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IP Encounter ReportMRN: DOB: Sex: MAdm:D/C:H&P - All Notes (continued)PLAN:I have discussed the case with the referring provider and the family and our plan is Bilateral VEPTR insertionRibs 4/5, L2-3Post procedure ice, rest and elevation were dicussed.Patient education regarding wound and/or cast care, and return to clinic precautions were discussed.Pain management with morphine was discussed with the patient and/or family.Michael R. Ballard, PA-C(MR # Printed by  at 10/11/13 10:09 AMPage 5Electronically signed by Ballard, Michael R. at 6:17 AMElectronically signed by Erickson, Mark A. at 10:35 AM
IP Encounter ReportMRN: DOB: Sex: MAdm:D/C:Consults - All NotesPhysical Therapy Spinal Fusion Progress NoteTreatment Time: AM- 0945-1030 x 3PM- 1:00-1:30 x 2Relevant Medical History:is a 9 year old male with a history of severely progressive early onset scoliosis. Heunderwent one level fusion L2-L3, placement of initial vertical expandable prosthetic titanium rib (VEPTR)implants from ribs 4 to L3, and expansion thoracoplasty/initial VEPTR lengthening on PT ProgressAssessment/Plan:did a great job on his first day post-operative, despite having had a difficult morning due to pain andanxiety leading to increased respiratory distress and having had an RRT called prior to therapy session. Hismobility was limited during the morning session to bed mobility and sitting at the edge of the bed due to shortoxygen lines and need for high flow heated nasal cannula. He progressed to a stand pivot transfer to bedsidechair in the afternoon. Continue inpatient physical therapy twice per day until all goals met.Pain: 1-2/10 (verbally reported by patient) in a.m., 2-7-4/10 in p.m. sessionIntervention for pain: Clinician bolus, patient controlled analgesia and oral pain medications all given prior tomorning session, oral pain medication and patient controlled analgesia in p.m. sessionPain at end of session: 0/10 in a.m., 4/10 in p.m.Post operative Day 1: Patient transferred to bedside chair: YesGoals and Progress:1.will logroll with minimal assistanceProgress: Moderate assistance to log roll this morning.2.will require minimal assist from caregiver with transitions sidelying to sitting and sitting tosidelyingProgress: Moderate assistance to go from sidelying to sitting at the edge of the bed in the morning. Able tosit with close guarding for safety x 5 minutes, mild complaints of nausea prior to sitting, but no complaints ofpain or nausea once sitting.3.will ambulate 250 feet with stand by assist from caregiverProgress: Not addressed today, did sit to stand and stand pivot transfer from bed to wheelchair withmaximal assistance due to bed height and patient's complaints of pain during p.m. Session. Father of childand nurse reported feeling safe and comfortable with assisting patient back to bed after therapist reviewed anddemonstrated proper technique.
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Trigraph, Mark Erickson, Brien M. Rabenhorst, •HYDROmorphone, •ondansetron