[Solved]: Scenario 3 INDICATIONS FOR PROCEDURE The patient…

Scenario 3 INDICATIONS FOR PROCEDURE The patient presents for a bedside speech and language pathology consultation to evaluate speech and swallowing abilities. The patient is currently NPO with G-tube to meet all of his hydration and nutritional needs. Patient is a 55-year-old male who self-reports history of head and neck cancer. Patient also has a trach and is currently using finger occlusion to achieve voice. PROCEDURE A clinical swallow evaluation was performed. Patient’s laryngeal area was palpated during a dry swallow and indicated that he does have significantly reduced laryngeal elevation and radiation fibrosis. Additional evaluation of swallowing function is needed for safety purposes. As such, a modified barium swallow study needs to be completed to objectively evaluate his swallow safety and rule out aspiration. FINDINGS On the dry swallow during evaluation, we reduced the patient’s laryngeal area and tissues around his larynx, which revealed radiation fibrosis. The patient’s neck range of motion appeared to be adequate and within the normal limits. Finally, patient was able to actively swallow with stimulation, approximately 30% of presentation. Workbook 69 IMPRESSION The patient has history of head and neck cancer, status postradiation and chemotherapy with radiation fibrosis. This is impeding his swallowing abilities. The patient would benefit from outpatient skilled speech therapy for neuromuscular electrical stimulation for muscle re- education, to improve his swallowing function and swallowing safety. In addition, he would benefit from placement of a Passy-Muir valve to have hands-free communication ability. ICD-10-PCS: _____ 18. Scenario 4 SUBJECTIVE Patient is 19-year-old male with heroin addiction, admitted with heroin toxicity. He admits to continuous heroin use and has tried methadone as well as weaning from methadone with no success. OBJECTIVE Patient lacks insight into his drug problem. He is otherwise healthy, other than needle marks on his extremities and obvious lack of hygiene. He shows obvious signs of depression. ASSESSMENT Heroin addiction, depression. PLAN I discussed with the patient my unwillingness to prescribe controlled substances or narcotics for him, due to his drug use issues. However, I do feel his depression demands treatment, so I am prescribing fluoxetine 20 mg 1 tab daily. I discussed potential side effects in detail. I also warned him that all antidepressant medications carry increased risk of suicide. I instructed the patient to contact outpatient behavioral services to continue his substance abuse treatment. Patient agreed to do this. ICD-10-PCS: _____ 19. Scenario 5 REASON FOR EXAM Prostate cancer. PRIMARY PROCEDURE WHOLE-BODY RADIONUCLIDE BONE SCAN. PROCEDURE After 3.5 hours of the intravenous administration of 26.5 mCi of technetium 99m MDP, the skeleton was imaged in the anterior and posterior projections. There appears to be a focus of abnormal increased tracer activity overlying the right parietal region of the skull. The uptake in the remainder of the skeleton is within normal limits and the kidneys image normally. There is increased activity in the urinary bladder, which may suggest possible urinary retention. There appears to be a focus of abnormal increased tracer activity overlying the right parietal region of the skull. CT scan of magnetic resonance imaging of the skull and brain is recommended for further assessment if it is clinically indicated. ICD-10-PCS: _____