「Domestic Violence」の編集履歴(バックアップ)一覧はこちら
「Domestic Violence」(2006/11/28 (火) 17:24:01) の最新版変更点
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<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">1.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
痛みの性状</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
視力障害・平衡障害・錯乱・嗜眠はあるか</span><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">.</font></span>
<span style="FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発熱あるか</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
眼痛はあるか</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
複視はあるか</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
麻痺はあるか</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
頭痛の発症はいつからか</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">何歳からか</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">).</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
前兆はあるか</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
これまでの頭痛と違うところがあるか</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
頻度はどのくらいか</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
痛む部位</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
随伴する特徴</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
悪化要因や緩和要因</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
経時的変化</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">2.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
次の予約を入れる</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
息子も連れて来るように言う</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
育児・しつけについて相談できる機関</span> <span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">児童相談所など</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
を紹介</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">You explain the headaches she describes
are consistent with <u>muscle contraction, or "tension" headaches</u>. Your
recommendations include <u>keeping a headache journal and using acetaminophen
650mg every 4-6 hours PRN</u>. You also encourage the patient to <u>identify
additional areas of stress in her life</u>, while trying to participate in
<u>light exercise</u> a few times a week to help reduce
stress.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">You also suggest the patient talk with
school guidance counselor regarding her son's school behavior and academic
issues.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Lastly, you have Mrs. Miller schedule her
annual physical for next month, with plans to follow-up on her headaches and
stress level at that time.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">3.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
乳癌・子宮癌検診</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">A complete physical exam, including a
gynecological exam (clinical breast and <u>pelvic exams</u> and <u>pap
smear</u>). The patient should be educated on <u>breast
self-exams</u>.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Immunizations should be reviewed and
updated (tetanus and influenza). <u>Due to the patient's hypothyroidism and use
of Synthroid, a TSH and T4 should be checked every six
months.</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Cholesterol levels within the desired
range (in this case <200mg/dL) do not need to be checked more frequently
than every three years.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">4.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt">Diet</span></b> <span lang="EN-US" style="FONT-SIZE: 9pt">- A
low fat, high fiber diet, with at least 1200 mg/day of elemental calcium should
be encouraged.<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt">Exercise</span></b> <span lang="EN-US" style=
"FONT-SIZE: 9pt">- You encourage Mrs. Miller to participate in a minimum of 20
minutes of aerobic exercise three times per week. You also discuss the
importance of strength building/resistance exercises to help maintain optimal
bone density.<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt">Substance Use</span></b><span lang="EN-US" style=
"FONT-SIZE: 9pt">- Mrs. Miller <u>denies the use of tobacco products and
illicit drugs</u>. She drinks <u>one to two glasses of red wine each night to
help her "fall asleep"</u>.<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt">Safety</span></b> <span lang="EN-US" style="FONT-SIZE: 9pt">-
Seat belt use is reviewed, as is the presence of smoke detectors in the home
and the use of helmets when bicycling.<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt">Domestic violence</span></b> <span lang="EN-US" style=
"FONT-SIZE: 9pt">- <u>When Mrs. Miller is asked if she feels safe in her home,
her eyes quickly focus on the floor.<br></u></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">5.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
家庭内暴力の存在が疑われる</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">家庭で安心できるかという問に答えなかったこと</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
両側膝点状出血の既往などから</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">).<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Mrs. Miller has many features suggestive
of domestic abuse:<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 27pt; TEXT-INDENT: -9pt; mso-list: l2 level1 lfo1; tab-stops: list 27.0pt">
<span lang="EN-US" style=
"FONT-SIZE: 10pt; FONT-FAMILY: Symbol; mso-bidi-font-size: 9.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">