray lips and fingernail |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | 25 years old young female with a previous history of health. She complains of a primary physician because in the least three days she started with nasal congestion and sneezing. The patient complains nasal discharge that is clear and coughing. Also, she reports itchy in both eyes with a lot of tears. |
| Diagnostic Codes: | J30.89 | Other allergic rhinitis |
| Patient Age: | 25 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have itching and nasal congestion". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: General interventions 1. Avoid allergens (most effective treatment). 2. Keep bedroom as allergen-free as possible. C. Pharmaceutical therapy Loratadine (Claritin) 10 mg by mouth daily (adults). NASAL SPRAY OF NORMAL SALINE |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | 24y old young man with a previous history of health that complains primary physician because he started suddenly with right eye pain radiating to the right side of the head which is severe 7/10 in pain scale. He reports blurred vision with decreased visual acuity as well as black spots. He refers to nausea. |
| Diagnostic Codes: | H44.131 | Sympathetic uveitis, right eye |
| Patient Age: | 24 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my right eye" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: A. General interventions: 1. Treat underlying cause as indicated. 2. Provide immediate referral to an ophthalmologist. Follow-Up A. The patient with uveitis needs a follow-up with an ophthalmologist. Consultation/Referral A. The patient should be referred immediately to an ophthalmologist for evaluation and intervention. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Exam of Eye for Foreign Body Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A 23-year-old female with a previous history of health that complains, primary physician because in the honeymoon she started with a burning sensation during urination and severe pain. She denies fever. |
| Diagnostic Codes: | N30.00 | Acute cystitis without hematuria |
| Patient Age: | 23 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I am burning sensation with urination" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure. Intake a lot of fluids Ciprofloxacin, 500 mg every 12 hours Oral 3 days |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/16/2019 |
| Rotation Type: | NSG6440 |
| Comments: | HPI. A patient is a 20-years-old man with a previous history of health. He complains of primary physician because in the least two weeks he started with a persistent cough that was dry and worsened at night. The patient reports that the physician ordered antitussive treatment medication as Dextromethorphan 30 mg every 12 hours without improves. Patient complaints that cough was worsened in the least three days. He reports shortness of breath with wheezes that are permanent. According to the patient, the cough is worsened and night with green sputum. Also, he refers to generalized body weakness and fever. |
| Diagnostic Codes: | J20.9 | Acute bronchitis, unspecified |
| Patient Age: | 20 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 10 |
| Student Participation: | 100% |
| Chief Complaint: | "I have dyspnea and wheezes" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan No pharmacologic treatment: To rest. Avoid the physical activities. Intake a lot of fluids. Pharmacologic treatment: (Laopaiboon et al.,2015). Azithromycin, 500 mg every 12 hours first day. Continue 500mg daily per six days. Education for avoiding dissemination of respiratory infections. PREVENTION: Avoid dissemination of upper respiratory infections washing hands. To use cover mouth. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old female with a previous history of health that she complains of a primary physician with burning and stinging in superior and inferior lips. She noted small grouped of cutaneous lesions as vesicles in the orofacial region. |
| Diagnostic Codes: | B00.9 | Herpesviral infection, unspecified |
| Patient Age: | 26 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I have lesions in my superior and inferior lip. " |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Direct immunofluorescent antibody slide tests offer rapid, sensitive diagnosis. Viral culture may also be helpful. Specific HSV 2 serology by Western blot assay or enzyme-linked immunosorbent assay (ELISA) can determine who is HSV-infected and potentially infectious. Such testing is very useful in couples in which only one partner reports a history of genital herpes. Acyclovir 5% Apply to the affected area 5 times a day for 4 days. Therapy should be started as early as possible following onset of signs and symptoms (i.e., during the prodromal phase or when lesions appear). Cool compress, Soothes painful muscles or joints and may help reduce inflammation Evaluation: Patient to follow-up with primary care provider in two weeks after finishing acyclovir. Told to return if patient begins to complain more lesions, fever or systemic clinical manifestations. |
| Skills/Procedures (Select All That Apply): | Cultures/Swabs/Wet Mount Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 17-year-old female with a previous history of health that complains primary physician because today suddenly she started with abundant green discharge in both eyes. The patient reports the sensation of foreign body in both eyes and difficulty for vision with redness discoloration of both eyes. |
| Diagnostic Codes: | H10.89 | Other conjunctivitis |
| Patient Age: | 17 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 39 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have my eyes red" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan General interventions 1. Distinguish between bacterial, allergic, or viral infection. 2. Consider other diagnoses if eye pain is noted. B. Patient education: How to Administer Eye Medications. 1. Cool compresses to affected eye should be applied several times a day. 2. Clean eyes with warm, moist cloth from inner to outer canthus to prevent spreading infection. 3. Encourage good hand washing with antibacterial soap. 4. Instruct on the proper method of instilling medication into eye. Give patient the teaching guide on How to Administer Eye Medications. 5. Teach the patient/parent the difference between bacterial, allergic, and viral infection. Educate according to appropriate diagnosis. 6. If using aminoglycoside or neomycin ointments or drops, use caution and monitor closely for reactive keratoconjunctivitis. 8. Bacterial conjunctivitis is contagious until 24 hours after beginning medication. Pharmaceutical therapy 1. Bacterial a. Aminoglycosides: Gentamicin 0.3%:: 2 gtts every hour on Day 1, then 1 to 2 gtts every 4 hours for 5 to 7 days. Follow-Up A. If resolution occurs within 5 to 7 days after proper treatment, follow-up is not needed. B. If patient continues to have symptoms or if different symptoms appear, then follow-up with the primary provider is recommended. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A 21-year-old female patient with a previous history of health that complains, primary physician because after she takes a bath in the swimming pool she refers purulent discharge in the left ear with intense pain. |
| Diagnostic Codes: | H60.502 | Unspecified acute noninfective otitis externa, left ear |
| Patient Age: | 21 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 100% |
| Chief Complaint: | "I have pain in my left ear" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | DIAGNOSTIC TESTS: Culture of discharge Fundamental to the treatment of external otitis is protection of the ear from additional moisture and avoidance of further mechanical injury by scratching. Otic drops containing a mixture of aminoglycoside antibiotic and anti-inflammatory corticosteroid in an acid vehicle are generally very effective (eg, neomycin sulfate, polymyxin B sulfate, and hydrocortisone). Purulent debris filling the ear canal should be gently removed to permit entry of the topical medication. Drops should be used abundantly (five or more drops three or four times a day) to penetrate the depths of the canal. When substantial edema of the canal wall prevents entry of drops into the ear canal, a wick is placed to facilitate entry of the medication. PROMOTION Explain on complications of external acute otitis. Call emergency services if symptoms worsened. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 24-year-old female with a previous history of health that complains primary physician with itching in upper lips and cutaneous lesions that are painful. The patient refers to the burning, tingling sensation in upper lip. |
| Diagnostic Codes: | P35.2 | Congenital herpesviral [herpes simplex] infection |
| Patient Age: | 24 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have painful lesions in my lips" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN A. General interventions 1. Comfort measures. Ice may be used to reduce swelling as needed. 2. Vaseline or other lip ointments may be applied as needed and lip ointment with SPF 30 or greater when exposed to sunlight. B. Patient teaching 1. Educate the patient regarding the disease process of HSV-1. 2. Instruct patient to wash hands frequently. 3. Suggest proper care of lips to prevent drying and to reduce pain. 4. Educate regarding transmission of virus to others. 5. Teach patient to expect recurrences at variable times. C. Pharmaceutical therapy: Precautions should be used when administering medication to patients who are immunocompromised and who have a history of renal insufficiency. 1. Lidocaine 2% as needed for comfort 2. Diphenhydramine (Benadryl) elixir may be used to rinse mouth as needed. 3. Acetaminophen (Tylenol) as needed for pain 4. Campho-Phenique application as needed 5. Initial episode: Acyclovir 200 mg by mouth five times per day for 7 to 10 days or until resolved |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 24-year-old male patient with a previous history of health that complains, primary physician because he detected himself yellow discoloration of skin and mucosae. The patient refers to fever, loss of appetite and abdominal pain. Also, the patient reports a lack of energy |
| Diagnostic Codes: | B17.9 | Acute viral hepatitis, unspecified |
| Patient Age: | 24 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | Mother arrives with the child as informant. abdominal pain and jaundice |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Antibody to hepatitis A (anti-HAV) appears early in the course of the illness. Both IgM and IgG anti-HAV are detectable in serum soon after the onset. Peak titers of IgM anti-HAV occur during the first week of clinical disease and disappear within 36 months. Detection of IgM anti-HAV is an excellent test for diagnosing acute hepatitis A. The white blood cell count is normal to low, especially in the preicteric phase. Large atypical lymphocytes may occasionally be seen. Strikingly elevated AST or ALT occurs early, followed by elevations of bilirubin and alkaline phosphatase. Prevention Strict isolation of patients is not necessary, but hand washing after bowel movements is required. Thorough hand washing by medical staff who may contact contaminated utensils, bedding, or clothing is essential. Medical staff should handle disposable needles carefully and not recap them. Treatment Bed rest is recommended only if symptoms are marked. If nausea and vomiting are pronounced or if oral intake is substantially decreased, intravenous 10% glucose is indicated |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-year-old male with a previous history of health. The patient complains of a primary physician because he started yesterday with high fever, generalized body weakness and decrease appetite. He complains sore throat. He reports a decreased appetite. |
| Diagnostic Codes: | J02.9 | Acute pharyngitis, unspecified |
| Patient Age: | 25 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 100% |
| Chief Complaint: | "I have throat ache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Penicillin V potassium (Pen-Vee-K): 250 mg four times daily for 10 days. Follow-Up A. If symptoms do not improve in 3 to 4 days, recheck patient. Consultation/Referral A.Consult physician if patient has severe dysphagia or dyspnea, signaling possible airway obstruction. B. Refer the patient to an otolaryngologist if peritonsillar abscess is noted. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | Patient of 18 years old with a previous history of health. He complained of a primary physician because yesterday started with sore throat and fever. Also, the patient refers difficult to swallow anything. |
| Diagnostic Codes: | J02.0 | Streptococcal pharyngitis |
| Patient Age: | 18 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 43 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 100% |
| Chief Complaint: | Mother refers child has throat pain. |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | DIAGNOSTIC TESTS: RAPID STREP GROUP A, THROAT. Results: Strep: positive. 1. Bicillin LA (penicillin G benzathine) 1,200,000 units/2ml IM syringe by intramuscular route in office Follow up: patient should return for reevaluation Education: 1. It is important to explain the mother about the symptoms that required emergency attention as severe dyspnea 2. Increase fluid intake 3. Do not return to school for a full 24 hours |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 23-year-old female with a previous history of health that after intakes spice food she started with lesions that are painful in mouths and lips. The patient reports the burning sensation of the tongue. |
| Diagnostic Codes: | K12.1 | Other forms of stomatitis |
| Patient Age: | 23 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have lesions in my tongue" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Treatment is nonspecific. Topical corticosteroids (triamcinolone acetonide, 0.1%, or fluocinonide ointment, 0.05%) Education: 1. It is important to explain the patient on lesion in tongue. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/13/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient a 56-year-old woman with previous history of arterial hypertension treated with 50mg of Losartan. She complains of a primary physician because in the least six months she started with weight gain, fatigue, constipation and cool intolerance with a change in the characteristics of the skin. |
| Diagnostic Codes: | E03.9 | Hypothyroidism, unspecified |
| Patient Age: | 56 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 100% |
| Chief Complaint: | "I increase my body weight" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan A. Pharmacological therapy 1. Patients requiring therapy with levothyroxine should be treated with the same brand/generic consistently since potency varies between brand and generics. a. Levothyroxine (Synthroid, Levoxyl, Levothroid, Unithroid) 1.6 /kg/d by mouth is administered as a single dose in the morning on an empty stomach. Follow-Up A. Patients who are not treated with medication should be seen every 6 to 12 months for reevaluation. B. When medication is instituted, monitor laboratory values and patient well-being in the office every 4 to 6 weeks. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 17-year-old female with a previous history of health that she complains primary physician with left ear pain (rated 6/10) that started two days ago. The patient complains of fever and generalized body weakness. |
| Diagnostic Codes: | H65.192 | Other acute nonsuppurative otitis media, left ear |
| Patient Age: | 17 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Uninsured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my left ear". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Rx: Amoxicillin (90mg/kg/day, max 3g/24h) PO BID q 10 days Tylenol suspension (160mg/5ml) q4-6hrs PRN for fever or pain. +/- Benzocaine 20% otic drops 4 drops q1-2 hours PRN for pain Patient Ed: Symptoms should improve in 24-48 hours after starting antibiotic therapy. PLAN/TEST: CBC or Count Blood Cells: leukocytosis. By orthoscopic the doctor discovers that the tympanic membrane is erythematous, bulging, and has decreased motility Follow-up: It is important to visit Family Nurse Practitioner if symptoms are worsen. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-year-old man with a previous history of health that complains primary physician because one week ago, she started with tender sores around the mouth and nasal area. |
| Diagnostic Codes: | L01.00 | Impetigo, unspecified |
| Patient Age: | 15 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have painful lesions in mouth and nose" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN None required. May perform culture if recurrent or resistant to treatment. A. General interventions 1. Crusted lesions may be removed with thorough, gentle washing with mild soap three to four times daily. 2. Impetigo must be adequately treated and resolved to prevent postinfection complications such as the following: poststreptococcal acute glomerulonephritis, cellulitis, ecthyma, and bacteremia. B. Patient teaching: Encourage good hand washing and hygiene to reduce spreading infection. C. Pharmaceutical therapy 1. If few lesions noted without involvement of face or cellulitis: Mupirocin (Bactroban) ointment to site four times daily for 10 days. 2. Systemic antibiotics Dicloxacillin 12.5 to 25 mg/kg/d four times daily for 10 days. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 20-year-old male with a previous history of health. Patient complains primary physician because he started with fever, generalized headache and malaise. He refers sore and/or scratchy throat. |
| Diagnostic Codes: | J02.9 | Acute pharyngitis, unspecified |
| Patient Age: | 20 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have throat ache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN General interventions 1. Patients with a history of rheumatic fever and those who have a household member with a documented Group A streptococcal infection need immediate treatment without prior testing. Penicillin V potassium (Pen-Vee-K): 250 mg four times daily twice daily for 10 days. Follow-Up A. If symptoms do not improve in 3 to 4 days, recheck patient. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | H & P: 26 years old young man with the previous history of health that he visits the primary physician because three days ago, he started with the right pain in his left wrist after trauma. Pain is worsening during the movement of the wrist. |
| Diagnostic Codes: | M12.532 | Traumatic arthropathy, left wrist |
| Patient Age: | 26 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in my left wrist" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | General interventions 1. Confirm diagnosis. 2. Provide the patient support and education to improve patient well-being and reduce discomfort. 3. Physical therapy and/or occupational therapy should be initiated, if indicated. Reinforce the importance of joint protection; avoid repetitive stress or trauma. 3. Encourage daily exercises and strengthening. 4. Encourage weight loss if the patient is obese. C. Pharmaceutical therapy 1. First-line agents: The goal of treatment is to preserve joint mobility. First-line agents should be used in a stepwise approach. a. Acetaminophen 500mg tid daily. Follow-Up A. Follow-up is based on disease severity and therapeutic treatment. If the patient is treated with first-line agents, follow up on pain control, nonpharmocologic interventions, and possible side effects of medications within 2 to 4 weeks. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 26-year-old man with a previous history of health that started in the least three days with ocular and/or nasal pruritus, sneezing, and rhinorrhea. |
| Diagnostic Codes: | J30.5 | Allergic rhinitis due to food |
| Patient Age: | 26 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 41 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have nasal pruritus" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Drinking a lot of fluids helps to loosen secretions and hydrate the body. Encourage patient to use medications as prescribed. OTC medications such as antihistamines and decongestants should be used with caution. Diphenhydramine 25 mg twice daily. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 30-year-old female with a previous history of health that complains primary physician because yesterday she started with a cough, shortness of breath and fever that started suddenly. Also, patient reports cough with, purulent sputum. |
| Diagnostic Codes: | J18.9 | Pneumonia, unspecified organism |
| Patient Age: | 30 Years |
| Patient Sex: | F |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I have fever and shortness of breath" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: Blood Cultures: The yield from blood cultures, even those obtained before antibiotic therapy. Antigen Tests: Two commercially available tests detect pneumococcal and certain Legionella antigens in urine. Polymerase chain reaction (PCR) tests are available for a number of pathogens, including L. pneumophila and mycobacteria. Serology: A fourfold rise in specific IgM antibody titer between acute- and convalescent-phase serum samples is generally considered diagnostic of infection with the pathogen in question. Pharmacologic treatment: Previously healthy and no antibiotics in past 3 months a macrolide or azithromycin (500 mg PO twice, first day and continues with 500 mg daily per 6 days. Continues Losartan 50mg daily. Count Blood Cells: Increase in white blood cells with shift deviation. Eritrosedimentation rate is elevated. PCR is elevated. Chest X Ray: Consolidation with radiopacity in left pulmonary base. Prevention The main preventive measure is vaccination. The recommendations of the Advisory Committee on Immunization Practices should be followed for influenza and pneumococcal vaccines. In the event of an influenza outbreak, unprotected patients at risk from complications should be vaccinated immediately and given chemoprophylaxis with either oseltamivir or zanamivir for 2 weeks. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 42-year-old man with a previous history of health that complains primary physician because five days ago started with yellow and green nasal discharge. Patient reports fever and facial pain that increases with percussion. |
| Diagnostic Codes: | J01.90 | Acute sinusitis, unspecified |
| Patient Age: | 42 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | "I have nasal congestion and green discharge" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | 1. Teach patient to avoid smoking and secondhand smoke. 2. Drinking extra fluids helps to loosen secretions and hydrate the body. 3. Encourage patient to use medications as prescribed. OTC medications such as antihistimines and decongestants should be used with caution. 4. Application of warm, moist compresses to the face several times a day will help with discomfort. 5. Humidifiers should be used daily. 6. Nasal saline to the nares three times a day will help to keep nasal passages moist. 7. Provide patient with teaching guide on Sinusitis. Augmentin. 45 mg/kg/d in twice daily dosing for 10 to 14 days. Mometasone furoate monohydrate (Nasonex): Two sprays daily Next appointment in 1 weeks. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-year-old man with a previous history of health that he complains of a primary physician because two hours ago he started suddenly with severe abdominal pain. The pain is located in the periumbilical region initially and it is irradiated to the right lower part of the abdominal region. Abdominal pain as severe 7/10 in scale pain. |
| Diagnostic Codes: | K35.80 | Unspecified acute appendicitis |
| Patient Age: | 25 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 51 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | "I have abdominal discomfort" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Count Blood cells. Urine test. Abdominal ultrasound. Abdominal X Ray. Refer to Emergency department for Surgery to remove the appendix (appendectomy). Avoid strenuous activity at first. Follow up : two weeks after appendectomy. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/11/2019 |
| Rotation Type: | NSG6440 |
| Comments: | The patient is a 22-year-old young woman with a personal history of seasonal rhinitis. She complains of a primary physician because two weeks ago she, started with itching and cutaneous lesions disseminated in all the body which improves with OTC antihistaminic. |
| Diagnostic Codes: | L20.9 | Atopic dermatitis, unspecified |
| Patient Age: | 22 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 40 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 100% |
| Chief Complaint: | "I have generalized itching" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests: Radioallergosorbent tests (RASTs) or skin tests may suggest dust mite allergy Eosinophilia Serum IgE levels may be present. General Measures: Promotion and Education Atopic patients have hyperirritable skin. Avoid anything that dries or irritates the skin. Diphenhydramine 25 mg twice-daily p/o. Phototherapy Referral: Dermatologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | The patient is an 18 years old female with a previous history of anxiety disorders in relation to difficulties in school, that complains primary physician because two months ago started with Sleep difficulty, which continues, unchanged. She feelings of increased muscular tension across neck and shoulders. The patient describes feeling irritable. Continuing difficulty concentrating. In addition, she is feeling fatigued. |
| Diagnostic Codes: | F41.1 | Generalized anxiety disorder |
| Patient Age: | 18 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 41 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "Sleep difficulty" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. The main therapeutic techniques used this session involved helping to identify areas of difficulty, to develop coping skills, and to manage stress This session the therapeutic focus was on improving the patient's self-compassion. Patient will make positive statements regarding self and the ability to cope with the stresses of life. Psychotherapy. Prozac (fluoxetine) Initial: 20 mg PO qd. Physical activities. Healthy diet. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 62-years-old man with a previous history of arterial hypertension using losartan 50mg daily p/o that complains primary physician with dyspnea on exertion that started two months ago. The shortness of breath was worsened and actually the ‶hunger of air″ occurs with minor physical activities. Patient reports palpitations and he reports that the shortness of breath increases at night when he is lying down requiring a lot pillow to be able to sleep. The hunger of air improves with rest. Other symptoms are generalized body weakness and palpitations. |
| Diagnostic Codes: | I50.22 | Chronic systolic (congestive) heart failure |
| Patient Age: | 62 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 100% |
| Chief Complaint: | "I have shortness of breath". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Two-dimensional echocardiography with Doppler. Radionuclide ventriculography. Coronary angiography. Anterior/posterior chest x-ray. EKG. Natriuretic peptides (BNP or NT-proBNP). PLAN: General interventions 1. Determine the etiology of the failure state and treat appropriately. 2. Treatment Treatment HTN Lipid panel test. Fasting venous glucose. Avoid tobacco obesity, substance abuse [alcohol, cocaine, etc.]). Furosemide 20mg daily p/o. Aspirin 81 mg daily p/o. Hydralazine with isosorbide 10mg twice daily p/o REFERRALS: Cardiologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 60-years-old man complains primary physician because in the last 6 months he started with middle pain in both extremities that worsened, progressively and pain is more severe when standing. The patient reports pain usually dull, aching, or cramping 7/10 in pain scale. Pain improved with the elevation of the legs. Patient reports itching sensation in both legs which are permanent. Patient reports ‶sensation of leg fatigue″. According to the patient, all symptoms worsened toward the end of the day and getting better with rest. |
| Diagnostic Codes: | I83.819 | Varicose veins of unspecified lower extremities with pain |
| Patient Age: | 60 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 43 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "Feeling of heaviness in extremity". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Diagnostic Tests. Trendelenburg test. Perthes test. Doppler ankle/brachial index (ABI). Duplex ultrasound. PLAN: Prevention: General Avoid prolonged standing or sitting. Exercise on a regular basis. Encourage smoking cessation, weight loss, exercise. If prolonged standing is required, shift weight from one leg to the other. Do not sit with legs dependent. Extremity elevation. Compression stockings. Exercise. Aspirin: 325 mg tablet p/o daily. Follow-Up A. Follow-up is determined by patients needs, frequency and intensity of symptoms, and the presence of other medical conditions. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 29-years-old woman with a previous history of health. She complains primary physician because one month ago started suddenly with bleeding after sexual intercourse without pain. The patient reports thick yellow vaginal discharge that started three weeks ago and dysuria, which is permanent. The patient also complains vulvar and vaginal irritation with pruritus that is moderate and increasing in the daytime. The discomforts decrease in the evening and in repose. The patient denies the previous history of sexually transmitted diseases. She reports had recent sexual intercourse without a condom. |
| Diagnostic Codes: | N72 | Inflammatory disease of cervix uteri |
| Patient Age: | 29 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 100% |
| Chief Complaint: | "Post-coital bleeding" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. A. WBC. B. Testing for syphilis (rapid plasma reagin [RPR] and Venereal Disease Research Laboratory test). C. Wet prep. D. Cervical cultures for gonorrhea and chlamydia E. Pap smear F. Urine culture and sensitivity. G. Herpes culture. PLAN A. General interventions B. Patient teaching 1. Women should be encouraged to obtain routine, annual Pap smear evaluations. 2. Patients should be cautioned to avoid alcohol. 3. Patient should have no sexual intercourse for 1 week. 4. Avoid tampons and douches until antibiotics are completed. 5. Give the patient teaching Cervicitis. C. Pharmaceutical therapy Doxycycline 100 mg twice daily for 7 days or azithromycin 1 g orally in a single dose. Treat all partners. Follow-Up A. Recommend test of cure: Reculture 1 to 2 weeks following completion of pharmacologic therapy. B. Follow up with Pap smear as mandated by result. Consultation/Referral A. Refer the patient to a physician for cervicitis unresponsive to treatment. B. If the cervix has a suspicious lesion, the patient should be referred for colposcopy and/or biopsy regardless of cytology results. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Microscopy Pelvic Exam STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 29-years-old woman with a previous history of health. She complains primary physician because one month ago started suddenly with bleeding after sexual intercourse without pain. The patient reports thick yellow vaginal discharge that started three weeks ago and dysuria, which is permanent. The patient also complains vulvar and vaginal irritation with pruritus that is moderate and increasing in the daytime. The discomforts decrease in the evening and in repose. The patient denies the previous history of sexually transmitted diseases. She reports had recent sexual intercourse without a condom. |
| Diagnostic Codes: | N72 | Inflammatory disease of cervix uteri |
| Patient Age: | 29 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 100% |
| Chief Complaint: | "Post-coital bleeding" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. A. WBC. B. Testing for syphilis (rapid plasma reagin [RPR] and Venereal Disease Research Laboratory test). C. Wet prep. D. Cervical cultures for gonorrhea and chlamydia E. Pap smear F. Urine culture and sensitivity. G. Herpes culture. PLAN A. General interventions B. Patient teaching 1. Women should be encouraged to obtain routine, annual Pap smear evaluations. 2. Patients should be cautioned to avoid alcohol. 3. Patient should have no sexual intercourse for 1 week. 4. Avoid tampons and douches until antibiotics are completed. 5. Give the patient teaching Cervicitis. C. Pharmaceutical therapy Doxycycline 100 mg twice daily for 7 days or azithromycin 1 g orally in a single dose. Treat all partners. Follow-Up A. Recommend test of cure: Reculture 1 to 2 weeks following completion of pharmacologic therapy. B. Follow up with Pap smear as mandated by result. Consultation/Referral A. Refer the patient to a physician for cervicitis unresponsive to treatment. B. If the cervix has a suspicious lesion, the patient should be referred for colposcopy and/or biopsy regardless of cytology results. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Microscopy Pelvic Exam STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 42-years-old man, obese with a previous history of health. The patient complains of a primary physician because six months ago he noted weight loss and lack of energy with generalized body weakness. The patient refers to fatigue, nausea, and increases hunger. The patient reports thirst as well as increase the frequency of urination. The patient refers to a sexual dysfunction that started three months ago, including impotence or pain during sexual activities. He also, reports genital itching which it is permanent as well as visual disturbances |
| Diagnostic Codes: | E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| Patient Age: | 42 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "Weight loss and lack of energy" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | General a. Exercise plan b. Weight reduction. c. LDL-C and non-HDL-C laboratory studies. d. Self-monitoring blood glucose (SMBG): e. Involve the family to improve compliance with the individualized meal plan. f. Overweight/obese patients are encouraged to set a goal of healthy eating strategies to enhance weight loss. g. It is recommended to perform at least 150 minutes per week of moderate intensity physical exercise for at least 3 days a week, with not more than 2 consecutive days of rest. h. Resistance training is recommended. Metformin 500mg twice daily p/o. Follow-Up. Determine follow-up A glycosylated hemoglobin determination every 3 months can assist the provider in measuring control. REFERRALS: Endocrinologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management Diabetic Foot Care Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 48-years-old man with a previous history of health. He complains primary physician because two weeks ago he started suddenly with explosive, foul-smelling diarrhea. The patient reports that there is mucus in stools and bulky stools. The patient reports upper abdominal pain or discomfort with flatulence. He reports nausea which is permanent and anorexia. The patient refers to weight loss and generalized body weakness. |
| Diagnostic Codes: | A07.1 | Giardiasis [lambliasis] |
| Patient Age: | 48 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 44 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "Explosive, foul-smelling diarrhea" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests EIA and direct fluores cence antibody (DFA). Stool bacteria culture and sensitivity. Mucus stool for leukocytes. Stool for ova and parasites. Stool for occult blood. Advise the patients household and sexual contacts to seek medical examination and treatment. Recommend contact precautions for duration of illness for diapered and/or incontinent children. 1. Tell the patient to prevent dehydration from diarrhea by increasing fluids. 2. Advise restricting milk products to rule out lactose intolerance. 3. Tell people likely to be exposed to contaminated water to avoid drinking directly from streams. 4. To make water for safe drinking, boil water, or use chemical disinfection or filtration. Boiling water is the most reliable method to make water safe for drinking. Metronidazole (Flagyl) 250mg orally three times daily for 5 to 7 days. Referral: no Follow-Up. Schedule followups at 6 weeks and 6 months after treatment, as indicated. If diarrhea persists for 2 weeks or more, secondary evaluation is indicated. Stools should be examined again for blood, leukocytes, and parasites. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 37-year-0ld man with a previous history of health. The patient visits primary physician because three days ago, it started suddenly with red urine (clots may be present). The patient reports back pain as colicky that radiating to the groin. Patient reports frequency in urination, difficulty to urination with urgency, and suprapubic pain. According to the patient, the red urine is permanent and he denies fever. |
| Diagnostic Codes: | R31.0 | Gross hematuria |
| Patient Age: | 37 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 52 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I have brown cola-colored urine on toilet" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Plan. Urinalysis Hgb or myoglobin with a urine dipstick. Urine culture and sensitivity. Urine cytology. CBC with differential. BUN. Creatinine. Prothrombin time (PT), partial thromboplastic time (PTT) platelet count, and bleeding time. General interventions 1. Investigate and diagnose cause(s). Repeat urinalysis in 2 weeks. B. Pharmaceutical therapy: None is recommended for hematuria unless an infection is diagnosed. Follow-Up: Evaluate weekly. Referral: Urologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Microscopy Prostate Examination X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/09/2019 |
| Rotation Type: | NSG6440 |
| Comments: | HPI. A patient is a 15-years-old young man with a previous history of hyperactivity, impulsivity, and inattentiveness. In the least seven weeks, his teacher and families refer that he has poor performance and poor friend relationships. The patient has all-time in school and in his house inattention and easily distracted when completing jobs. Also, the mother reports that he complaints daydreams. He doesnt finish work, loses things, and he has difficulty concentrating. His mother complains that he is impulsive with risk-taking, impatient, very emotional. The mother is worried because he is hyperactivity and his speech and motor skills are overactive. He has a serious problem in school for difficulty with learning, and poor performance in school. |
| Diagnostic Codes: | F90.1 | Attn-defct hyperactivity disorder, predom hyperactive type |
| Patient Age: | 15 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | Mother complains: "My son has poor school performance". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Further testing. Complete blood count (CBC) to rule out iron deficiency anemia Thyroid studies to rule out other organic problems. Refer for testing for psychological tests to measure IQ, social/emotional adjustment, and presence of learning disabilities. Electroencephalogram (EEG). Magnetic resonance imaging (MRI). Administer the NICQH Vanderbilt Assessment Scale Medication. Methylphenidate (Ritalin) 5 mg before breakfast and 5 mg before lunch. Increase dose by 5 to 10 mg weekly. Education. The primary care provider, school psychologist and school nurse, or parent may function as the case manager to coordinate services. The general purpose of ADHD therapy is to build the childs sense of ability and functioning. FOLLOW-UP. At 1 month: Inquire about improvements in each area of life and duration of the medications actions. Referral. Consult with the psychiatrist to help coordinate the medications. Consult with the school psychologist if indicated for additional data. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 16-year-old young female with a history of abundant blood loss by menses that complains to a primary physician with easy fatigability, tachycardia, palpitations, and tachypnea on exertion. Also, the patient reports skin and mucosal changes, as the smooth tongue, fragile nails, and cheilosis. The patient refers to craving specific foods like ice and chips. |
| Diagnostic Codes: | D50.0 | Iron deficiency anemia secondary to blood loss (chronic) D50.9 | Iron deficiency anemia, unspecified |
| Patient Age: | 16 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "I have generalized body weakness" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. The serum ferritin will become abnormally low. A ferritin value less than 30 mcg/L is a highly reliable indicator of iron deficiency. The serum total iron-binding capacity (TIBC) rises. Bone marrow biopsy for evaluation of iron stores is now rarely performed because of intraobserver variation in its interpretation. Serum iron values decline to less than 30 mcg/dL and transferrin saturation to less than 15%. The MCV falls and the blood smear shows hypochromic microcytic cells. With further progression, anisocytosis (variations in red blood cell size) and poikilocytosis (variation in shape of red cells) develop. Severe iron deficiency will produce a bizarre peripheral blood smear, with severely hypochromic cells, target cells, hypochromic pencil-shaped cells, and occasionally small numbers of nucleated red blood cells. Gynecologic ultrasound shows small uterine myoma. The platelet count is increased. Pharmacological treatment. Ferrous sulfate, 325 mg three times daily, which provides 180 mg of iron daily of which up to 10 mg is absorbed (though absorption may exceed this amount in cases of severe deficiency), is the preferred therapy. Parenteral iron therapy should be used only in cases of persistent anemia after a reasonable course of oral therapy. The indications are intolerance to oral iron, refractoriness to oral iron, gastrointestinal disease (usually inflammatory bowel disease) precluding the use of oral iron, and continued blood loss that cannot be corrected The most important part of treatment is identification of the causeespecially a source of blood loss. In this patient there is blood loss by menstruation however it is important the treatment of gynecologic cause. Ultrasound may be useful to evaluate endometrial thickness or to diagnose intrauterine or ectopic pregnancy or adnexal masses. Endovaginal ultrasound was used to diagnose endometrial polyps or subserous myomas. Teaching and follow up about healthy diet. To treatment with gynecologist. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 48-years-old man with a previous history of arterial hypertension using losartan 50mg daily p/p and spironolactone 25mg daily p/o. He complains of a primary physician because six months ago he has enlargement in both breast and discomfort. He denies nipple discharge. He reports that he does not palpate himself any mass. He denies trauma. |
| Diagnostic Codes: | N62 | Hypertrophy of breast |
| Patient Age: | 48 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "Enlargement of both breast and discomfort" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Pharmaceutical therapy 1. Antiestrogens (tamoxifen). 1 tabl twice daily p/o. 2. Avoid spironolactone. Follow-up: every 4 months for evaluation of development or regression. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 42-years-old man with a previous history of health that two days ago had trauma in left scrotum practicing sports. He complains of primary physician because after the trauma he has swollen in the left scrotum which is painless smooth, and firm. The patient refers to the discomfort that gets worsening during physical activities and it improves with the supine position. He denies changes in the color of no fever or other clinical manifestation. |
| Diagnostic Codes: | N43.3 | Hydrocele, unspecified |
| Patient Age: | 42 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 39 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 50% |
| Chief Complaint: | "I have increase in size in my left scrotum" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: General interventions: Evaluate factors that indicate surgical repair: as failure to resolve by age; continued discomfort; enlargement or waxing and waning in volume; unsightly appearance; secondary infection. Pharmaceutical therapy: None is recommended. Follow-Up A. Monitor every 3 months. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 65-years-old man with a previous history of intake alcohol. He is obese. A patient complains of a primary physician because in the least three weeks he started with painful swallowing and difficult for swelling solid foods. The patient reports nocturnal aspiration, water or acid brash. The patient refers to nausea and upper abdominal pain with the burning sensation in the retrosternal region. The symptoms get worse at bedtime. |
| Diagnostic Codes: | E66.9 | Obesity, unspecified F10.229 | Alcohol dependence with intoxication, unspecified F17.200 | Nicotine dependence, unspecified, uncomplicated K21.9 | Gastro-esophageal reflux disease without esophagitis |
| Patient Age: | 65 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | "Regurgitation of fluid or food" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN. General interventions: Dietary management 1. Weight loss is advised for overweight or obese patients with GERD symptoms. 2. At present, there is no supporting data for special dietary precautions. Avoid species, caffeine, and alcohol. Stop smoking. PREVENTION Avoid things that increase abdominal pressure: 1. Wearing tight clothes and belts 2. Lying down or bending over for 3 hours after eating, which is the time frame of greatest reflux. 3. Coughing 4. Straining C. Avoid medications, such as aspirin or ibuprofen, that may irritate stomach. Omeprazole 20mg: 1 pill 30 to 60 minutes before meals p/o. Follow-Up. Empiric treatment with omeprazole may be attempted for a short period except for patients presenting with any alarm symptoms. Schedule a return visit in 1 to 2 weeks to evaluate the relief of symptoms. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Pulmonary Function Test Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 64-years-old male who complains of a primary physician because he started with joint pain of onset, frequently nocturnal, precipitants cause was alcohol excess (particularly beer). The first Metacarpophalangeal (MTP) joint of the great toe is the most painful joint ("podagra"), also, patient reports pain in others as, feet, ankles, and knees. |
| Diagnostic Codes: | M10.00 | Idiopathic gout, unspecified site |
| Patient Age: | 64 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have joint pain" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. The serum uric acid. ESR. Count blood cells. Joint fluid by material aspirated from a tophus. NSAIDs: These drugs are the treatment of choice for acute gout. Indomethacin is initiated at a dosage of 50 mg orally every 8 hours and continued until the symptoms have resolved (usually 5 days). Intra-articular administration (eg, triamcinolone, 1040 mg depending on the size of the joint). Education on Diet: Potentially reversible causes of hyperuricemia are a high-purine diet, obesity, alcohol consumption, and use of certain medications . Beer consumption appears to confer a higher risk of gout than does whiskey or wine. Higher levels of meat and seafood consumption are associated with increased risks of gout, whereas a higher level of dairy products consumption is associated with a decreased risk. Although dietary purines usually contribute only 1 mg/dL to the serum uric acid level, moderation in eating foods with high purine content is advisable. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 60-years-old male who complains of a primary physician because he started with joint pain from activity-related. Pain comes on either during or just after joint use and then gradually resolves. Pain included knee or hip pain with going up or downstairs, pain in weight-bearing joints when walking, also pain is episodic, triggered often by a day or two of overactive use of a diseased joint, such as knee when taking a long run. The patient reports that pain becomes continuous and even begins to be incommodious at night. Stiffness of the affected joint may be prominent, but morning stiffness is usually brief ( |
| Diagnostic Codes: | M16.10 | Unilateral primary osteoarthritis, unspecified hip M17.10 | Unilateral primary osteoarthritis, unspecified knee |
| Patient Age: | 60 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 6 |
| Student Participation: | 75% |
| Chief Complaint: | "I have pain in joint of both knee and in right hip". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: Education and health promotion: Non-pharmacological treatment. 1) Avoiding activities that overload the joint, as evidenced by their causing pain. (2) Improving the strength and conditioning of muscles that bridge the joint, to optimize their function. (3) Unloading the joint, either by redistributing load within the joint with a brace or a splint or by unloading the joint during weight bearing with a cane or a crutch. Exercise: Osteoarthritic pain in knees or hips during weight bearing results in lack of activity and poor mobility and, because OA is so common, the inactivity that results represent a public health concern, increasing the risk of cardiovascular disease and of obesity. Aerobic capacity is poor in most elders with symptomatic knee OA, worse than others of the same age. Acetaminophen (paracetamol) Prescription: 500mg tid p/o. Intraarticular Injections: Glucocorticoids and Hyaluronic Acid if it is necessary weekly. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Joint Injection Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 46-years-old man with a previous history of viral disease one month ago that complains of primary physician with mucosal and skin bleeding. Patient reports epistaxis, oral bleeding, purpura, and petechial cutaneous lesions. |
| Diagnostic Codes: | D69.3 | Immune thrombocytopenic purpura |
| Patient Age: | 46 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 47 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | "I have cutaneous lesion and nasal bleeding" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Initial treatment is with prednisone, 12 mg/kg/d. Prednisone works primarily by decreasing the affinity of splenic macrophages for antibody-coated platelets. High-dose prednisone therapy also reduces the binding of antibody to the platelet surface, and long-term therapy may decrease antibody production. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 25-years-old male who complains of a primary physician because he started 4 weeks ago with sudden onset of generalized body weakness, loss of appetite, nausea, and vomiting. Nausea and vomiting are frequent after meals, which are worsening after fatty food, but all meals provoke nausea according to the patient and vomiting occurs with any type of smell. Fatigue and malaise started suddenly for 4 weeks, which has been worsening progressively. The patient reports generalized arthralgia and myalgias permanent with the mild intensity that is worsening during physical activities and these clinical manifestations improve during rest. The patient also reports headache in frontal region 3/10 in pain scale that is dullness and permanent without factors that worsening or improving the headache accompanies of photophobia that is permanent; afterward patient noted yellow discoloration of the mucosae and skin. Nausea, vomiting, and anorexia were frequently associated with alterations in olfaction and taste. All the smell and/or taste are unpleasant for the patient. A fever was of 38 (100F) permanent if the patient uses drugs for improving the clinical manifestations as ibuprofen 400mg in tab p/o has vomited. The patient reports dark urine and clay-colored stools from 15 days before the onset of changes in the color of the skin. The patient also reports mild weight loss (2.55 kg) and pain in the upper right part of the abdomen. Some persons in school have been presented similar clinical manifestations. |
| Diagnostic Codes: | B15.9 | Hepatitis A without hepatic coma |
| Patient Age: | 25 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | "Abdominal pain and yellow discoloration of skin" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN Count blood cells. Abdominal ultrasound. Alanine transaminase (ALT) Albumin Alkaline phosphatase Alpha-fetoprotein Aspartate transaminase (AST) Bilirubin Gamma-glutamyl transpeptidase Lactate dehydrogenase 5-Nucleotidase Prothrombin time (PT). Preventive measures. Washing hands thoroughly before handling food. Not sharing needles to inject drugs. Not sharing toothbrushes, razors, or other items that could get blood on them. Practicing safe sex: using barrier protection such as a condom. Limiting the number of sex partners. Supportive care. Avoid alcohol. Rest. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Microscopy STD & HIV Screening/Counseling |
Case Log - Use as of 7/11/2019
| Date: | 12/06/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 20-year-old man who complains of a primary physician because today suddenly started with abdominal discomfort. The pain is described as being located in the periumbilical region initially and then it is localized to the right lower part of abdominal region. The patient refers to abdominal pain that is permanent and severe 7/10 in scale pain. |
| Diagnostic Codes: | K35.80 | Unspecified acute appendicitis |
| Patient Age: | 20 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 45 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I am with abdominal discomfort" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN Count Blood cells. Urine test. Abdominal ultrasound. Abdominal X Ray. Refer to Emergency department for Surgery to remove the appendix (appendectomy). Avoid strenuous activity at first. Follow up : two weeks after appendectomy. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 62-year-old man with a history of obesity that complains primary physician because in the least six months he reports restless sleep associated with dry mouth and sore throat which are permanent. The patient refers to a lack of physical or mental energy with a decrease in concentration during intellectual activities and cognitive deficits. He is worried because always falling asleep when watching TV. He reports the same problem when he is reading, and driving/riding in a car. The patient reports morning headaches localized in the posterior region with decreased libido and impotence. The clinical manifestations are permanent. |
| Diagnostic Codes: | G47.33 | Obstructive sleep apnea (adult) (pediatric) |
| Patient Age: | 62 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 4 |
| Student Participation: | 75% |
| Chief Complaint: | "Daytime sleepiness" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN: Patient Teaching Educate patient about modifying controllable risk factors such as keeping diabetes and hypertension under control, diet, exercise, and stopping smoking. 2. Treatment with CPAP and BiPAP is required at all times during the night and during naps. 3. Behavioral strategies include sleeping in a nonsupine position using a positioning device (e.g., alarm, pillow, backpack, tennis ball are used for positional therapy). 4. Give patient teaching sheet on sleep apnea. 5. Dietary management: Even a modest weight loss of 10% to 20% has been associate. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 45-year-old man who complains of a primary physician because three days ago started with high fever and chills permanent with sweating. Fever is persistent and decreases for a few hours using ibuprofen 400mg tid p/o. The patient reports cough that is permanent and productive of mucoid, purulent, or blood-tinged sputum that has progressively increased with shortness of breath without relation with physical activities that worsened with the breathing and is permanent. The patient denies any factors that improve the shortness of breath thus, the patient is able to speak in full sentences without shortness of breath. The patient reports right chest pain as sharp sensation 7/10 in pain scale that worsening during breathing and it improves when the patient stops breathing. Also, the patient reports nausea, vomiting, and/or diarrhea, which are in relation to cough and sputum. Other disturbances are generalized body weakness, myalgias, and arthralgias. |
| Diagnostic Codes: | J15.9 | Unspecified bacterial pneumonia |
| Patient Age: | 45 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 44 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 100% |
| Chief Complaint: | "I have fever and cough" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. A. General interventions 1. Encourage rest during acute phase. 2. Encourage patients to avoid smoking/secondhand smoke. 3. Encourage good hand washing or use of hand sanitizer. C. Dietary management: Encourage a nutritious diet with increased fluid intake. D. Pharmaceutical therapy 1. Azithromycin 500mg first day p/o. Continue 250mg daily per 5 days p/o. 2. Acetaminophen (Tylenol) 500mg tid p/o |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 58-year-old man with a previous history of recurrent allergic rhinitis since childhood. The physician ordered nasal Saline Spray 1 squirt per nostril BID and Zyrtec (tablet) 10mg daily p/o as treatment of allergic rhinitis that he uses when presenting nasal congestion. The patient complains of the intermittent sensation of chest tightness and cough that started three days ago after viral upper respiratory disease. The shortness of breath, and/or wheezing are persistent. The cough is nonproductive. Deep respiratory effort increases paroxysmal shortness of breath. The symptoms become relatively persistent and affect daily activities. Symptoms (shortness of breath and cough) often worsen with activity, exposure to strong odors as fragrance, disinfectant; substances as chlorine. There are not factors that improve the clinical manifestations; according to the patient, the cough and shortness of breath improve spontaneity. The patient reports that clinical manifestations of cough and dyspnea get worse at night, and patients typically awake in the early morning hours. Patients may report difficulty in filling their lungs with air. The patient has the sensation that ‶there is increased mucus production, with typically tenacious mucus that is difficult to expectorate″. Patient visits the physician two days ago and he ordered OTC: Zyrtec 10mg p/o twice daily but the patient reports that the clinical manifestation has worsened. |
| Diagnostic Codes: | J30.5 | Allergic rhinitis due to food J45.20 | Mild intermittent asthma, uncomplicated |
| Patient Age: | 58 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 49 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 100% |
| Chief Complaint: | Chief Complaint: "chest tightness, and cough" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Spirometry. Peak flow. Chest X ray. Total serum IgE. Budesonide (Pulmicort Flexhaler, Rhinocort).(nebulizer). Inhaled 2 puffs 2 times each day Montlukast (Singulair): 10 mg (single 10-mg tablet) orally once daily in evening. Albuterol spray: Aerosol metered-dose inhaler: 180 mcg (2 puffs) inhaled PO q4-6hr; not to exceed 12 inhalations/24 hr. Education How to use their inhalers correctly. Recognize worsening of asthma and how to step up therapy. Avoid tobacco smoke. Annual influenza vaccine. Maintain adequate hydration with 8 glasses of water per day. |
| Skills/Procedures (Select All That Apply): | Lab Studies Interpretation Spirometry in office Strep / Influenza Testing X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 46-year-old male with a previous history of deep venous thrombosis two months ago, secondary to immobilization due to traumatic fracture. The patient was hospitalized and he used anticoagulant medication. He was discharged with warfarin 1 mg daily p/o ambulatory. The patient refers that the International Normalized Ratio (INR) has been normal (2.5) according to a physician. The patient reports dull ache or pressure sensation in both legs that started two weeks ago after prolonged standing and worsening during the standing position. It is relieved with leg elevation. Patient reports that the legs ‶feel heavy″ and mild ankle inflammation develops occasionally which relieve with leg elevation. |
| Diagnostic Codes: | I83.10 | Varicose veins of unsp lower extremity with inflammation I83.813 | Varicose veins of bilateral lower extremities with pain |
| Patient Age: | 46 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 42 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | Chief Complaint: "Pain in both legs". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Check INR weekly. Prolonged standing is avoided. External compression stockings for three months. Sclerotherapy. Venous duplex or ultrasound. |
| Skills/Procedures (Select All That Apply): | EKG Interpretation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 66-year old man smoker and obese with a previous history of cerebrovascular disease six months ago using anticoagulant treatment (warfarin 2 mg daily) as a sequel patient has impairment in the motility of right hand. Patient reports hyperlipidemia. A patient complains primary physician because three months ago started with intermittent episodes of digital blanching, blue discoloration, and redness discoloration of the fingers or toes following cold exposure and subsequent rewarming. Emotional stress may also precipitate the changes in the fingers. The patient reports that color changes are usually well-demarcated and are confined to the fingers or toes. In addition, he refers that, one or more digits will appear white when the patient is exposed to a cold environment or touches a cold object. The patient refers to a sensation of cold or numbness or paresthesia of the digits that often accompanies the phases of pallor and blue discoloration of the fingers. |
| Diagnostic Codes: | E66.9 | Obesity, unspecified F17.200 | Nicotine dependence, unspecified, uncomplicated I69.898 | Other sequelae of other cerebrovascular disease I73.00 | Raynaud's syndrome without gangrene |
| Patient Age: | 66 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 53 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | Chief Complaint: "I have change in the color of my fingers". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure. The cold stimulation test: The test involves: A small temperature-measuring device is attached to the patient fingers with tape, after the hands are placed in ice water to trigger symptoms and then removed. The measuring device records how long it takes the fingers to return to normal body temperature. If it takes longer than 20 minutes, the result is Raynauds phenomenon Other tests are: nailfold capillaroscopy Antinuclear antibodies test. C-reactive protein Sedimentation rate Rheumatoid factor Thyroids disorders Keeping the body warm Warm clothing in colder environments Cotton gloves can be helpful while searching the frezzer. Headwear can help the body retain heat by minimizing heat dissipation. Rubber gloves protect the hands and prevent cooling while washing hands Barefoot walking should be minimized. Direct and indirect (secondhand smoke) smoking Care of the nails must be done carefully to avoid injuring sensitive toes and fingertips. Ulcers on the digits should be monitored closeted. Ointments that open tips of the blood vessels as nitroglycerine ointment 1% once daily. Nifedipine 10 mg twice daily. Avoiding smoking. Warfarin 2 mg daily. Control INR in the range of 2.5 weekly |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation EKG Interpretation Lab Studies Interpretation Pulmonary Function Test Interpretation Spirometry in office X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 65-year-old male with a previous history of arterial hypertension and hyperlipidemia that started 12 years ago using metoprolol 20mg daily p/o. He complains of a primary physician because two months ago, he started with chest pain, typically located in the substernal region or sometimes in the middle region of the abdominal area that radiates to the neck, left shoulder, and left arm. The patient reports that chest pain started with physical activities and worsen with exercises. And usually is 8-10 in pain scale. The pain improves with the rest and use of one tab sublingual of nitroglycerine, the duration is less than 30 minutes This discomfort is usually severe enough to be considered painful. The patient denies diaphoresis, pale cool skin, and tachycardia. |
| Diagnostic Codes: | I20.8 | Other forms of angina pectoris I27.2 | Other secondary pulmonary hypertension |
| Patient Age: | 65 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Black or African American |
| Insurance: | Insured |
| Time with Patient (min): | 48 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | "I have chest pain". |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Exercise ECG testing A radioactive tracer such as thallium. Angiography. Echocardiogram. Troponin. Chest X Ray. Isosorbide: 20 mg twice daily p/o Metoprolol 100 mg daily, given in a single dose p/o. Aspirin 81 mg daily p/o Nitroglycerin 0.5mg as needed. 1 tab sl. PREVENTION; Prevention of Angina Making Lifestyle Changes Healthy lifestyle choices can help prevent or delay angina and heart disease. To adopt a healthy lifestyle, patient quit smoking and avoid secondhand smoke Avoid angina triggers Follow a healthy diet Be physically active Maintain a healthy weight Learn ways to handle stress and relax. |
| Skills/Procedures (Select All That Apply): | EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 40-years-old female with a previous history of bronchial asthma using frequent steroid treatment with 20 mg prednisone daily p/o. He complains of a primary physician because he started with increase abdominal circumference (truncal obesity) progressively also the primary physician diagnosed arterial hypertension three months ago without treatment. The patient reports fatigability and weakness. He also refers to the deposition of adipose tissue in characteristic sites, notably the upper face (producing the typical "moon" facies), the interscapular area (producing the "buffalo hump"), supraclavicular fat pads, and the mesenteric bed (producing "truncal" obesity). He also refers to generalized bruising. |
| Diagnostic Codes: | E24.2 | Drug-induced Cushing's syndrome J45.40 | Moderate persistent asthma, uncomplicated |
| Patient Age: | 40 Years |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I am with fatigue and weakness" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Magnetic resonance scanning. Measuring blood or urine cortisol levels in a basal state Gradual withdrawal of prednisone. Referal to the endocrinology MD. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 60-year-old male with a previous history of arterial hypertension. He uses Amlodipine 10mg p/o daily as antihypertensive treatment. The patient complains of a primary physician because three months ago started with fatigue, palpitations, and shortness of breath. Initially, dyspnea and palpitations were observed only during exertion. On this occasion, the patient refers that dyspnea as well as palpitations occurring in the recumbent position. The shortness of breath is worsened with physical activities and improves with rest. The patient reports anorexia, nausea, and early satiety associated with abdominal pain and fullness two weeks without relation to physical activities that worsen after meals. |
| Diagnostic Codes: | E66.9 | Obesity, unspecified I50.20 | Unspecified systolic (congestive) heart failure |
| Patient Age: | 60 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 46 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 100% |
| Chief Complaint: | "I have fatigue and shortness of breath" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | PLAN Lab Tests Complete blood count, a panel of electrolytes, blood urea nitrogen, serum creatinine, hepatic enzymes, and a urinalysis. Fasting serum glucose or oral glucose tolerance test, fasting lipid panel, and thyroid-stimulating hormone level, T3 and T4, HbA1c). Electrocardiogram (ECG): A routine 12-lead ECG Chest X-Ray Biomarkers: Both B-type natriuretic peptide (BNP) and N-terminal pro-BNP. C Reactive protein. Echocardiogram. Treatment HF patients should be advised to stop smoking and to limit alcohol consumption to two standard drinks per day in men or one per day in women. Education: Patients suspected of having an alcohol-induced cardiomyopathy should be urged to abstain from alcohol consumption indefinitely. Extremes of temperature and heavy physical exertion should be avoided. Patients should receive immunization with influenza and pneumococcal vaccines to prevent respiratory infections. It is equally important to educate the patient and family about HF, the importance of proper diet, as well the importance of compliance with the medical regimen. Furosemide 20 mg qd p/o. Low salt diet, low carbohydrates diet and low fat. Losartan 12.5 mg qd p/o Aspirin 81 mg daily p/o. Prevention Control body weight. Patient encounter: Patient with previous history of arterial hypertension that complains primary physician with fatigue and shortness of breath and orthopnea, The risk factor is arterial hypertension and the primary diagnosis is Congestive heart failure. Use healthy diet. Adequate control of arterial hypertension. |
| Skills/Procedures (Select All That Apply): | Cardiovascular Risk Assessment/Management Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 12/04/2019 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 52-years-old man who complains of a primary physician because five months ago started with palpitations of sudden onset unrelated to physical activities. Other accompanies symptoms are hyperactivity, irritability. He reports a weight loss of 20 lbs. progressively |
| Diagnostic Codes: | E05.00 | Thyrotoxicosis w diffuse goiter w/o thyrotoxic crisis |
| Patient Age: | 52 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 42 |
| Consult with Preceptor (minutes): | 8 |
| Student Participation: | 75% |
| Chief Complaint: | "I have palpitations" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Procedure complete. Lab Tests: TSH level T4 and T3 levels. Thyroid peroxidase antibody (TPO) antibodies Thyroid binding inhibitory immunoglobulin (TBII) Thyroid stimulating immunoglobulin TSI. Count blood cells Platelet count. Thyroid ultrasound. Electrocardiogram. Echocardiogram Treatment Propylthiouracil 100 every 68 h p/o Propranolol 40 mg tid. p/o |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management Lab Studies Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 02/05/2020 |
| Rotation Type: | NSG6440 |
| Comments: | A patient is a 40-year-old man with a previous history of health. She complains of a primary physician because in the least three months she started with a headache that occurs in the morning and is localized to the posterior region. The patient also, reports dizziness, palpitations, easy fatigability, and ringing in ears. |
| Diagnostic Codes: | I11.9 | Hypertensive heart disease without heart failure |
| Patient Age: | 40 Years |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Insurance: | Insured |
| Time with Patient (min): | 54 |
| Consult with Preceptor (minutes): | 5 |
| Student Participation: | 75% |
| Chief Complaint: | "I have headache" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | A. Hematocrit LFTs (LDH [lactate dehydrogenase], uric acid) Chemistry profile D. Lipid profile (total and HDL-cholesterol and triglycerides) Urinalysis for proteinuria Estimated GFR EKG. General interventions. Change lifestyles. Pharmaceutical therapy If lifestyle changes alone are not adequate to control HTN, consider drug therapy. Medication doses are dependent on age, ethnicity, and comorbid conditions. Most patients will require two or more medications to control their BP. Consider starting antihypertensive and/or diuretics Amlodipine 10 mg daily p/0 plus Hydrochlorothiazide 25mg daily p/o. Antihypertensive/diuretics should be started low and increased if there is inadequate response to initial therapy and no adherence is ruled out. Follow-Up A. If drug therapy is initiated, see the patient again in 2 to 4 weeks for follow-up. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Cardiovascular Risk Assessment/Management EKG Interpretation Lab Studies Interpretation X-ray Interpretation |
Case Log - Use as of 7/11/2019
| Date: | 02/12/2020 |
| Rotation Type: | NSG6440 |
| Comments: | HPI. Mr. AG is a patient of a 48-year-old man with a previous history of cigarette smoking since 10 years ago. He refers to excessive mucus secretion with chronic or recurrent productive cough occurring 3 successive months a year for 2 consecutive years despite therapy with acetylcysteine. He complains of a primary physician with a worsening cough which is hacking, harsh, or raspy sounding and changes in the color of sputum that is greenish, with an increase in the amount, and viscosity of sputum. The patient reports dyspnea with wheezing and change in color of his fingers and month with a bluish color. |
| Diagnostic Codes: | J41.0 | Simple chronic bronchitis |
| Patient Age: | 48 Years |
| Patient Sex: | M |
| Patient Ethnicity: | Hispanic or Latino |
| Insurance: | Insured |
| Time with Patient (min): | 56 |
| Consult with Preceptor (minutes): | 7 |
| Student Participation: | 75% |
| Chief Complaint: | "I have bluish color of the skin" |
| Reason for Visit (Check at least one): | New Consultation |
| Procedure: | Lab Tests. A. Patients with uncomplicated respiratory illness need little, if any, laboratory evaluation. B. Pulse oximetry. C. Sputum culture to identify bacteria. D. CXR may help exclude other diseases or complications. E. Pulmonary function studies. F. EKG and pulmonary function tests (PFTs). G. Sweat test may be necessary to rule out CF. |
| Skills/Procedures (Select All That Apply): | Interprofessional Collaboration / Referral / Consultation Lab Studies Interpretation Strep / Influenza Testing X-ray Interpretation |
Nurse Practitioner Program Student Evaluation Midterm and Final
200216111236_Student_Final_Evaluation_6440.docx (.docx) 0.03mb
Nurse Practitioner Program Student Evaluation for site and preceptor
200216110859_Preceptor_Evaluation_NSG_6440.docx (.docx) 0.01mb 
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