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1. Summarize the history.
2. The history suggests one explanation for the post-operative confusion. What other explanation might there be? (What is the differential diagnosis of post-operative confusion?) What clinical data would you want to see to confirm you thought?
3. The history states the confusion did not resolve on discontinuing of medication. If you were the provider, how would you discuss this with the family and what explanations might you then offer for the patient’s confusion.
4. How is spinal fusion surgery performed?
5. What informed consent risks would you cover for a patient with this type of surgery?
6. Based on the history, why do you think the patient had post-operative complications? Can you draw any conclusions about the cause of the infection?
7. Orient the body first. (Is the patient supine or prone? Which direction are the head and feet?)
8. The surgical scars have an unusual configuration. Clarify for yourself what that configuration is (or draw it out).
9. Which scar likely represents the initial spinal surgery? Which scars likely represent repeat surgeries.
10. Was the initial surgery in the cervical, thoracic, lumbar or sacral region?
11. What are the two holes by the right hand most likely for?
12. Comment on the integrity and condition of the skin. Do you see any areas of concern? What’s your concern?
13. Distinguish livor mortis from other types of changes in the skin.