According to the American Correctional Association’s (ACA) e…
Questions
Accоrding tо the Americаn Cоrrectionаl Associаtion's (ACA) early training standards for correctional officers, how many hours of preservice training were required?
Review the pаtient infоrmаtiоn аbоve and document complete and thorough Admission Orders:
Which оf the fоllоwing best describes this imаge:
Review the pаtient infоrmаtiоn belоw. Then, document complete аnd thorough Admission Orders in the following essay question. Patient Information HPI: Tobias Floyd is a 25 y/o M who presents s/p fall from his dirt bike that occurred while riding just prior to arrival. Pt was in process of training for an upcoming motocross event as he is a professional motocross rider. He states he was attempting a trick jump when he fell from 2-3 feet up, but the dirt bike launched and landed on his R leg from 3-4 feet in the air. He arrives via ambulance reporting L leg pain and deformity and concern for a fracture after the fall. The pain is worse with attempted movement of the L leg, better without movement or touching it. The pain radiates down the L leg. The pain is currently rated 10/10. Pt reports tingling / decreased sensation of the left foot but denies known focal weakness. He also notes having multiple “scrapes” on the posterior aspect of both arms from the fall. He was wearing a helmet. He recalls the event well and denies memory loss. He denies head injury, LOC, or neck pain. No reported lacerations. Pt denies nausea/vomiting, dizziness, confusion. Pt denies hx of a bleeding disorder, the use of any blood thinners, or use of any alcohol / drugs today prior to the fall. Past Medical History (PMHx): Illnesses/Injuries: Patient reports no chronic past medical history. L4 vertebrae fx due to prior dirt bike accident. Hospitalizations: None Surgical History: Repair (stabilization) of vertebral fx (L4) from fall (4 years ago) Screening/Preventive History: Pt is up-to-date on all vaccinations and preventative screenings, with exception of Tdap/Tetanus (last occurred at age 30). Medications (Prescription, Over the Counter, Supplements): -No daily medications Allergies (e.g. environmental, food, medication and reaction): NKDA Family Medical History: Mother (alive, age 51) has history of thyroid cancer Father (alive, age 49) has history of alcohol abuse Sister (alive, 22) no known medical hx Daughter (alive, 24) - healthy No genetic disorders known in family Social History: Substance Use / Alcohol Use: No tobacco use. Pt admits to occasional marijuana use. Pt denies alcohol use. Diet: Pescatarian Home Environment: Lives alone in an apartment with stairs at home (one flight of 6 stairs) Occupation: Professional motorcross racer Leisure Activities: Pt likes to ride his dirt bike and fix it. He is an avid photographer and likes to play pickleball. Exercise: Active daily, mostly conditioning for motorcross, pickleball, or surfing. Sleep: 6-7 hours per night Religion: Atheist Sexual: Sexually active only with his long-term girlfriend, uses condoms. ROS (Review of Systems): General: No weight loss, fever/chills, or night sweats. Skin: See HPI. No eczema, dry skin, or skin changes reported. HEENT: No headache, neck pain/stiffness, no sore throat. No vision changes or double vision. No congestion/runny nose. Respiratory: No cough, shortness of breath or wheezing. Cardiovascular: No chest pain or palpitations. Gastrointestinal: No n/v, diarrhea or constipation. No reported abdominal pain, flank pain, or change in bowel consistency. Genitourinary: No change in urination, dysuria, hematuria, or increased urinary frequency. Musculoskeletal: See HPI. No back pain or neck pain reported. Psychiatric: No depression, anxiety, or thoughts of self-harm. Hematologic: No known easy bruising/bleeding, or gum bleeding. Endocrine: No hot or cold intolerance. Neurologic: See HPI. No dizziness, headache, confusion, or disorientation. No numbness or weakness reported. Physical Exam: General: Pt appears uncomfortable, in acute painful distress, and wearing normal clothing on arrival. Pt is a WDWN male otherwise. Pt is alert and cooperative. Skin: Abrasions noted over B/L posterior aspects of arms; L worse than R. Abrasion also noted over L lateral deltoid/shoulder area. There is no visible ecchymosis. No lacerations or active bleeding visualized otherwise. Skin is warm, no other rashes, normal turgor, no pallor or cyanosis throughout. Head: Normocephalic, atraumatic. No obvious signs of head trauma on exam such as contusion, abrasion, bruising, or laceration. Eyes: PEERLA B/L, EOMI B/L, sclera anicteric, conjunctiva clear. Ears, Nose, Throat: Normal ear, nose, and throat inspection. No pharyngeal erythema or lymphadenopathy noted. Ear canals patent B/L. Hearing grossly intact B/L. No hemotympanum, raccoon eyes, Battle sign, or otorrhea noted. Neck: Non-tender, c-spine ROM intact, no midline TTP, step-offs, or deformity. No visible skin changes, contusion, or abrasion. Pulmonary: Lungs clear to auscultation B/L, no crackles, wheezes, or rhonchi. Cardiac: Tachycardia noted, with normal rhythm, no murmurs, gallops, or rubs. Normal S1 and S2 otherwise. Peripheral Vascular: Capillary refill less than 2 seconds throughout distal extremities bilaterally. Peripheral pulses full and equal bilaterally, most notably 2+ DP and PT pulses B/L Les with normal capillary refill of B/L LEs. Abdomen: Soft, non-distended, non-tender. Normoactive BS presents in all 4 quadrants. No signs of abdominal trauma such as contusion, abrasion, or bruising. Rectal: Deferred GU: Normal external genitalia without evidence of trauma or injury. MSK: Cervical, thoracic and lumbar spine are without midline tenderness, step-off or deformity. Pelvis stable and without TTP. No crepitus, or depression appreciated. The left leg has obvious deformity (mid-shaft) with ROM of L knee and ankle that could not be immediately assessed due to pain and distal deformity. The appears to be misalignment of the mid tib/fib shaft without ecchymoses. There is mild overlying swelling. R LE is WNL. Feet/toes on B/L feet WNL, without deformity, and ROM is intact. ROM intact B/L at hip. There is no obvious laceration or injury overlying the area of deformity to suggest open fx. B/L upper extremities with superficial abrasions as noted previously in “skin” system area. Neuro: Pt is AAOX4. Memory and recall intact of the fall and recent events. Sensation noted to be decreased to L distal foot when compared to R and otherwise intact throughout upper and RLE extremities. Strength 5/5 all extremities at major joints with exception of L knee, ankle, foot which could not be fully assessed due to pain and/or obvious deformity limiting exam. Other than findings noted here, CN 2-12 exam is otherwise grossly intact. Gait could not be assessed. Reflexes 2+ in all extremities with exception of LLE which could not be assessed due to pain/deformity/swelling. No tremor noted. Psychiatric: Appropriate mood and affect for situation