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starhospitalseo · 1 day ago

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Star Hospitals - Knee Replacement Surgery

Earlier, when people heard the word "surgery," they often felt it was extremely distressing, risky, and expensive. They often felt surgery should be avoided and suffered for years. With the advancement of knee replacement surgery in Hyderabad, patients can rest assured of complete resolution and faster recovery, causing minimum discomfort.

What is Knee Replacement Surgery?

Knee replacement surgery, known as knee arthroplasty, involves replacing your damaged knee joint with artificial parts. This procedure is especially viable for patients with severe knee pain due to arthritis.

Why is Knee Replacement Needed?

Patients suffering from chronic pain, stiffness, and loss of mobility, often caused by osteoarthritis or rheumatoid arthritis, can benefit from knee replacement surgery in Hyderabad.

Are There Any Risks?

While rare, knee replacement surgeries have risks like any other surgery. These include infections, blood clots, and implant issues. However, choosing the best orthopedic hospital near you for the best knee replacement hospital in Hyderabad can help minimize complications and ensure the best results.

Preparation:

Before surgery, patients undergo a full Preop medical assessment to ensure fitness for surgery. Preparing your home for post-surgery care is crucial. If you're considering knee replacement surgery in Hyderabad, you can visit Star Hospitals for pre-surgery consultations that help you prepare adequately and clear your doubts.

What to Expect During and After Surgery?

During Surgery: The ideal procedure takes between 1-2 hours wherein the damaged knee joint is replaced with Artificial implants. Robotic knee replacement in Hyderabad provides a more refined approach with improved accuracy.

After Surgery: Post-surgery recovery involves physical therapy to regain mobility. Most patients can walk with assistance in a few days and fully recover within weeks.

Why Choose Star Hospitals?

If you're looking for the best orthopedic hospital near you or the best knee replacement hospital in Hyderabad, Star Hospitals is the name you can trust. The triple promise of excellence, expertise, and empathy is always shining bright at Star Hospitals. With advanced technology, and an expert team of surgeons, we ensure patients recover faster and get a long-term solution to their ailments.

For expert care and personalized treatment plans, visit STAR HOSPITALS today!

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jj-lynn21 · 5 years ago

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Doctor Istvan Günther intern at large

warnings: This is mostly just fluff and a dash of angst.

One shot

Bill sits in the administration office waiting area with his business manager, Jake Glassgo. The secretary attempts to hold her cellphone to take a picture to send to her friends. Jake notices.

He leans in hiding Bill’s face with his hand, “You want me to take her phone?”

Bill sighs, “I’ll try to ask nicely, first.”

He walks over to the woman’s desk with a kind smile on his face. “I don’t want to be a dick, but I’d appreciate you not taking random picture of me here. I am trying not to get any press or fanfare right now. I can give you one good selfie for you to post in a week when I am done, alright?”

She nods excitedly.

“What’s your name?” He reached for her phone and she gave it up willingly while getting lost in his emerald gaze.

“Pam Pitson,” She smiled. At least she thought she smiled.

“Nice to meet you Pam.” Bill deleted photos she had already taken. He glanced through her social media to see if she posted anything yet. She hadn’t. He held the camera in front of them tilting it to get a good angle for them both to look their best. “Smile, Pam.” She did and he snapped the photo and handed her back her phone. “Remember don’t post that for a week or it will breach the contract I’m about to sign and you will be fired.”

She was blushing so enamored of him she would agree with anything. She manages to get out a, “k”

The intercom fuzzes with static before the manager asked, “Ms. Pitson, I am ready to see Mr. Skarsgard and Mr. Glassgo now.”

Pam answered, “I’ll send them right back Mr. Garrett.”

Bill and his manager sat in the office with Mr. Garrett. Mr. Garrett handed them a stack of papers to sign. Mr. Glassgo took out a stack of paper from his briefcase for the hospital administrator to sign.

“All the staff throughout the hospital were informed you will be here for the week.” Mr. Garrett said as he signed the paperwork given to him. “They will not be bothering you for autographs or photos. If someone does please inform me. They know the consequences.”

Bill nods as he finishes signing papers, “they will treat me like the rest?”

“For the most part,” Mr. Garrett informed him. “our interns are questioned about possible diagnosis and medical conditions. You will not be put on the spot in any way. You will be going through a quick overview of how to do a basic assessment and asked to do that during rounds. A Doctor will reassess the patient when you are through which is a normal procedure. Others in the group may also assess the patient. The other thing we can’t control is patients recognizing you.”

“Understandable,” Bill thinks for a moment. “what about those getting ready for surgery. Doctors visiting right before surgery would wear a mask and in recovery wear masks?”

“Yes, also patients in reverse isolation in which the Doctors have to wear masks and gowns because the patient could be in danger from outside germs.” Mr. Garett said. “You can go into those rooms if you do exactly what the team leader tells you.”

“Of course,” Bill agreed, “I would never want to put anyone in danger. Learning what to do in those situations would be helpful.”

They all shook hands and Bill parted ways with his manager to start right away. Mr. Garett took Bill to the Doctors’ locker room to get a white coat and Stethoscope. Then he took him to a new class of interns that was due to start in minutes. Most of them were seated.

“This is Doctor Istvan Günther,” He used Bill’s middle names for slight anonymity. “He is joining you all in this learning process. I expect the best from you all. "Doctor Günther, take a seat. Good luck. Feel free to come to me with any questions.”

Bill sat in the back. Doctor Marker, the head of surgery was also the head of the internship program. Today’s lecture was on viral pathogen control inside the hospital. Bill took notes on the lecture and also on how the students around him were acting.

After the lecture, Doctor Marker separated the class into small groups to work in different departments with the head Doctors in those departments. “Doctor’s Standard, Henshire, Staplton, and Günther follow me. This week we will be assessing patients before and after their surgeries. You will be viewing a tonsillectomy, heart catheterization and coronary artery bypass this week.” Doctor Marker walked quickly.

Doctors Standard and Staplton whispered and giggled glancing at the new tall intern joining them. All of them had been doing rounds in different departments for weeks. They had all gotten a form letter Bill would be joining them at some point.

“Doctor’s I would appreciate, professionalism, ” Bill told the gigglers.

“I’d appreciate working with all professionals,” Doctor Henshire murmured.

“Sorry Doctor Günther,” I’m Breanna or Doctor Standard if you will. The rude mumbler is Doctor Henshire. He is just a little cranky baby to everyone so don’t take anything he says personally.“

"I’m Doctor Jason Staplton,” He smiles. “It is a pleasure to have you work with us. I think what you are doing to get more realism into your work is great.”

“Yeah,” Doctor Standard looked up to him with big blue doe eyes. “Any questions you have, we have no problem trying to answer. Anything, at all.”

Bill smiled nervously, “Thank, I appreciate that.”

They get to the door of the first patient. Masks and gloves are outside the door. Doctor Marker put his mask and gloves on and the others follow suit.

“This patient, female 25 years old presented with pain on the right side of the throat, difficulty swallowing, A hoarse voice, fever, swollen lymph nodes, yellow coating on the tonsils, and a severe recurring sore throat over the last year. Who would like to tell me why she is here?”

Doctor Staplton jumped on the question first. “She needs her tonsils taken out.”

Doctor Mark nodded, “Correct Doctor Staplton. We will go in and each access here one last time before her surgery. Then you will watch me in the observation room. She was just medicated for surgery minutes ago. How should we proceed when we walk in her room? ”

“We should inform her on the dangers of the surgery before checking her vitals,” Doctor Henshire said smugly.

“No Doctor Henshire,” Doctor Marker glared at him. “The patient is told of the dangers and all possible outcomes in the initial consultation. We need to make sure she is relaxed and in good spirits before going to surgery. Talk kindly to her. Ask her if she has any questions. Answer her calmly.”

Everyone walked into the room.

The patient was smiling. Her eyes were glossy from the medication. “Hey there Doctor sexy eyes.” She giggles looking at Bill. “Those eyes belong to Bill Skarsgard. What a Hunk.” She giggles again.

Bill chuckles nervously.

Doctor Marker picked up her chart on the end of the bed. “How are you feeling Miss Johnston?”

“Dandy as candy,” She smiled. Her eyes were a little droopy.

“We are going to listen to your heart and check your lymph nodes before you go down to surgery Miss Johnston.” Doctor Marker flipped through her chart. “Looks like blood pressure and blood work are good. These interns are Doctor Standard, Doctor Henshire, Doctor Staplton, and Doctor Günther.”

They all listened to her heartbeat and felt under her neck. Bill went last and did as he saw everyone else do. She was smiling ear to ear as he heard her heartbeat so steadily. He glands were so swollen even he could feel how abnormal they felt.

As they were taking her vitals the transporter came in with the gurney. They all walked to the operating room.

Miss Johnston looks up at Bill. His hand on the rail walking along side. She reached for his hand. “Will, you be there when I wake?”

“Bill takes her hand,” His eyes light up with a smile. “Yeah, I promise I’ll be there.”

He was not sure if that was an appropriate response from a Doctor. He made a mental note to ask later.

“Thank, Bill,” she murmured before they wheeled her into the operating room.

Bill followed the other interns up some stairs, “Was it alright for me to hold the patients hand and reassure her like I did?” He threw the question out for any of the others to answer.

“No,” Doctor Henshire chastised instantly.

Doctor Standard glared at Doctor Henshire, “To elaborate on Doctor Henshire’s comment, it is not something most Doctors do. Sometimes a family member will walk with the patient holding their hand before they get to the operating room. It is fine to comfort a patient before surgery and I think you helped her be in good spirits which is important for a Doctor to do, in my opinion.”

“ I think holding a patient’s hand is fine if it makes them trust you better, Doctor Staplton chimed in, "You just have to watch you don’t get to emotional invested in the patients. If you do that, this place will rip you to pieces emotionally.”

“Yeah,” Bill nodded, “My brother offered me that advise also. He is a Doctor in Sweden. I tagged along with him last week but I really wanted to see things inside of a hospital in the States for the character I will be playing next.”

They sit in an enclosed glass room over looking the operating room. Doctor Marker explains everything he is doing step by step. He wants his students to be ready to join him in the operating room and eventually perform the procedure by themselves. Bill’s eyes are big and interested as he watches and takes notes. He also takes notes on how the others are reacting to watching.

Bill is standing at Miss Johnston’s bedside when her eyes flutter open, “Don’t try to speak Miss Johnston. If you can keep the secret you know who I am I will bring you something special when you feel better tomorrow.” He winks.

She smiles and nod yes that she will keep it a secret he is there. Then she nods back off to sleep. She is unsure if he was really who she thought he was with the preop shot and the haze she was still in when she woke in recovery.

The interns followed Doctor Marker for ten hours checking in on patients. Also learning about the paper work that must be done. “It is an important part of the job,” he told them. Other than stopping in the cafeteria for 15 minutes to grab a coffee and a snack on the run they had no real break. But finally the exhausting day came to an end.

“Hey Doctor Günther, we are going for a drink at Cleats,” Doctor Staplton looked to Bill as they hung up their white coats in the locker room. “You want join us?”

“Thanks man, um Doctor Staplton,” Bill said politely. “I have some more work to do tonight. Then getting some rest.” Bill wanted to make sense of his notes while they were fresher in his mind so he could make character suggests in the script to show the director next Monday.

“We will see you tomorrow at 4am then,” Doctor Staplton walked out with Bill.

“Sure thing,” Bill said excitedly. Most of them seemed to be cool with him being there. “I’m looking forward to learning more.”

The next morning as he got to the last light before pulling into the Doctor’s parking lot in his rented black kia telluride with tinted windows he saw the vultures. Media trucks, reporters and camera people covered the entrance to the hospital. Bill shook his head as he pulled into the parking lot.

When he parked he took his phone out to call his manager, “I had one good day before they all found out. Any patient or visitor could have informed them. Can you be here within a half an hour. Bring some signed posters of my characters. I have a fan I want to visit before leaving today. And bring Mr. Mike.”

His manager and bodyguard, Mr. Mike, got there within twenty-five minute. They all went to the administration office to have another chat with Mr. Garrett.

“I’m sorry about all that craziness out there, ” Mr. Garrett apologized.

“I don’t think it was your people Mr. Garrett,” Bill shook his head. “Everyone was pretty cool yesterday. I’m sorry they are in the way out there. Why don’t you go out to give a statement that I was here yesterday researching a new role. I’m going to visit a patient I met yesterday before I leave through the back. I’m really sorry about the media barrage.”

“I’m sure they will leave once I tell them you are not here,” He shakes Bill’s hand.

Pam comes in to take notes for an amendment to the original paperwork that both parties do not blame employees for the media presence. Bill agrees that instead of a week, one day was enough to get the information he was looking for in the experience. She typed it all up and both parties signed. The amendment was attached to the original contract that Bill’s manager and Mr. Garrett had handy.

“Pam you may share that picture tonight after work as long as say I was only here one day,” Bill smiles kindly.

Pam got excited, “Of course Mr. Skarsgard.”

Bill’s manager and bodyguard follow him to the lockers. Bill gets the coat and stethoscope in his assigned locker. He grabs a mask from the secretary at the closest desk. They get on the elevator to head to the eighth floor where Miss Johnston was taken after her recover time.

Bill walked in her room. His manage walks in with him holding a bag of posters and things signed. Mr. Mike, stands at the door.

“How is my first ever patient today?” His sparkling green eyes smile at her.

She drops her spoon in her oatmeal mid-bite, “Doctor um Günther.” She turns beat red. “I was sure I hallucinated I saw you. I, are you…”

He took his mask off, “You weren’t that out of it Miss Johnston.”

She was so surprised, “call me Jen, um Bill?”

He chuckled, “Yeah, you can call me Bill. You didn’t tell anyone you thought you saw me, did you Jen.”

“No, I really thought I dreamed it. "She laughed.

"Good,” he smiled as he sat on the edge of her bed. “Who’s your favorite character I’ve played?”

“Oh I love a lot of them for different reason and some of them really just need more love to help them…”

He sat just listening to her paddle on for a moment.

“But Mickey is the best,” She giggled. “Such a lovable little small time criminal. He deserved better. I cried to hard at the end of that movie. But I have also already pre-cried for…”

“Okay, No spoilers.” He fake pouts like Mickey. “I don’t know if I know how my projects based on books ended yet. Sorry I made you cry so much.”

“It is like you are killing me with these tv shows and movies and I love it,” She giggled more.

“Well, I have a few things for you before I go.” Bill grinned. Mr. Glassgo hand me the Mickey things.“

His manager hand him a two rolled up posters and a funko pop of Mickey from Villains.

Jen unrolls a poster and stares at it. The stares at Bill and stares back at Bill.

"Pretty silly, right?” Bill chuckles. “Its a one of a kind poster. The back is signed. The other one is just the original poster from the movie Villains.”

She unrolled it, “Thanks, Bill. I really appreciate you stopping by and all these things. But especially just holding my hand before I went into surgery.”

“You are welcome Jen,” He gets up. “I have to go. You know what Mr. Glassgo?”

“What Bill?” his manager answers.

“Just give her the whole bag of stuff you brought.” Bill grabbed the bag and tossed it to her before leaving.

Jen squealed as she reached for it. Posters and funko pops for everything he has ever been in and a few posters for movies not yet out.

He got out of the hospital without being seen. The hospital administrator made a statement so most of the media were gone by the time he drove back to the hotel. The ones that stayed tried to continue to interview hospital personnel, but most people had no contact with him. Those that did knew not to comment to the media.

By 8pm Pam sends the picture of her and Bill to all her social media with the hashtag #whatahunk

#doctor #Doctor Istvan Günther #bill skarsgard #one shots #fluff #original story

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mcatmemoranda · 2 years ago

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We had a lecture on preop evaluation today:

RCRI is a validated tool to calculate risk. CABG doesn’t count on this score. IDDM counts as 1 point on the score.

EKG is only needed if pt has hx of coronary disease

If pt can perform greater than or equal to 4 METs, no need for additional pre-op testing

PFTs not necessary unless going for lung surgery

ARISCAT can be used to risk stratify before lung surgery

arozullah respiratory failure index

Gupta calculator for post op respiratory failure

Stop smoking any time before surgery but ideally 4 weeks before

If COVID + and elective procedure, delay surgery

Preop chlorhexidine reduces risk of postop pneumonia

Platelets less than 50 is a contraindication. High bilirubin is a contraindication. Child Pugh score assesses risk. No surgery if Child Pugh class C, EtOH hepatitis

Say the pt is medically optimized for surgery (not “cleared”)

#preop evaluation

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medicalmiracle · 7 years ago

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Rotation wrap-up: OB-GYN

I’m so late with this and I have to try desperately to remember things. Here goes...

I did my OB-GYN mostly at our local VA hospital. They only do GYN there, so out program gave me two days per week at our institution’s hospital so I could get some OB exposure. This meant one day in clinic there during the week and one 12-hours day a week on weekends in Labor & Delivery. I worked six days a week and I did not like this. I am weak, yes, but I was so fucking tired.

What I did:

At the VA: Came in around 8AM, picked up a printed clinic schedule from the front desk, and went into the resident’s room to read about patients on the EMR. For established patients, I would read the initial consult note and the last follow-up office visit note. For new patients, I would briefly look over the last note from their referring physician. In the VA system records are pretty accessible even if the patient is coming from another state, so that’s a good thing. Patients were scheduled from 8:30AM-4ishPM. I was usually home by 5ishPM at the latest. This was pretty fucking great.

Twuce a week was urogyn clinic with a urogyn surgeon. Know the different types if incontinence and how to manage them. I didn’t realize this was a part of OB-GYN and was pretty clueless the first week and felt stupid because of it.

The nurse would bring the patient back, take vitals, and bring me a folder with a documentation sheet and a discharge form for the patient. There were family medicine and OB-GYN residents there as well from another medical school, and a thing that upset me is that any procedure folders (IUD/implant insertions, colposcopies, biopsies, etc) were always given to them and I always got the office visit folders. Like, hello? As a PA student you can teach me to do these things too? I wasn’t sure how to change this during my rotation so I let it slide, but definitely gave feedback to the program about it.

Once the patient was in the room I pretty much did everything from then on. I took a history, presented to the attending, did the pelvic exam (with the attending present as chaperone), came up with an assessment and plan, wrote the note, and placed orders. I loved the independence I had and the way I was given full responsibility for the patient but the attending was always right there if I wasn’t sure.

At the OB-GYN clinic:

Started early, ended late, patients every 15 or occasionally every 30 minutes. Well woman, problem visits, OB checks, preop and postop, procedures of all kinds. I loved it but man it was exhausting.

ALL THE PREGNANT LADIES. This was my favorite part. I learned to tailor my history taking to pregnant lady issues, like energy levels and vomiting and eating and discharge and bleeding and all the swelling and fetal movement. I answered all their questions and loved reassuring them that everything was okay even if it didn’t feel like it at the time. If I could only do OB without the GYN I would do it in a second, but I think this is just related to my love of pediatrics. I dunno. We’ll see.

I learned how to estimate the size of a uterus from the outside of a body. So cool.

I learned to find a baby’s heartbeat with the Doppler. This was so emotional for me and the moms. I loved it.

I took all the histories, presented the patient, and was present for all exams and did maybe half of them. The attending was super busy so if she was running behind she would generally take over. I didn’t mind.

She would feel the carotid artery for regular rate and rhythm because she actually said “I don’t carry a stethoscope” by way of explanation. She never listened to lungs or bowel sounds for any reason. I found this weird, but I didn’t know how to ask her about it so I just didn’t.

At L&D:

12 hour shifts on a Friday or Saturday, after a full week of clinic. I got to follow moms from admission, through their labor, through delivery and after. I caught lots of babies and even got to stitch a couple of tears. The attendings often took the medical students with them and not me, but this was okay because I made friends with the midwives and that’s how I got to do things as a PA student. It shouldn’t be that way, but you do what you have to do to get your education and experience.

Impression/Advice:

Know your vaginal infections (including skin things like fungal skin infections and lichen simplex which commonly occur in the groin) and how to diagnose and treat them. A course of metronidazole is usually followed by 1-2 doses of Diflucan. Review microscopy of vaginal smears. Vaginal bleeding in a postmenopausal woman is always abnormal and requires further investigation.

Know how to do a good breast exam, remembering to assess the lymphatic chains which drain the breast. Pick a pattern (clock face, concentric, lawnmower), learn it, and stick with it. Don’t forget to feel all the breast tissue including up through the tail of Spence. Don’t let a large breast flop around awkwardly when you’re doing your exam. It’s okay to use your other hand to support the breast. It takes some doing, but you’ll get it.

Remember to always place downward pressure on the speculum during insertion to avoid the sensitive urethra and surrounding tissues. If you can’t find the cervix, try angling the tip of the speculum downwards, or retracting it slightly in case you went past the cervix. The most common mistake is that you’re not deep enough, but I had heard that and always went too far and was in the posterior fornix, so I would have to pull back slightly and angle upwards and the cervix would pop into view. IF YOU CAN’T FIND IT, IT MIGHT BE WEIRDLY ANGLED, SO TAKE THE SPECULUM OUT, STAND UP, AND INSERT A FINGER TO FEEL FOR WHERE IT IS. The urogyn surgeon who held urogyn clinic twice a week taught me this and it was a lifesaver. Especially if a woman has had pelvic surgery or sometimes it’s just their normal anatomy, but sometimes the cervix is just angled differently.

Vaginal swabs for BV/yeast/trich go in the posterior fornix, which is where discharge collects when a woman is lying supine. Gonorrhea/chlamydia are endocervical and are inserted in the cervical os. The smaller brush for Pap smears goes into the os and the larger broom-type brush is rotated at the outside of the os to assess the junctional zone. My attending just handed me the swabs on my first day and expected me to know what to do with them. I did not, and felt really dumb.

For the love of all that is good and holy, please know the ACOG (or whatever governing body in your country) algorithms for managing abnormalities on Pap smear. This literally came up multiple times every day. Know when to do further testing (high risk HPV, colpo, LEEP) and when to retest with Pap and when to just reassure. Many women think they have cancer when their Pap smear comes back abnormal, and it’s your job to tell them this is not always the case.

Odors and discharge are a thing. A couple of times there was discharge or blood or urine on the floor or on my shoes. Not often, but it happened. The smells are a thing, even in healthy women. Keep a straight face, because you can make a patient feel really uncomfortable or upset them if you don’t. We never had masks or anything like that. It’s just a part of being a female human, and it’s okay.

I didn’t enjoy this rotation as much as I thought I would. It was basically 3 problems: abnormal discharge, abnormal vaginal bleeding, and incontinence. Over and over and over. It was just meh and I was bored. OB clinic saved this rotation.

This is all I can remember for now. I hope you are all enjoying your clinical education, remember that it’s okay to mess up or be unsure as a student, because you’re there to learn.

#clinical rotations #obgyn #pablr #medblr #PA school

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bloojayoolie · 6 years ago

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Being Alone, Andrew Bogut, and Apparently: A SWEET, SOCIAL, AFFECTIONATE, MIDDLE AGED GENTLEMAN DREAMS OF A FAMILY WHO STAYS.KNOWS MANY COMMANDS WELL BEHAVED HOME ALONE, HOUSETRAINED, LOVES SLOW WALKS, BUT NOT CRAZY ABOUT BATHS Sweet "Spartagus Id 56631, 7 Years Old, 77 lbs. of Love, Neutered & waiting with hope, at the Brooklyn ACC TO BE KILLED – 3/28/2019 Adopted then returned, Spartagus is rightly confused. Friendly, social, affectionate and sweet with everyone he lived with and every new person he met, he needed time to decompress and slowly warm to his new surroundings. But in a family with 4 adults and 4 kids that was not to be and this new and busy environment was a bit overwhelming for him. It’s not that he didn’t try. He knows so many commands and happily “gave paw” when asked. He never soiled his new home because, good boy that he is, he was perfectly housetrained. And he never yanked anyone around the block on leash, because he preferred leisurely strolls, taking time to enjoy the sights, and bask in his newfound happiness --- a home, and his parent by his side. We can only imagine how he felt when he was dumped one week later back into the shelter by the family he thought would commit to him forever. Now he is alone again, trying to sort it all out, and hoping that a new family will see what a special boy he is, and that acclimating takes time! If you are an experienced foster or adopter in an adult only home who can give Spartagus the stability, structure and calm, quiet adult only home in which he would flourish, please message our page or email us at [email protected] for assistance. He’s neutered and ready to go! SPARTAGUS, ID# 56631, 7 Yrs. Old, 77.6 lbs. Neutered Male Brooklyn ACC, Large Mixed Breed, Black Surrender Reason: Return, 3/21/2019 Shelter Assessment Rating: New Hope Rescue Only Medical Behavior Rating: 5. red AT RISK MEMO: Spartagus was release for placement with a rescue partner only due to his bite history. due to this and his behavior displayed in the care center Spartagus was placed at risk. Spartagus is otherwise healthy. INTAKE NOTES – DATE OF INTAKE, 3/21/2019: Upon intake Spartagus was calm and relaxed. He ate treats and was tolerate when putting collar around his neck. He scanned negative for a microchip and allowed all handling. OWNER SURRENDER NOTES – BASIC INFORMATION: Spartagus is a 7 year old altered male large mix breed. He was adopted from ACC on 3/12/19. He appears healthy and doesn't have any health concerns. Spartagus was returned due to concerning behavior in the home. He previously lived with 4 adults and 4 kids. Spartagus has been friendly and outgoing towards strangers and people who visit the household. Spartagus has been around children in the household ages 7-16 years old. Owner stated he is usually tolerant. Behavior is unknown towards dogs. Behavior is unknown towards cats. Owner stated Spartagus isn't bothered if you touch his food while eating but is unknown about his toys or treats. Spartagus did bite a family member on the hand last Tuesday when he was told to lay down in his bed. When he bit he released and walked away. Spartagus is housetrained. He has a medium energy level. Other Notes:: Spartagus barks and growl when being restrained. He wasn't given a bath but likes being brushed. He isn't bothered when unfamiliar come come house or family member. He has never had medical concerns. For a New Family to Know: Spartagus is trained to used the bathroom and goes on slow walks and pulls lightly. He eats Pedigree wet and dry food twice a day. he likes to sleep in the living room and follow owner around the house. He knows cues such as sit, come, stay and give paw. He is well behaved when home alone and never been crate trained. Owner stated Spartagus is friendly, affectionate and excitable. SHELTER ASSESSMENT SUMMARIES - Date of assessment:: 3/9/2019 LEASH WALKING Strength and pulling: No pulling Reactivity to humans: None Reactivity to dogs: None Leash walking comments: SOCIABILITY Loose in room (15-20 seconds): Drooling, wandering around, solicits attention, social Call over: Approaches readily Sociability comments: HANDLING Soft handling: Neutral body, leans in, accepts contact, ears back Exuberant handling: Neutral/Somewhat tense body, leans in, accepts contact, ears back Handling comments: AROUSAL Jog: Follows handler loosely Arousal comments: Knock Knock Comments: Approaches, soft and loose Toy Toy comments: Grips and relinquishes PLAYGROUP NOTES – DOG TO DOG SUMMARIES: According to Spartagus's previous adopter, he has not interacted with other dogs previously so his past behavior around other dogs is unknown. 3/21: Due to Spartagus's DOH status, a muzzle was placed on him. He is introduced to a novel female dog. When greeting the female dog, he becomes sexually motivated - he has a high flagging tail, heightens his stance, stands on his tiptoes, and whines. His leash is held due to the female's inexperience. Once in the pen, Spartagus looms over the female and places his chin over her back in an attempt to mount her. He is slow to listen to handler interruptions and is then separated from her. 3/26: Spartagus's behavior remains the same. INTAKE BEHAVIOR - Date of intake:: 3/8/2019 Summary:: Friendly and solicited attention, allowed all handling MEDICAL BEHAVIOR - Date of initial:: 3/9/2019 Summary:: Very friendly, affectionate, snapped once during blood draw ENERGY LEVEL:: Spartagus has been observed to exhibit a medium level of energy during his interactions in the care center. IN SHELTER OBSERVATIONS:: 3/9/19: Upon approaching Spartagus' kennel, he was at the front of his kennel with a loose and soft body. I presented treats which he initially took with a very soft mouth. During a second presentation of the treats, Spartagus displayed resource guarding by growling and snapping at the treats. He quickly recovered and after a few moments readily took an HVT through the kennel door with a soft mouth. 3/23/19: During his session out in the pens, handler went to pick up toy near Spartagus while he played with a different toy. Spartagus noticed and quickly came to nudge handlers hand away. BEHAVIOR DETERMINATION:: New Hope Only Behavior Asilomar: TM - Treatable-Manageable Recommendations:: No children (under 13),Place with a New Hope partner Recommendations comments:: No children: Due to Sparatagus' known behavior concerns combined with his bite history and reports of lunging at a child, we feel he would be best set up to succeed in an adult only home environment. Place with a New Hope partner: Due to Spartagus' bite incident which occurred in his previous home environment, we feel he would be best set up to succeed if placed with an experienced rescue partner. We recommend allowing Spartagus to interact and decompress at his own pace. Force-free, reward based training only is advised when introducing or exposing him to new and unfamiliar situations. Potential challenges: : Resource guarding,Handling/touch sensitivity,Fearful/potential for defensive aggression,Bite history (human) Potential challenges comments:: Handling/touch sensitivity: Spartagus has been observed to display some handling sensitivity during an interactions in the care center. He was observed to snap once when being handled during his medical exam. It did not escalate and it has not been observed since. Please refer to the handout on Handling/sensitivity behavior. Resource guarding: Spartagus has been observed to display some resource guarding while in his kennel in the care center. He was observed to growl and snap over the treats that were presented on his kennel floor. He quickly recovered and afterward was able to readily receive an HVT through the kennel door with a soft mouth. Please refer to the handout on Resource guarding. Fearful/potential for defensive aggression: Spartagus was observed to lunge at a child in his previous home environment as well as biting his previous owner, please see handout on Fearful/potential for defensive aggression. MEDICAL EXAM NOTES 9/03/2019 [DVM Intake] DVM Intake Exam Estimated age: 7 years Microchip noted on Intake? No Microchip Number (If Applicable): History : O/S Subjective: BARH. No csvd Observed Behavior - Very friendly and affectionate, but becomes reactive when medical procedures done, ie turned around and snapped (blood draw, MC implantation) Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective P = wnl R = wnl BCS 4/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: mild to moderate dental tartar PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: intact male with two descended testicles, no discharge MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: normal externally Assessment Underweight Prognosis: good Plan: If continues to be underweight, recommend full workup SURGERY: Okay for surgery 12/03/2019 PreOp Exam Hx: Diagnosed underweight SO: BARH, NPO for surgery, unremarkable eliminations BCS 4/9 EENT: eyes clear, ears clean, no cough, sneeze or discharge noted on exam Oral: unremarkable adult dentition H/L: Eupneic, no irregular beats, normal heart and lung sounds MSI and Abd palp unremarkable Male intact 2 testicles soft and symmetric A: apparently healthy - no longer underweight P: Ok to elective surgery 12/03/2019 Dog Neuter Was this dog a cryptorchid? No, 2 testicles palpated If so describe - Pre scrotal Incision Spermatic Cord Ligation with: 0PDS in 2 millers knots Sub Q closure: Subcutaneous to intradermal closure with 0PDS Skin closure? Yes A linear green tattoo was placed in the incision site 21/03/2019 [DVM Intake] DVM Intake Exam Estimated age: 7 years Microchip noted on Intake? Yes Microchip Number (If Applicable): 985113002500370 History : Return, DOH-B. Subjective: BARH. No csvd Observed Behavior - Very unpredictable. Initially ok, but trying to do any medical task will quickly escalate him to lunging and snarling. Since his full exam was recent, a visual only exam was performed. Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective P = wnl R = wnl BCS 5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: not performed H/L: eupnic ABD: Non painful, no masses palpated U/G: MN, no discharge MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment apparently healthy Prognosis: good Plan: no tx needed *** TO FOSTER OR ADOPT *** SPARTAGUS IS RATED NEW HOPE RESCUE ONLY. You must fill out applications with New Hope Rescues to foster or adopt him. He cannot be reserved online at the ACC ARL, nor can he be direct adopted at the shelter. PLEASE HURRY AND MESSAGE OUR PAGE FOR ASSISTANCE! HOW TO RESERVE A “TO BE KILLED” DOG ONLINE (only for those who can get to the shelter IN PERSON to complete the adoption process, and only for the dogs on the list NOT marked New Hope Rescue Only). Follow our Step by Step directions below! *PLEASE NOTE – YOU MUST USE A PC OR TABLET – PHONE RESERVES WILL NOT WORK! ** STEP 1: CLICK ON THIS RESERVE LINK: https://newhope.shelterbuddy.com/Animal/List Step 2: Go to the red menu button on the top right corner, click register and fill in your info. Step 3: Go to your email and verify account \ Step 4: Go back to the website, click the menu button and view available dogs Step 5: Scroll to the animal you are interested and click reserve STEP 6 ( MOST IMPORTANT STEP ): GO TO THE MENU AGAIN AND VIEW YOUR CART. THE ANIMAL SHOULD NOW BE IN YOUR CART! Step 7: Fill in your credit card info and complete transaction HOW TO FOSTER OR ADOPT IF YOU *CANNOT* GET TO THE SHELTER IN PERSON, OR IF THE DOG IS NEW HOPE RESCUE ONLY! You must live within 3 – 4 hours of NY, NJ, PA, CT, RI, DE, MD, MA, NH, VT, ME or Norther VA. Please PM our page for assistance. You will need to fill out applications with a New Hope Rescue Partner to foster or adopt a dog on the To Be Killed list, including those labelled Rescue Only. Hurry please, time is short, and the Rescues need time to process the applications. Shelter contact information Phone number (212) 788-4000 Email [email protected] Shelter Addresses: Brooklyn Shelter: 2336 Linden Boulevard Brooklyn, NY 11208 Manhattan Shelter: 326 East 110 St. New York, NY 10029 Staten Island Shelter: 3139 Veterans Road West Staten Island, NY 10309 *** NEW NYC ACC RATING SYSTEM *** Level 1 Dogs with Level 1 determinations are suitable for the majority of homes. These dogs are not displaying concerning behaviors in shelter, and the owner surrender profile (where available) is positive. Some dogs with Level 1 determinations may still have potential challenges, but these are challenges that the behavior team believe can be handled by the majority of adopters. The potential challenges could include no young children, prefers to be the only dog, no dog parks, no cats, kennel presence, basic manners, low level fear and mild anxiety. Level 2 Dogs with Level 2 determinations will be suitable for adopters with some previous dog experience. They will have displayed behavior in the shelter (or have owner reported behavior) that requires some training, or is simply not suitable for an adopter with minimal experience. Dogs with a Level 2 determination may have multiple potential challenges and these may be presenting at differing levels of intensity, so careful consideration of the behavior notes will be required for counselling. Potential challenges at Level 2 include no young children, single pet home, resource guarding, on-leash reactivity, mouthiness, fear with potential for escalation, impulse control/arousal, anxiety and separation anxiety. Level 3 Dogs with Level 3 determinations will need to go to homes with experienced adopters, and the ACC strongly suggest that the adopter have prior experience with the challenges described and/or an understanding of the challenge and how to manage it safely in a home environment. In many cases, a trainer will be needed to manage and work on the behaviors safely in a home environment. It is likely that every dog with a Level 3 determination will have a behavior modification or training plan available to them from the behavior department that will go home with the adopters and be made available to the New Hope Partners for their fosters and adopters. Some of the challenges seen at Level 3 are also seen at Level 1 and Level 2, but when seen alongside a Level 3 determination can be assumed to be more severe. The potential challenges for Level 3 determinations include adult only home (no children under the age of 13), single pet home, resource guarding, on-leash reactivity with potential for redirection, mouthiness with pressure, potential escalation to threatening behavior, impulse control, arousal, anxiety, separation anxiety, bite history (human), bite history (dog) and bite history (other). New Hope Rescue Only Dog is not publicly adoptable. Prospective fosters or adopters need to fill out applications with New Hope Partner Rescues to save this dog.

#funny #lol #humor #memes #meme #memehumor #dank memes #funny pics #rolf #lmao #Being Alone #Andrew B

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stateofcoloradojobs · 5 years ago

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Registered Nurse RN-PACU/Pre-Op

Registered Nurse RN-PACU/Pre-Op in Fort Collins, Colorado | Careers at Banner Health

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Registered Nurse RN-PACU/Pre-Op

Job Number266661FacilityBanner Ft Collins Medical CtrDepartmentSurg-HospAddress : Street4700 Lady Moon DrAddress : LocationUS-CO-Fort CollinsWork ScheduleDayPosition TypeFT: Full-TimePosting CategoryNursing – Surgery

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When our patients need surgery, our outstanding surgery services team steps in to help ensure excellent outcomes and maintain a positive patient experience. Surgery nurses play a huge role in the care of our patients, and we’re proud of the work they do. If you want to make a difference in people’s lives – and your own – you could find the opportunity you’ve been waiting for.

Banner Fort Collins Medical Center is looking for a Preop/PACU RN to join our team. The Registered Nurse Intraoperative candidate will have previous experience as a OR circulator.

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

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About Banner Ft. Collins Medical Center Banner Fort Collins Medical Center is built on a 28-acre campus located at Harmony Road and Lady Moon Drive and is the third Banner Health facility in the Front Range. The state-of-the-art, two story facility features a 24-bed inpatient unit, emergency department, lab services, labor and delivery rooms, medical imaging, surgical services and women’s services. The campus includes an outpatient clinic and medical office building.

About Banner Health Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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Job Summary

This position assesses, plans, implements, evaluates and documents nursing care of patients in accordance with organizational policies and in accordance with standards of professional nursing practice utilizing the framework for professional nursing practice and development. This position is accountable for the quality of nursing services delivered by self or others who are under their direction. This position utilizes specialized knowledge, judgment, and nursing skills necessary to assess data and plan, provide and evaluate care appropriate to the physical and developmental age of assigned patients.

Essential Functions

Assesses patient physical, psychological, social, spiritual, educational, developmental, cultural and discharge planning needs. Reviews patient history and physical with patient/family and assures completion within appropriate timeframe. Reviews available information obtained by other health care team members. Reviews diagnostics and laboratory data and reports abnormal results to the physician(s) and other appropriate caregivers. Completes assessment and reassessments according to patient need and as outlined in policy.

Formulates a plan of care, including the discharge plan, utilizing assessment data and patient, family and health team input. Initiates a plan of care based on patient-specific needs, assessment data and the medical plan of care. Goals for patient are realistic, measurable and developed in conjunction with the patient/family. Considers the physical, cultural, psychosocial, spiritual, age specific and educational needs of the patient in the plan of are. Plans care in collaboration with members of the multidisciplinary team. Reviews and revises the plan of care to reflect changing patient needs based on evaluation of the patients status.

Implements the plan of care through direct patient care, coordination, delegation and supervision of the activities of the health care team. Provides care based on physician orders and the nursing plan of care, in compliance with policies and procedures, standards of care, and regulatory agency requirements. Delegates appropriately, and provides nursing supervision in the provision of care to patients by other licensed nurses and other personnel. Promotes continuity of care by accurately and completely communicating to other caregivers the status of patients for whom care is provided.

Evaluates the patient’s and family’s response to care and teaching, and revises the plan of care as needed. Evaluates patient progress towards goals and expected outcomes in collaboration with other health care team members. Evaluates patient’s response and the effectiveness of patient teaching.

Documents assessment, planning, implementation and evaluation in the patient record. Documentation is legible, timely and in accordance with policy. Documentation reflects objective/subjective data, nursing interventions and patients response to treatment. Notes physician orders accurately and in a timely manner.

Provides care based on the best evidence available and may participate in research activities within clinical practice. Participates in unit or facility shared leadership. Interacts and participates in the education, role development, and orientation of facility personnel, patients, students, families and visitors. Promotes/supports growth of others through precepting and mentoring when appropriate.

Contributes to society through activities that lead to excellent patient outcomes through timely, effective, efficient, equitable, and safe care. Actively participates in the improvement of national nursing quality indicators and outcomes. Such activities may include participating in professional organizations.

In some roles, this position may supervise staff and work flow of the department.

Minimum Qualifications

Must possess a current, valid RN license in state of practice, temporary/interim RN license in state of practice, or compact RN licensure for current state of practice. BLS certification is required. Additional certification or continuing education may be required based on area of practice.

Relates throughout the interview process the experience, training and education needed to perform the job. Experience in the clinical area for which he or she is applying is desired. Must maintain clinical performance competencies appropriate to the area in which they work as demonstrated through annual validations. Banner Registry and Travel acute care positions require a minimum of one year experience in an acute care hospital setting. Experience must include working in an acute care setting within the past 12 months as a Registered Nurse in the specialty area. Banner Registry and Travel physician practice positions require a minimum of one year experience as a Registered Nurse in a physician practice or an acute care setting.

Preferred Qualifications

Bachelors degree preferred.Professional certification preferred.

Additional related education and/or experience preferred.

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daniablub · 6 years ago

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Machine-Learning Algorithm Outperforms Clinician Judgment for Preop Risk Assessment

MySurgeryRisk, a new machine-learning algorithm that integrates existing electronic health record (EHR) data, outperforms clinician judgment for preoperative assessment of the risk for postoperative complications, researchers report. Reuters Health Information from Medscape Medical News Headlines https://ift.tt/2IUGLI5 via IFTTT

#IFTTT #Medscape Medical News Headlines

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jeromechill1 · 7 years ago

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The Effect of Prehabilitation Exercise on Strength and Functioning after Total Knee Arthroplasty in Patients with Osteoarthritis

This blog is a critical appraisal of the following randomized controlled trial: The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty

Background

Total Knee Arthroplasty (TKA), known as a total knee replacement, are widely performed and very common throughout the globe. In the UK alone there are around 70,000 TKA’s performed each year. Some of these TKA’s are due to inflammatory diseases but most commonly performed for Osteoarthritis (Arthritis Research UK, 2017). Given the popularity of this procedure there is a lack of evidence on pre-habilitation and if there are any benefits of such a program. (McKay, 2017)

The Study

The study was a randomized controlled trial (RCT) in which 54 community-dwelling patients, all scheduled for a unilateral TKA, were recruited from a single orthopaedic office. All patients were above 50 years old and were screened for exclusion criteria for engaging in moderate intensity exercise. The aim of the study was to determine the effects of prehabilitation training on strength and functioning post TKA.

The 54 participants were randomly allocated, 28 to the prehab group and 26 to the control group. The prehab group were asked to participate in at least 3 prehab sessions per week, one under the guidance of research personnel and the other two at home. The prehab group were taught how to conduct each intervention session focusing on resistance, flexibility and step training. This intervention consisted of a 5-minute warm up followed by 9 various lower limb resistance exercises then by a series of various step up exercises and was concluded with stretching and a 5-minute walk.

An outcome measure looking at knee pain using a visual analogue scale (VAS), functional ability, quadriceps strength and strength asymmetry where measured at baseline, 1 week pre and 1 and 3 months post-surgery. The participants where all asked to perform walking distance in 6 minutes, transferring from bed to sitting, negotiating stairs and going from sitting to standing (STS) as many times as they could in 30 seconds.

Results

One week pre surgery the prehab group had significantly increased their STS task whilst the control reported no change in performance and increased pain. At 1 month post-surgery the prehab group still only maintained improved performance in STS tasks whilst the control group had a decrease in 6 minute walking, pain and surgical leg strength and had increased strength asymmetry and non-surgical leg strength. Finally at 3 months post-surgery, the prehab group increased on 3 of the 4 functional tasks, decreased pain and increased strength in both legs whilst the control improved on 2 of the 4 functional tasks, decreased pain but exhibited greater leg length asymmetry.

Pros and Cons

In order to appropriately evaluate the research, understanding-health-research.org will be used as a guideline. Firstly looking at the sample size, there are positive and negatives. The researchers clearly justified the sample size and the recruitment process was to minimise the potential effects of varying surgical techniques and the pre/post-surgical staff and care protocols. However, as mentioned in the study this limits external validity and decreases clinical significance.

The study is a RCT but there is no mention of how the patients were randomly assigned which offers no information to support attempts to eliminate bias. In order to increase internal validity the study mentions that the care staff and health professionals were blinded but again no mention of how this was performed or ensured. The patients themselves were not blinded which possibly means positive expectations of the prehab group may have encouraged participants in the control group to carry out their own exercise (Lewis, 2017).

Throughout the study there was no mention or monitoring of pain medication or how pain was measured, specifically sub-group analysis for male and female participants. This is particularly relevant as pain is said to be more intense in females than males. (Stanford medicine, 2012). Due to possible complications, patient’s pain medication is temporarily stopped before surgery which may have affected the results of the prehab intervention.

One major confounding factor that was noticed during the study was there was no set amount of prehab exercise sessions, these varied from 4 – 23 sessions with only one per week under supervision. Inconsistencies between the prehab training and measuring of functional ability may have affected the results by the change in open/closed chain movements, squat exercises being closed whilst the assessment of quadriceps strength being open chain.

The most significant finding was the improvement of STS in the prehab group. Although this could be down to the similarities the functional task has to the squat exercise done throughout the pre-rehabilitation. This can be supported by the theory of specificity training (LIVESTRONG.COM, 2018).

Conclusion

The study itself supports its original hypothesis but due to several limitations it is unable to have any real clinical significance. Participants not being blinded, number/intensity of prehab sessions, unmonitored consumption of pain medication and the sample size all need to be considered in further studies, along with a longer period of time in order to determine any significant effects and if it is applicable to the wider population.

References

Arthritis Research UK (2017) Knee replacement surgery. [online] Available at: https://www.arthritisresearchuk.org/arthritis-information/surgery/knee-replacement.aspx [Accessed 13 Dec. 2017].

Lewis S, Warlow CP (2017) How to spot bias and other potential problems in randomised controlled trials. [online] BMJ. Available at: http://jnnp.bmj.com/content/75/2/181 [Accessed 13 Dec. 2017].

LIVESTRONG.COM (2018). What Is Specificity in Exercise? [online] Available at: https://www.livestrong.com/article/548564-what-is-specificity-in-exercise/ [Accessed 3 Jan. 2018].

McKay, C. (2017) Prehabilitation for TKA: Preop and postop benefits. [online] Lower Extremity Review Magazine. Available at: http://lermagazine.com/article/prehabilitation-for-tka-preop-and-postop-benefits [Accessed 13 Dec. 2017].

STANFORD MEDICINE.,( 2012) Women report feeling Pain more Intensely than Men, says study of electronic records [online]. [Viewed 05 January 2018]. Available from: https://med.stanford.edu/news/all-news/2012/01/women-report-feeling-pain-more-intensely-than-men-says-study-of-electronic-records.html

Topp R, Swank AM, Quesada PM, Nyland J, Malkani A (2009). The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty [online] PM R. August;1(8):729-35. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19695525

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jj-lynn21 · 5 years ago

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Doctor Istvan Günther intern at large

@lokis-favorite-follower

Day June 3rd prompt: "What a hunk" word count: 2,833 Fandom: Bill Skarsgard character: Self-insertion

warnings: This is mostly just fluff and a dash of angst.

Bill sits in the administration office waiting area with his business manager, Jake Glassgo. The secretary attempts to hold her cellphone to take a picture to send to her friends. Jake notices.

He leans in hiding Bill’s face with his hand, “You want me to take her phone?”

Bill sighs, “I’ll try to ask nicely, first.”

She nods excitedly.

“What’s your name?” He reached for her phone and she gave it up willingly while getting lost in his emerald gaze.

“Pam Pitson,” She smiled. At least she thought she smiled.

She was blushing so enamored of him she would agree with anything. She manages to get out a, “k”

The intercom fuzzes with static before the manager asked, “Ms. Pitson, I am ready to see Mr. Skarsgard and Mr. Glassgo now.”

Pam answered, “I’ll send them right back Mr. Garrett.”

Bill nods as he finishes signing papers, “they will treat me like the rest?”

“Understandable,” Bill thinks for a moment. “what about those getting ready for surgery. Doctors visiting right before surgery would wear a mask and in recovery wear masks?”

“Of course,” Bill agreed, “I would never want to put anyone in danger. Learning what to do in those situations would be helpful.”

They all shook hands and Bill parted ways with his manager to start right away. Mr. Garett took Bill to the Doctors' locker room to get a white coat and Stethoscope. Then he took him to a new class of interns that was due to start in minutes. Most of them were seated.

"This is Doctor Istvan Günther," He used Bill's middle names for slight anonymity. "He is joining you all in this learning process. I expect the best from you all. "Doctor Günther, take a seat. Good luck. Feel free to come to me with any questions."

Bill sat in the back. Doctor Marker, the head of surgery was also the head of the internship program. Today's lecture was on viral pathogen control inside the hospital. Bill took notes on the lecture and also on how the students around him were acting.

After the lecture, Doctor Marker separated the class into small groups to work in different departments with the head Doctors in those departments. "Doctor's Standard, Henshire, Staplton, and Günther follow me. This week we will be assessing patients before and after their surgeries. You will be viewing a tonsillectomy, heart catheterization and coronary artery bypass this week." Doctor Marker walked quickly.

"Doctor's I would appreciate, professionalism, " Bill told the gigglers.

"I'd appreciate working with all professionals," Doctor Henshire murmured.

"Sorry Doctor Günther," I'm Breanna or Doctor Standard if you will. The rude mumbler is Doctor Henshire. He is just a little cranky baby to everyone so don't take anything he says personally."

"I'm Doctor Jason Staplton," He smiles. "It is a pleasure to have you work with us. I think what you are doing to get more realism into your work is great."

"Yeah," Doctor Standard looked up to him with big blue doe eyes. "Any questions you have, we have no problem trying to answer. Anything, at all."

Bill smiled nervously, "Thank, I appreciate that."

They get to the door of the first patient. Masks and gloves are outside the door. Doctor Marker put his mask and gloves on and the others follow suit.

"This patient, female 25 years old presented with pain on the right side of the throat, difficulty swallowing, A hoarse voice, fever, swollen lymph nodes, yellow coating on the tonsils, and a severe recurring sore throat over the last year. Who would like to tell me why she is here?"

Doctor Staplton jumped on the question first. "She needs her tonsils taken out."

Doctor Mark nodded, "Correct Doctor Staplton. We will go in and each access here one last time before her surgery. Then you will watch me in the observation room. She was just medicated for surgery minutes ago. How should we proceed when we walk in her room? "

"We should inform her on the dangers of the surgery before checking her vitals," Doctor Henshire said smugly.

"No Doctor Henshire," Doctor Marker glared at him. "The patient is told of the dangers and all possible outcomes in the initial consultation. We need to make sure she is relaxed and in good spirits before going to surgery. Talk kindly to her. Ask her if she has any questions. Answer her calmly."

Everyone walked into the room.

The patient was smiling. Her eyes were glossy from the medication. "Hey there Doctor sexy eyes." She giggles looking at Bill. "Those eyes belong to Bill Skarsgard. What a Hunk." She giggles again.

Bill chuckles nervously.

Doctor Marker picked up her chart on the end of the bed. "How are you feeling Miss Johnston?"

"Dandy as candy," She smiled. Her eyes were a little droopy.

"We are going to listen to your heart and check your lymph nodes before you go down to surgery Miss Johnston." Doctor Marker flipped through her chart. "Looks like blood pressure and blood work are good. These interns are Doctor Standard, Doctor Henshire, Doctor Staplton, and Doctor Günther."

As they were taking her vitals the transporter came in with the gurney. They all walked to the operating room.

Miss Johnston looks up at Bill. His hand on the rail walking along side. She reached for his hand. "Will, you be there when I wake?"

"Bill takes her hand," His eyes light up with a smile. "Yeah, I promise I'll be there."

He was not sure if that was an appropriate response from a Doctor. He made a mental note to ask later.

"Thank, Bill," she murmured before they wheeled her into the operating room.

Bill followed the other interns up some stairs, "Was it alright for me to hold the patients hand and reassure her like I did?" He threw the question out for any of the others to answer.

"No," Doctor Henshire chastised instantly.

Doctor Standard glared at Doctor Henshire, "To elaborate on Doctor Henshire’s comment, it is not something most Doctors do. Sometimes a family member will walk with the patient holding their hand before they get to the operating room. It is fine to comfort a patient before surgery and I think you helped her be in good spirits which is important for a Doctor to do, in my opinion."

" I think holding a patient's hand is fine if it makes them trust you better, Doctor Staplton chimed in, "You just have to watch you don't get to emotional invested in the patients. If you do that, this place will rip you to pieces emotionally."

"Yeah," Bill nodded, "My brother offered me that advise also. He is a Doctor in Sweden. I tagged along with him last week but I really wanted to see things inside of a hospital in the States for the character I will be playing next."

They sit in an enclosed glass room over looking the operating room. Doctor Marker explains everything he is doing step by step. He wants his students to be ready to join him in the operating room and eventually perform the procedure by themselves. Bill's eyes are big and interested as he watches and takes notes. He also takes notes on how the others are reacting to watching.

Bill is standing at Miss Johnston's bedside when her eyes flutter open, "Don't try to speak Miss Johnston. If you can keep the secret you know who I am I will bring you something special when you feel better tomorrow." He winks.

The interns followed Doctor Marker for ten hours checking in on patients. Also learning about the paper work that must be done. "It is an important part of the job," he told them. Other than stopping in the cafeteria for 15 minutes to grab a coffee and a snack on the run they had no real break. But finally the exhausting day came to an end.

"Hey Doctor Günther, we are going for a drink at Cleats," Doctor Staplton looked to Bill as they hung up their white coats in the locker room. "You want join us?"

"Thanks man, um Doctor Staplton," Bill said politely. "I have some more work to do tonight. Then getting some rest." Bill wanted to make sense of his notes while they were fresher in his mind so he could make character suggests in the script to show the director next Monday.

"We will see you tomorrow at 4am then," Doctor Staplton walked out with Bill.

"Sure thing," Bill said excitedly. Most of them seemed to be cool with him being there. "I'm looking forward to learning more."

The next morning as he got to the last light before pulling into the Doctor's parking lot in his rented black kia telluride with tinted windows he saw the vultures. Media trucks, reporters and camera people covered the entrance to the hospital. Bill shook his head as he pulled into the parking lot.

When he parked he took his phone out to call his manager, "I had one good day before they all found out. Any patient or visitor could have informed them. Can you be here within a half an hour. Bring some signed posters of my characters. I have a fan I want to visit before leaving today. And bring Mr. Mike."

His manager and bodyguard, Mr. Mike, got there within twenty-five minute. They all went to the administration office to have another chat with Mr. Garrett.

"I'm sorry about all that craziness out there, " Mr. Garrett apologized.

"I don't think it was your people Mr. Garrett," Bill shook his head. "Everyone was pretty cool yesterday. I'm sorry they are in the way out there. Why don't you go out to give a statement that I was here yesterday researching a new role. I'm going to visit a patient I met yesterday before I leave through the back. I'm really sorry about the media barrage."

"I'm sure they will leave once I tell them you are not here," He shakes Bill's hand.

"Pam you may share that picture tonight after work as long as say I was only here one day," Bill smiles kindly.

Pam got excited, "Of course Mr. Skarsgard."

Bill's manager and bodyguard follow him to the lockers. Bill gets the coat and stethoscope in his assigned locker. He grabs a mask from the secretary at the closest desk. They get on the elevator to head to the eighth floor where Miss Johnston was taken after her recover time.

Bill walked in her room. His manage walks in with him holding a bag of posters and things signed. Mr. Mike, stands at the door.

"How is my first ever patient today?" His sparkling green eyes smile at her.

She drops her spoon in her oatmeal mid-bite, "Doctor um Günther." She turns beat red. "I was sure I hallucinated I saw you. I, are you..."

He took his mask off, "You weren't that out of it Miss Johnston."

She was so surprised, "call me Jen, um Bill?"

He chuckled, "Yeah, you can call me Bill. You didn't tell anyone you thought you saw me, did you Jen."

"No, I really thought I dreamed it. "She laughed.

"Good," he smiled as he sat on the edge of her bed. "Who's your favorite character I've played?"

"Oh I love a lot of them for different reason and some of them really just need more love to help them..."

He sat just listening to her paddle on for a moment.

"But Mickey is the best," She giggled. "Such a lovable little small time criminal. He deserved better. I cried to hard at the end of that movie. But I have also already pre-cried for..."

"Okay, No spoilers." He fake pouts like Mickey. "I don't know if I know how my projects based on books ended yet. Sorry I made you cry so much."

"It is like you are killing me with these tv shows and movies and I love it," She giggled more.

"Well, I have a few things for you before I go." Bill grinned. Mr. Glassgo hand me the Mickey things."

His manager hand him a two rolled up posters and a funko pop of Mickey from Villains.

Jen unrolls a poster and stares at it. Then stares at Bill and stares back at the poster.

"Pretty silly, right?" Bill chuckles. "Its a one of a kind poster. The back is signed. The other one is just the original poster from the movie Villains."

She unrolled it, "Thanks, Bill. I really appreciate you stopping by and all these things. But especially just holding my hand before I went into surgery."

"You are welcome Jen," He gets up. "I have to go. You know what Mr. Glassgo?"

"What Bill?" his manager answers.

"Just give her the whole bag of stuff you brought." Bill grabbed the bag and tossed it to her before leaving.

Jen squealed as she reached for it. Posters and funko pops for everything he has ever been in and a few posters for movies not yet out.

By 8pm Pam sends the picture of her and Bill to all her social media with the hashtag #whatahunk

#bill skarsgard #Istvan Günther intern #Doctor #bill istvan günther skarsgård #june2020writingchallenge #fluff #angst

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phoenixjobs8 · 3 years ago

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Registered Nurse (Float)

Under the direction of a Nurse Manager, the Internal Resource Pool Registered Nurse floats between at least two departments within two different service lines providing professional skilled age specific nursing care for patients in collaboration with the physician and other disciplines.

Performs all aspects of patient care, including but not limited to: patient assessment, medication administration; identifying nursing problems; plans of care; provides or delegates care according to Valleywise Health policies; functions as a client advocate and educator; completes and processes all required documentation; indirectly supervises ancillary personnel as directed; and participates in team building and quality improvement activities.

The position demonstrates the professional skills and behaviors to promote comprehensive, cost effective, and meaningful healthcare for consumers in a diverse healthcare environment.

Qualifications: Education: * Prefer a Bachelor’s degree or higher in Nursing.

Experience: * Must have at least two (2) years of acute care RN experience that demonstrates an understanding of the required knowledge, skills and abilities.

Specialized Training: * None Certification/Licensure: * Must possess a current, valid AZ RN license; temporary AZ RN license; or valid compact RN licensure for current state of practice.

Must also be in good standing with the issuing Board of Nursing.* Requires BLS.

A BLS card obtained through an approved American Heart Association (AHA) training center is preferred and will be required within 3 months.* Additional certification(s) as listed below will be required to float to departments:* APCU – Must have ACLS upon hire.* Antepartum Testing Center – Advanced Fetal Monitoring Certification* Burn – Must obtain ACLS and PALS certification within 12 months* Burn Med Surg-Must have ACLS upon hire.* Critical Care – Must obtain ACLS certification within 6 months* ED – Must obtain ACLS and PALS certification within 6 months; and ATNC or TNCC certification must be obtained within 12 months* Family Health Centers (FHC) – ACLS, NRP, PALS, Chemo-certified, triage certification, CCRN and/or RNC certifications are strongly preferred.* L&D – ACLS & NRP must be completed within 6 months.

If less than 2 years of RN L&D experience the candidate must complete AWHONN Intermediate Fetal Monitoring class within 6 months and AWHONN Advanced Fetal Monitoring class within 2 years.

If greater than 2 years of RN L&D experience will need to complete AWHONN advanced fetal monitoring within 1 year.

Advanced Fetal Monitoring must be maintained every 2 years through an approved course.* Medical Imaging – ACLS required and PALS must be obtained within 6 months* NICU – NRP required within 6 months* Nursing Float – Must have ACLS upon hire.* Nursing IRP – Must have ACLS upon hire* OR – CNOR certification is preferred* PACU – Must obtain ACLS & PALS within 6 months; and TNCC must be obtained within 12 months* Peds – PALS certification is required within 6 months* Peds ED – PALS, ACLS, & ENPC must be obtained within 6 months; and TNCC or ATCN must be obtained within 12 months* Post Partum – NRP is required within 6 month of hire; Intermediate Fetal Monitoring is preferred; ACLS and/or PALS may be required depending on area of specialty* PreOp – ACLS or PALS required* SICU – ACLS, NRP, PALS, ATN, TNCC or other certifications may be required * Ambulatory Clinics/Desert Vista – Unit 2 Adolescent: Must have a valid fingerprint clearance card issued by the Arizona Department of Public Safety OR submit a completed Affidavit at time of hire.

Must complete fingerprint clearance card application within seven (7) days of hire date.

Must present actual card within 90 days of applying for fingerprint clearance card.

Knowledge, Skills & Abilities: * Must be able to meet the conditions as stated in the employment agreement.* Must be able to float to at least two (2) departments within two (2) different service lines for which approved competencies must be demonstrated.* Ability to work with culturally diverse people is a must.* Must have excellent communication, time management and customer service skills.* Requires basic computer word processing skills (e.g.

formatting, editing, printing, composing email, internet searches, etc.) to be able to successfully navigate through an electronic medical record using a computer.* Requires the ability to read, write and speak effectively in English.

Bilingual is preferred.

Location: Valleywise Health System · Ambulatory Float PoolSchedule: Per Diem 16 Hour Per Week, Days

The post Registered Nurse (Float) first appeared on Valley of the Sun Jobs. source https://valleyofthesunjobs.com/healthcare/registered-nurse-float-00e960/?utm_source=rss&utm_medium=rss&utm_campaign=registered-nurse-float-00e960

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bloojayoolie · 6 years ago

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Being Alone, Cats, and Children: SENIOR ANGEL ALERT BROOKLYN ANIMAL CARE CENTER ID# 52856 8 yrs old 77.25 lbs TO BE KILLED - 1/25/2019 The sweetest lady and the most gentle soul – Split is a cute cow printed sweetheart, who came into the shelter with her housemate Jupiter. Their owner is hospital for one year now and the family cannot longer care for them. Split is a little chunky and so cute. She enjoys to be petted, to cuddle, wags her tail the whole time, walks nicely on leash and takes her treats softly. Please share this lovely sweetheart for a loving forever home! MY VIDEO: Angel Cow <3 https://youtu.be/bl7Ydtv8gCc Split https://youtu.be/mnGEhyd6X8c SPLIT, ID# 52856, 8 yrs old, 77,25 lbs, Brooklyn Animal Care Center, Medium Mixed Breed Cross, White / Black Female, Owner Surrender Reason: Jupiter and Split were surrendered by their owner’s nephew because their owner has unfortunately been in the hospital for about a year at this point and the nephew’s unable to continue caring for them. Shelter Assessment Rating: Level 2 Recommend no dog parks Medical Behavior Rating: Blue CAME IN WITH Jupiter ID# 52854 OWNER NOTES: Basic Information: Split is a ten year old black and white female that was surrendered to the center due to the owner not having enough time to care for her. She doesn't have any known health issues and has not seen the vet recently. Previously lived with: One adult and one dog How is this dog around strangers? She is shy around strangers. How is this dog around children? She has not live with children. How is this dog around other dogs: She lived with a medium male dog. She was relaxed around him. How is this dog around cats? She didn't live with cats. Resource guarding: She is not bothered if her food is touched while eating nor if an object is taken away from her. Bite history: No bite history with a person or animal. Housetrained: Yes Energy level/descriptors: high Other Notes: She is not bothered when held/restrained nor when disturbed while resting or being bathed. She barks when someone unfamiliar approaches the house or a family member. Has this dog ever had any medical issues? No For a New Family to Know She was described as friendly, affectionate and playful. She follows people around or likes to stay in her favorite spot. She plays with balls, stuffed and chew toys. She was kept mostly indoors. She eats dry food. She is house-trained and goes potty on grass and dirt. She might destroy the furniture when left alone in the house. She listens to sit and come. She is used to playing in the yard for exercise. BEHAVIOR NOTES Upon Intake: Behavior upon intake: Split was shy at first however allowed to be collared, scanned and petted after giving her treats and food. Split scanned negative for a microchip. Means of surrender (length of time in previous home): Owner Surrender Previously lived with: 1 adult, 1 dog Behavior toward strangers: shy Behavior toward children: unknown Behavior toward dogs: relaxed with resident dog Behavior toward cats: unknown Resource guarding: none reported Bite history: no history Housetrained: Yes Energy level/descriptors: prior owner stated she had high energy DATE OF ASSESSMENT: 19-Jan-2019 Summary: Handling Assessment Leash Walking Strength and pulling:Mild pulling Reactivity to humans: none Reactivity to dogs:none Leash walking comments:walks nicely Sociability Loose in room (15-20 seconds):Moderately social, checks in with handler; solicits attention but also explores room Call over:Approaches readily Handling Soft handling:Seeks contact, leans in, rolls over, jumps up, licks muzzle Exuberant handling:Seeks contact â€“ leans in, rolls over, jumps up, licks muzzle Arousal Jog:Unresponsive, does not engage (fearful) Arousal comments: followed then stopped and appeared fearful unwilling to move. She approached once assessor knelt and spoke softly to her. Knock:No response Toy:No response PLAYGROUP NOTES – DOG TO DOG SUMMARIES: According to Split's previous owner, Split was social with the other resident dog. 1/18: When off leash at the Care Centers, Split slowly approaches the gate to greet the novel dog. She freezes then growls when the greeter is near. Due to these behaviors, the gate was not opened. ADDIOTIONAL STAFF NOTE: Jupiter and Split were surrendered by their owner’s nephew because their owner has unfortunately been in the hospital for about a year at this point and the nephew’s unable to continue caring for them. While they reportedly were social with each other in the home, they both displayed concerning behavior towards other dogs when introduced during playgroup (freezing, growling, etc) so we recommend a home with no other dogs. They don’t appear to be bonded so we believe they can be separated if necessary. Date of intake: 17-Jan-2019 Summary: shy Date of initial: 18-Jan-2019 Summary: active, allows exam ENERGY LEVEL: Split has shown a low to moderate energy level while in the care center. BEHAVIOR DETERMINATION: Level 2 Behavior Asilomar TM - Treatable-Manageable Recommendations: Recommend no dog parks Recommendations comments: Split was only socialized with resident dog in previous home. Due to her reaction in play group we recommend no dog parks at this time and that a thorough dog interaction is done if going to a home with another dog. Potential challenges: Handling/touch sensitivity Fearful Potential challenges comments: Split appears to be a bit shy and fearful at times and show some sensitivity to handling. She needs a slow approach. MEDICAL EXAM NOTES 18-Jan-2019 Bloodwork Interpretation CBC/Chem/T4- wnl 18-Jan-2019 DVM Intake Exam Estimated age: Approx 8 years Microchip noted on Intake? Negative, placed at intake History : Owner surrender Subjective: BARH, active, allows exam Evidence of Cruelty seen - none Evidence of Trauma seen - none Objective P = wnl R = wnl BCS = 7/9 EENT: Eyes clear, ears - moderate dark discharge and erythema AU, no nasal or ocular discharge noted Oral Exam: moderate tartar PLN: No enlargements noted H/L: NSR, NMA, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: Female intact, pendulous MGs MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat, but some scarring and small wounds on muzzle, pressure sores/callouses on legs CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally normal Assessment: Dental disease Otitis AU Overweight Pressure sores/callouses Prognosis: Good Plan: Ears cleaned, Claro applied AU CBC/Chem/T4 - preop bloodwork Spay, adoption Recommend weight loss and dental cleaning upon placement SURGERY: Okay for surgery * TO FOSTER OR ADOPT * HOW TO RESERVE A “TO BE KILLED” DOG ONLINE (only for those who can get to the shelter IN PERSON to complete the adoption process, and only for the dogs on the list NOT marked New Hope Rescue Only). Follow our Step by Step directions below! PLEASE NOTE – YOU MUST USE A PC OR TABLET – PHONE RESERVES WILL NOT WORK! * STEP 1: CLICK ON THIS RESERVE LINK: https://newhope.shelterbuddy.com/Animal/List Step 2: Go to the red menu button on the top right corner, click register and fill in your info. Step 3: Go to your email and verify account \ Step 4: Go back to the website, click the menu button and view available dogs Step 5: Scroll to the animal you are interested and click reserve STEP 6 ( MOST IMPORTANT STEP ): GO TO THE MENU AGAIN AND VIEW YOUR CART. THE ANIMAL SHOULD NOW BE IN YOUR CART! Step 7: Fill in your credit card info and complete transaction HOW TO FOSTER OR ADOPT IF YOU CANNOT GET TO THE SHELTER IN PERSON, OR IF THE DOG IS NEW HOPE RESCUE ONLY! You must live within 3 – 4 hours of NY, NJ, PA, CT, RI, DE, MD, MA, NH, VT, ME or Norther VA. Please PM our page for assistance. You will need to fill out applications with a New Hope Rescue Partner to foster or adopt a dog on the To Be Killed list, including those labelled Rescue Only. Hurry please, time is short, and the Rescues need time to process the applications.

#funny #lol #humor #memes #meme #memehumor #dank memes #funny pics #rolf #lmao #Being Alone #Cats #an

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bloojayoolie · 6 years ago

Photo

Being Alone, Andrew Bogut, and Cats: SENIOR ANGEL ALERT BROOKLYN ANIMAL CARE CENTER ID# 52856 8 yrs old 77.25 lbs INTAKE DATE: 01-17-2019 The sweetest lady and the most gentle soul – Split is a cute cow printed sweetheart, who came into the shelter with her housemate Jupiter. Their owner is hospital for one year now and the family cannot longer care for them. Split is a little chunky and so cute. She enjoys to be petted, to cuddle, wags her tail the whole time, walks nicely on leash and takes her treats softly. Please share this lovely sweetheart for a loving forever home! MY VIDEO: Angel Cow <3 https://youtu.be/bl7Ydtv8gCc Split https://youtu.be/mnGEhyd6X8c SPLIT, ID# 52856, 8 yrs old, 77,25 lbs, Brooklyn Animal Care Center, Medium Mixed Breed Cross, White / Black Female, Owner Surrender Reason: Jupiter and Split were surrendered by their owner’s nephew because their owner has unfortunately been in the hospital for about a year at this point and the nephew’s unable to continue caring for them. Shelter Assessment Rating: Level 2 Recommend no dog parks Medical Behavior Rating: Blue CAME IN WITH Jupiter ID# 52854 OWNER NOTES: Basic Information: Split is a ten year old black and white female that was surrendered to the center due to the owner not having enough time to care for her. She doesn't have any known health issues and has not seen the vet recently. Previously lived with: One adult and one dog How is this dog around strangers? She is shy around strangers. How is this dog around children? She has not live with children. How is this dog around other dogs: She lived with a medium male dog. She was relaxed around him. How is this dog around cats? She didn't live with cats. Resource guarding: She is not bothered if her food is touched while eating nor if an object is taken away from her. Bite history: No bite history with a person or animal. Housetrained: Yes Energy level/descriptors: high Other Notes: She is not bothered when held/restrained nor when disturbed while resting or being bathed. She barks when someone unfamiliar approaches the house or a family member. Has this dog ever had any medical issues? No For a New Family to Know She was described as friendly, affectionate and playful. She follows people around or likes to stay in her favorite spot. She plays with balls, stuffed and chew toys. She was kept mostly indoors. She eats dry food. She is house-trained and goes potty on grass and dirt. She might destroy the furniture when left alone in the house. She listens to sit and come. She is used to playing in the yard for exercise. BEHAVIOR NOTES Upon Intake: Behavior upon intake: Split was shy at first however allowed to be collared, scanned and petted after giving her treats and food. Split scanned negative for a microchip. Means of surrender (length of time in previous home): Owner Surrender Previously lived with: 1 adult, 1 dog Behavior toward strangers: shy Behavior toward children: unknown Behavior toward dogs: relaxed with resident dog Behavior toward cats: unknown Resource guarding: none reported Bite history: no history Housetrained: Yes Energy level/descriptors: prior owner stated she had high energy DATE OF ASSESSMENT: 19-Jan-2019 Summary: Handling Assessment Leash Walking Strength and pulling:Mild pulling Reactivity to humans: none Reactivity to dogs:none Leash walking comments:walks nicely Sociability Loose in room (15-20 seconds):Moderately social, checks in with handler; solicits attention but also explores room Call over:Approaches readily Handling Soft handling:Seeks contact, leans in, rolls over, jumps up, licks muzzle Exuberant handling:Seeks contact â€“ leans in, rolls over, jumps up, licks muzzle Arousal Jog:Unresponsive, does not engage (fearful) Arousal comments: followed then stopped and appeared fearful unwilling to move. She approached once assessor knelt and spoke softly to her. Knock:No response Toy:No response PLAYGROUP NOTES – DOG TO DOG SUMMARIES: According to Split's previous owner, Split was social with the other resident dog. 1/18: When off leash at the Care Centers, Split slowly approaches the gate to greet the novel dog. She freezes then growls when the greeter is near. Due to these behaviors, the gate was not opened. ADDIOTIONAL STAFF NOTE: Jupiter and Split were surrendered by their owner’s nephew because their owner has unfortunately been in the hospital for about a year at this point and the nephew’s unable to continue caring for them. While they reportedly were social with each other in the home, they both displayed concerning behavior towards other dogs when introduced during playgroup (freezing, growling, etc) so we recommend a home with no other dogs. They don’t appear to be bonded so we believe they can be separated if necessary. Date of intake: 17-Jan-2019 Summary: shy Date of initial: 18-Jan-2019 Summary: active, allows exam ENERGY LEVEL: Split has shown a low to moderate energy level while in the care center. BEHAVIOR DETERMINATION: Level 2 Behavior Asilomar TM - Treatable-Manageable Recommendations: Recommend no dog parks Recommendations comments: Split was only socialized with resident dog in previous home. Due to her reaction in play group we recommend no dog parks at this time and that a thorough dog interaction is done if going to a home with another dog. Potential challenges: Handling/touch sensitivity Fearful Potential challenges comments: Split appears to be a bit shy and fearful at times and show some sensitivity to handling. She needs a slow approach. MEDICAL EXAM NOTES 18-Jan-2019 Bloodwork Interpretation CBC/Chem/T4- wnl 18-Jan-2019 DVM Intake Exam Estimated age: Approx 8 years Microchip noted on Intake? Negative, placed at intake History : Owner surrender Subjective: BARH, active, allows exam Evidence of Cruelty seen - none Evidence of Trauma seen - none Objective P = wnl R = wnl BCS = 7/9 EENT: Eyes clear, ears - moderate dark discharge and erythema AU, no nasal or ocular discharge noted Oral Exam: moderate tartar PLN: No enlargements noted H/L: NSR, NMA, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: Female intact, pendulous MGs MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat, but some scarring and small wounds on muzzle, pressure sores/callouses on legs CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally normal Assessment: Dental disease Otitis AU Overweight Pressure sores/callouses Prognosis: Good Plan: Ears cleaned, Claro applied AU CBC/Chem/T4 - preop bloodwork Spay, adoption Recommend weight loss and dental cleaning upon placement SURGERY: Okay for surgery * TO FOSTER OR ADOPT * If you would like to adopt a NYC ACC dog, and can get to the shelter in person to complete the adoption process, you can contact the shelter directly. We have provided the Brooklyn, Staten Island and Manhattan information below. Adoption hours at these facilities is Noon – 8:00 p.m. (6:30 on weekends) If you CANNOT get to the shelter in person and you want to FOSTER OR ADOPT a NYC ACC Dog, you can PRIVATE MESSAGE our Must Love Dogs page for assistance. PLEASE NOTE: You MUST live in NY, NJ, PA, CT, RI, DE, MD, MA, NH, VT, ME or Northern VA. You will need to fill out applications with a New Hope Rescue Partner to foster or adopt a NYC ACC dog. Transport is available if you live within the prescribed range of states. Shelter contact information: Phone number (212) 788-4000 Email [email protected] Shelter Addresses: Brooklyn Shelter: 2336 Linden Boulevard Brooklyn, NY 11208 Manhattan Shelter: 326 East 110 St. New York, NY 10029 Staten Island Shelter: 3139 Veterans Road West Staten Island, NY 10309 * NEW NYC ACC RATING SYSTEM * Level 1 Dogs with Level 1 determinations are suitable for the majority of homes. These dogs are not displaying concerning behaviors in shelter, and the owner surrender profile (where available) is positive. Some dogs with Level 1 determinations may still have potential challenges, but these are challenges that the behavior team believe can be handled by the majority of adopters. The potential challenges could include no young children, prefers to be the only dog, no dog parks, no cats, kennel presence, basic manners, low level fear and mild anxiety. Level 2 Dogs with Level 2 determinations will be suitable for adopters with some previous dog experience. They will have displayed behavior in the shelter (or have owner reported behavior) that requires some training, or is simply not suitable for an adopter with minimal experience. Dogs with a Level 2 determination may have multiple potential challenges and these may be presenting at differing levels of intensity, so careful consideration of the behavior notes will be required for counselling. Potential challenges at Level 2 include no young children, single pet home, resource guarding, on-leash reactivity, mouthiness, fear with potential for escalation, impulse control/arousal, anxiety and separation anxiety. Level 3 Dogs with Level 3 determinations will need to go to homes with experienced adopters, and the ACC strongly suggest that the adopter have prior experience with the challenges described and/or an understanding of the challenge and how to manage it safely in a home environment. In many cases, a trainer will be needed to manage and work on the behaviors safely in a home environment. It is likely that every dog with a Level 3 determination will have a behavior modification or training plan available to them from the behavior department that will go home with the adopters and be made available to the New Hope Partners for their fosters and adopters. Some of the challenges seen at Level 3 are also seen at Level 1 and Level 2, but when seen alongside a Level 3 determination can be assumed to be more severe. The potential challenges for Level 3 determinations include adult only home (no children under the age of 13), single pet home, resource guarding, on-leash reactivity with potential for redirection, mouthiness with pressure, potential escalation to threatening behavior, impulse control, arousal, anxiety, separation anxiety, bite history (human), bite history (dog) and bite history (other). New Hope Rescue Only Dog is not publicly adoptable. Prospective fosters or adopters need to fill out applications with New Hope Partner Rescues to save this dog.

#funny #lol #humor #memes #meme #memehumor #dank memes #funny pics #rolf #lmao #Being Alone #Andrew B

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