Luke J. Frost was admitted on 70/21/y-2 and discharged on 07/24/y-2. Diagnosis on admission was fracture of the left femur distal third. Diagnosis on discharge was fracture of the left femur distal third and sciatic neuropraxia.
Surgery performed closed reduction and percutaneous pinning of the distal femur fracture and application of long-leg cast. The 5 year old male was admitted on 07/21/y-2 and prepared for surgery on 07/23/y-2. Neurologic examination showed lack of motor and sensory functions. There was no pain experienced on passive stretch. Cast was bivalved and continuous progress was observed on the patient. Tylenol no.3 Elixir medication single teaspoon by mouth every four hours was given on discharge. Patient has history of seizures no known allergies temp. 98.7 pulse 106 and respiration 24.
MR-2 part 1 07/27/Y-2 through 08/06/y-2
Your city childrens hospital initial diagnosis ischemic left leg left distal femur fracture post pinning and casting and cast saw cuts. Patient complained of having purple left toes. The father recalls that the patients toes turned blue after surgery. Because of the urgency to return to the states the cast was split to allow the leg to swell. They discussed the alternative methods of immobilizations as well as those appropriate for open physic. The report indicated that there was the significance for potential growth of distal femoral physic commonly fixed through internal intra medullar Roding. Afterwards the parents with the help of the doctors determined the optimal course to perform with closed reduction and percutaneous pinning to prevent for any swelling that might occur during the flight. On examination the patient was anxious; he was administered with pain medication and fentanyl. Cast split did not reach the knee also had a split in the cast behind the heel calf and thigh. The patient is to undergo an angiogram; left knee is disarticulated/amputated on 07/29/y-2. Patient is taken through rehabilitation course with PT OT and TR.
MR-2 part 2 07/27/Y-2 through 08/06/y-2
The patient was briefly attended to at St Elias where further bivalving of cast was done before transfer to YCCH. Initial diagnosis was ischemic foot with obvious discoloration and no pulse with apparent lacerations caused by cast bivalving. An angiogram revealed there was no circulation at the level of the popliteal artery distally. Planned amputation was commenced after discussion with the family and orthopeadic and plastic surgery service. The family agreed and gave a written consent. The patient was attended to by rehab medicine and plastic surgery on 07/28/y-2. After surgery the patient was extubated and moved to the pediatric intensive care unit in stable condition. The patient will continue on IV cefazolin monitoring of CPKs and will maintain his drain for a few days. He will also need x-rays.
MR-2 part 3 07/27/Y-2 through 08/06/y-2
The patient made positive developments during his short in patient rehabilitation exercise. Patient showed safe ambulation with FWW and CGA to changeover to toilet showed safe standing pivot transfer to BSC and showed LB dressing in bed. The parents were also taken through the rehab course and verbally exhibited understanding of all strategies. Upon discharge the patient was able to carry out simple tasks hence no out patient services were recommended. Due to the patient`s father concerns the patient is subjected to a mental evaluation. It is observed that the patient and the family understand and are coping with this challenge through emotional support from their community.
MR-2PART 4 07/27/Y-2 through 08/06/y-2
During the mental assessment follow up before discharge Luke appeared to be petulant with a tendency to screech. The overall view is that the patient was nervous and wanted the mother to assist him with his deeds. The patient is observed to be more comfortable with support from his siblings. The patient responds positively to options given to him. The mother is exhausted and stressed; both the patient and the mother are optimistic about the discharge. Recommendation are Luke`s behavior is to be checked progressively and adequately reinforced. The prognosis of attaining goal is good due to a caring and highly supportive family. The patient and family both illustrated knowledge and understanding of the situation and the family`s part in maximizing operational independence.
MR-3 PART 1 11/16/Y-2 through 11/26/y-2
The inpatient progressive note from Sun Valley Hospital for Children taken; shows that Luke progressed well after undergoing a knee ambulatory/disarticulation. The wounds have properly healed. From the x-ray it is not clear whether there is a patella although the family confirms that it was removed during amputation. The patient is to be fitted with prosthesis. The consequences of knee disarticulation have been extensively discussed with the patient and the family; they are comfortable with terminal growth. The patients femur is normal and it is projected to grow to its full length. Need of adjustments of socket fitting using socks has been adequately articulated because of the importance in change of the limbs shape. To reduce the length of socket it is recommended the use of seal-in linear to get the pivot of the knee as close as possible to the residual limb.
PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING TERM PAPERS TODAY AND GET AN AMAZING DISCOUNT
