SPAR assignment a Meet the Client bit LC is a 78-vest-ald man with a 3 year Atory of Partition formed (PD) He is a rosine married, and living with his wife in a small farming community He has A adult children Since his last visit to the clinic 6 morithe apo, I C. reports that his tremors are "about i’m the were. However, further questioning reveals that he feels his gait is a little more unsty and What has is slightly more noticeable. L. C. is also concerned about increased drooling. Among the Stations L.C takes are carbidopa levodopa 25/100 mg (Sinemel) and pramipexole (Mirapex) 0.5 me. each thing tion daily. On the previous visit the Sinemet was increased from 2 to 3 times daily. He reports thist he has become very somnolent with this regimen and that his dyskinetic movements appear to be worse just after taking his carbidopa-levodopa (Sinemet) SBAR assignment B Meet the Client: B.M B.M., a 22-year old female, saw her primary health care provider 1 week ago because she had a move on her right arm "that started changing," For years, the mole was flat and brown; over a period of several weeks recently, B.M. reports that the mole became slightly raised with irregular borders and changed to a blackish color, The provider noted the presence of a hard, non-tender mass in B.M.’s right axillary region, B.M. has a fair complexion, red hair, and blue eyes. She says that as a child, she had a bad sunburn at least once every summer but reports that she now uses sunscreen regularly. B.M. states that an uncle and a few cousins have had skin cancer, but it was "not the bad kind. " She has come to the dermatologist’s office today for further assessment.
This essay addresses two patient scenarios: one involving a 78-year-old male with Parkinson’s Disease (PD) and the other concerning a 22-year-old female with concerning skin changes. These scenarios illustrate the importance of comprehensive assessments, timely interventions, and patient education in delivering quality healthcare.
In Scenario A, the patient, L.C., presents with worsening symptoms of PD, including increased gait instability, tremors, and excessive drooling. L.C. is currently taking carbidopa-levodopa (Sinemet) and pramipexole (Mirapex) to manage his condition. While he initially reports that his tremors are slightly better, further exploration reveals ongoing challenges. L.C.’s increased somnolence after taking Sinemet and worsening dyskinetic movements are concerning side effects.
To address L.C.’s concerns and optimize his PD management:
Conduct a comprehensive medication review: Evaluate the timing and dosages of Sinemet and pramipexole to minimize somnolence and dyskinesia.
Discuss non-pharmacological interventions: Explore physical therapy, exercise, and speech therapy to improve mobility, balance, and manage drooling.
Provide education: Educate L.C. and his wife on the importance of adherence to medication regimens, side effect management, and the expected progression of PD.
Consider a multidisciplinary approach: Collaborate with a neurologist, physical therapist, and speech therapist to develop a holistic care plan.
In Scenario B, the patient, B.M., presents with concerning changes in a mole on her right arm. The mole has become raised, has irregular borders, and changed color, which raises suspicion of possible skin cancer. B.M. also has a family history of skin cancer, further increasing her risk.
To address B.M.’s skin lesion and assess her risk for skin cancer:
Conduct a thorough skin examination: Examine the suspicious mole and assess the presence of any other concerning lesions.
Perform a biopsy: If warranted, perform a skin biopsy on the mole to determine if it is cancerous or precancerous.
Educate on sun protection: Discuss the importance of sun protection measures, such as sunscreen, protective clothing, and regular self-examination.
Refer to a dermatologist: Given the family history and the changing characteristics of the mole, refer B.M. to a dermatologist for further evaluation and potential excision if malignancy is confirmed.
These patient scenarios highlight the significance of a patient-centered, holistic approach to healthcare. Effective assessment, intervention, and patient education are essential components of providing high-quality care to individuals with complex health needs. By addressing both neurological and dermatological concerns, healthcare professionals can enhance patient outcomes and well-being.
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