Question Answered step-by-step The patient presents with a S/P R TKA, which stands for a “statuspost right total knee replacement,” of rehabilitation after a surgical right knee replacement. The patient is a 60-year-old male. The following information was obtained as a result of his initial evaluation:Subjective:Current History/ Mechanism: -Patient has experienced about 10 years of right knee pain -Received injection in knees but did  not help with pain; pain has worsened and patient has experienced a decreased range of motion -Previous appendectomy -Surgery on 10/10/11: in hospital for four days and took part in home health physical therapy for three weeks but experienced no improvements -Suffers from Type II diabetes -Bad circulation in familyPrevious History/ Surgery: -6/1010: Left Total Knee Replacement -Functionality: sore with walking and bending, no driving, trouble putting on socks; only sleeps 3-4 hours at nightMajor Complaints: -Pain rating: 3-4 on a scale of one to 10 (1= no paint, 10= go to ER)Assisting Device/ Splint/ Brace -Walks with a cane in public for increased stability and confidence in walking but not at home -Sleeps in bed with feet up -Bathes in tub, able to step overMedication: -Prescribed as oxycodone for pain as needed, takes 2-3 per dayOccupation/ Hobbies: -Retired -Since June 2001, has lived alone in one story home with 5-6 steps to enter and a ramp -Enjoys watching TV, working on the computer, and writingDiagnostic Tests: -X-Rays/ MRI: show healing wellObjective:Posture/Gait: -Walks with supporting cane; uses walker to get into tub -Slight right limp -Decreased extension during hamstring bending and stanceRange of Motion: -Left: 4-115 degrees -Right: 22-96 degrees -Restricted patellar mobility: all directionsSpecial Test: -Lower Extremity Functional Scale: 36% functionStrength: -Left: 5 out of 5 -Right: Hip flexion= 4 out of 5; Quad= 3 out of 5; Hip= 3 out of 5Neurological: -Some tingling in hands and feet and has worsened since surgeryPalpation: -NormalEdema/ Atrophy: -Moderate right edema -Encision Healing wellGoals: -Increase extension to 0 degrees to improve heel strike during gait -Increased range of motion to fully bend knee -Increase functioning so as to be able to drive and activities of daily living (socks, shoes, etc.).B. InterventionIn order to increase range of motion and flexion and extension of the knee, the patient will come into the clinic for Physical Therapy three times a week for up to twelve visits to participate in range of motion, stretching, strengthening, and balancing/proprioceptive exercises in addition to physical therapy education, manual therapy, and modalities via application of electrical stimulation and ice.Exercises:Treatment: what exercise are appropriate for each phase C. Outcomes: The patient’s progress was marked through the compiling of daily SOAP notes. Notes of the patient’s progress may be found below:DateSubjectiveObjectiveAssessmentPlan11/7See evaluation under “Diagnosis”11/9Patient reports back pain with exercisesScar healing; Added single leg stance and weight shifting, CKC TKE, gastroc stretch, and bikeContinues to exhibit extension lag but improves with therapeutic exercises and manual therapyAdd bridging next visit; Continue with Plan of Care11/11Patient says not feeling good yetScar healing; Skin integrity normal; Added 1 # weights, bridgingPt. reports knee pops with long arch quads; almost able to fully rotate knee on bike; struggle with bridging and 1# Straight Leg RaisesContinue to progress and add weights and frequency; Add step-ups next visit.11/15Pt. reports pain medicine is giving acid reflux/indigestion so not taking any moreScar healing; normal skin integrity; Added step-ups and heel tapsPatient says difficult to lay flat on table; continues to walk with cane with flexed posture of the trunkLunges next visit11/16Tried no pain medicine but took Tylenol because was hurting in night; iced before came to PTAdded lunges; Axial Range of Motion Flexion: 111 degreesPt. able make complete revolutions forward and backward on bike; minor difficulty with lunges; improving range of motionComplete Doctor’s Note at next visit for doctor visit11/18Pt reports stiffness in the morning because of cold weatherScar healing; Skin integrity normal; added sit to stand exercise; improved supine flexion and extensionStruggled with sit to standAdd airex foam for squats next visit; Dr. note on Monday11/21Pt. reports better functioning in Activities of Daily LivingPain average about 4-5 out of tenPatient still use cane but moves at steady pace; back still arched; back pain during lungesContinue to progress with plan of care; add leg press11/23Pt. says experiencing some pain so take Tylenol at night and before coming to therapy; driving on own; relies on railing when doing single leg stanceImproved posture; experiences some tightness but loosens up with exercises.Pt. walks without cane but carries just in case; Increased speed in ROM on recreational bikeBack to Dr. in 3 months.; Increase leg press; Patient has 4 sessions left PHYSICAL THERAPY INTERVENTION Physical therapy related. answer questions 1-11 Total knee Arthroplasty (TKA). what happens during acute phase, sub acute and chronic phase of healing after TKA and what are the contradiction/precaution.what exercise can be done during this phase of healing in physical therapy and how would you instruct the patient to do them. and what modality are good to use for this phase of healing and why. strengthening resistive exercises and protocols. balance and functional exercises. goals what should they be able to do like ROM what are the protocols -what causes TKA -what are some of the precautions to treatment -what ae contraindications to treatment -Acute stage goals for -Acute weight bearing status and assistive devices -Acute stage exercises that are appropriate for this patient during physical therapy -Sub acute goals -sub acute exercises -chronic exercises -chronic stage goals -how would instruct a patient to do there exercises at home and tell them why its important to them Health Science Science Nursing NURSING 121 Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step Auditing 1011.a.  Patient complains of right shoulder painb.  Patient has SOB on exertion c.   Patient c/o hematuria for the past 3 daysd.  Patient complains of sore throat with fevere.  Patient is here to follow-up on hypertension, asthma and diabetes. All conditions are stable and doing well on medication. 1.Which of the following statement include location as and HPI element? _______2.Which of the following is a statement of 3 chronic conditions? ______3.Which of the following is a statement of duration as and HPI element? ___________4.Which of the following is a statement of associated sign and symptom as and HPI element? _________5.         Which of the following statement include context as an HPI element? ___________________2.  Patient is here to follow-up on COPD, hypertension, and hyperlipidemia all are stable and patient doing well.   This is an example of status of three ongoing medical conditions.   True or False.3.  Patient is alert and oriented, well-nourished white female. Blood pressure is 124/82 and she states her weight is 260 pounds. Conjunctivae are clear. Heart is RRR, lungs are clear. No lymphadenopathy. Abdomen is soft with normal bowel sounds, no HSM. Extremities without edema; pulses are strong. How many organ system would be counted using the 1995 exam criteria? _____4.  If the physician wants to code 99239, he needs to indicate what.___________________________5.  Three hours of critical care would be coded as ______________________________________6.  The physician documents that she spend 40 minutes with an established patient and documents she counseled the patient regarding a new diagnosis and management options. She counseled for 20 minutes. What code would you bill out? A.  99202b.  99215c.   99214d.  99203e.  992057. 7. Vitals: BP 120/40 P 62, R 16 ENT: Normal Lungs: Clear Heart: Regular Abd: Soft  What level would you give the exam if using the 1995 exam?    PF – EX PF – Detailed – ComprehensiveStudies1.  Patient complains of chest pain, which began three hours ago. Pain has been off and on since that time with each episode lasting two to three minutes. The pain is described as crushing and at times is rated as an eight on a scale of one to ten. The pain is associated with nausea and SOB. The pain was relieved when the patient took NTG tablet. Patient is negative for fevers, abdominal pain, and muscle joint pain. Patient has family history of CAD, and is a smoker. KNA.HPI elements_____________ ROS____________ PFSH____________ History level__________________2.  38-year-old new patient came in today with hip after falling off her deck this weekend. The pain comes and goes and she is using ice to keep the swelling down. Patient is negative for fever, SOB, CP, and gait problems. KNA, has HTN, DM.HPI elements_____________ ROS____________ PFSH____________ History level__________________3.  Ms. Miller is here today to monitor his ongoing medical conditions. Patient has CAD, hyperlipidemia, and hypothyroidism. Patient has been complaint with her meds and getting exercise when she can. She is negative for SOB, GI, GU, muscle joint pain, chest pain, abd pain, GU and psych. See list for medication, patient is working as in a nursing home as an aid. Refill medsHPI elements_____________ ROS____________ PFSH____________ History level__________________4.  Patient in today with bad sore throat has no fever. Did strep test, positive, Sent antibiotic to Walgreens follow-op PRN.HPI elements_____________ ROS____________ PFSH____________ History level__________________5.  She is alert and oriented x3, pupils PERLA, TM’s are clear, cardio no murmur. How many organ systems_______6.  ENT negative, GU negative, skin is warm to touch, patient has slight fever. How many organ systems________7.  CV: RRR, GI: abdomen is non-tender, ENT: TM’s clear, Neck: no thyromegaly, Constitutional: BP 100/60 ______Fill in correct HPI Element1.  It began in childhood__________________________2.  The patient has been wheezing and coughing__________________________3.  The indigestion happens mostly at night_____________________4.  The pain takes my breath away. _______________________5.  She tried elevating her head to take away the pain___________________Fill in ROS1.  No weight changes__________________2.  No hematuria_______________________3.  No depression or suicidal thoughts.____________________True or False1.   Medical necessity is the overarching criterion no matter how many HPI elements or ROS are documented. ____2.  Chief complaint only has to be on the initial visit. _______3.  Chronic can count as duration _____________4.  Wheezing can be consider a location_____5.  There are two types of exam 95 and the 97__________6.  HEENT is an organ system_______7.  You cannot give credit in the exam for pleasant ________8.  You can mix and match the 95 and 97 exam on the same encounter._____  1.Age is 19, weight 144, temp, 97.2, BP 108/64. TMS are negative. Throat is negative. Neck without adenopathy. Lungs are clear. She does significant tenderness in the paracervical musculature. a)  How many organ system documented_______________ What 95 exam Level ____________________b)  How many bullets _______________What 97 exam level_________________________ 2.  Patient is well nourished in NAD. BP 129/78, pulse 96. Patient is A&O x3. Eyes: no conjunctival injection. Nose: turbinate’s erythematous 1+ boggy. Throat: OP erythematous. C/V: RR, no murmur. Lungs: +inspiratory wheeze RRL/RML improved after coughing. Skin: clear, no rashes. Extremities: no clubbing or cyanosisa)  How many organ system_______________________ What 95 exam Level ____________________3.  He is a clean, well/nourished, well-developed 15-year-old boy. He is alert and oriented to person, place and time. W:148, T: 99.2, BP: 100/54. ENT are all negative. Respirations are equal and unlabored, lungs are clear to auscultation. Hear is regular rate and rhythm, no murmurs, gallops or rubs. Abdomen has no tender areas. He has active bowel sounds. a)  How many organ system documented______________________ What 95 exam Level _____________4.  BP is 137/62, respiratory rate is 14, heart rate 75. The patient is alert and oriented x3, PERRLA, Neck is supple without lymphadenopathy, no thyroid enlargement or tenderness, lungs are decreased air entry, no rhonici or wheezes, Heart is normal S1 and S2 no murmurs, abdomen is soft no tenderness, extremities have +2 distal pulses. NO lower extremity edema or swelling, skin no rash, neurologic power 5/5 in all extremities. Sensation is intact and reflexes are +2. a)  How many bullets identified on the 95 exam_____________ What 95 exam level___________5.  General Appearance: well appearing, no acute distressEyes/Ears/Nose/Throat: pupils equal round and reactive to light. Canals clear and tympanic membrane visible. Respiratory: Lungs without crackles, rhonchi or wheezes. Cardiovascular: Hear has a normal RRRIntegumentary: Skin is without rashes, or suspicious nevi. Normal to palpationNeurological: Alert and oriented to person, place, time. Gait and station normal. a)  How many organ system documented______________________ what 95 exam level______________b)  How many bullets identified_______________________________ what 97 exam level _________6.  HEENT: clearNeck: supple w/o bruitChest: lungs clearCV: RRRAbdomen: soft non-tenderGI: slightly more pronounced inguinal rig reducible w/o bowel sounds presenta)  How many organ system documented________________________ what 95 exam level _____________b)  How many bullets identified ___________________________ what 97 exam level __________________7.  BP pressure is 157/85, respiratory rate is 20, heart rate is around 110. Alert and oriented x3. HEENT: Negative, Lungs: no wheezes. Abdomen: soft and lax. No tenderness. Extremities: +2 distal pulses. No lower edema and positive right big toe blackish.a)  How many organ system documented______________________ what 95 exam level _____________8.  HEENT: conjunctival prominence with erythema of bilateral upper and lower lids. EOM intact. Chin with ecchymosis.Neck: suppleLungs: clear to auscultation, assessment of respiratory effect negative, no wheezingHeart: RRR, no edema, clear to pedal pulsesAbdomen: normal bowel sounds and tenderness, normal liver and spleenSkin: no lesions a)  How many organ system____________________________________ what 95 exam level____________9.  General: Patient is awake, alert, communicative, and in no acute distressNeck: SuppleHEENT: ClearLungs: Clear to auscultation with decreased air entry in bases and has respiratory effort. Heart: S1, S2, Extremities: Edema present. a)  How many organ system documented________________________ what 95 exam level______________10. Physical exam: pleasant female no istress her lungs are clear heart is regular abdomen is soft there is tenderness in the right upper quadrant there is no masses extremities are without cyanosis or clubbing. a)  How many organ system documented.____________________________ what 95 exam level_________   Health Science Science Nursing HIT MISC Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step Image transcription text:11 PM Sat Jul 17 060% ugf.mrooms3.net Case 1 B.T. is a 42-year-old woman who complains of increasing jointpain and stiffness in her hands, wrists, shoulders, and knees. She has been taking aspirin every 4 to 6 hourswith little relief. Her physician suggests x-ray and blood studies to evaluate her joint dysfunction. … Show more… Show more Health Science Science Nursing Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step What are General Equivalence Mappings (GEM) how are they important in ICD coding Health Science Science Nursing HTH 2309 Share QuestionEmailCopy link Comments (0)

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