In Context Case Summaries Profile of Adult Patient Cases pages 2-37


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In Context Case Summaries

Profile of Adult Patient Cases pages 2-37

Profile of Learning Difficulties Cases pages 37-41

Profile of Mental Health Cases pages 41-52

Profile of Paediatric Cases pages 52-57

Profile of Physiotherapy Cases pages 57-59

Profile of Adult Patient Case 00-002

Document summary

No admission notes. Unclear why or where from admission took place.

Diagnosed as suffering from a carcinoma of the lung confirmed as being an undifferentiated small cell carcinoma from biopsies taken at the time of bronchoscopy.

Nursing care issues predominantly relate to care of the terminally ill patient and palliation. Marked weight loss associated with nausea a key case feature.

Patient ultimately discharged to care of District Nurse, McMillan nurse and GP.

Profile of Adult Patient Case 00-004

Document summary

71 year old male admitted via outpatients with Shortness of Breath and diagnosed as exacerbation of Asthma. Known asthmatic, three previous admissions for flare up of his asthma.

Treatment included 02 therapy a range of bronchodilators, steroids and antibiotics. Sputum incubated Haemophilus parainfluenza. Allergic reaction to Singulair resulted in quite marked Angio Oedema.

Nursing care input focused on management of the marked and prolonged breathlessness and its impact on his ability to self care. Gradually improved over the course of his eighteen day admission and was discharged care of GP.

Profile of Adult Patient Case 00-005

Document summary

This fifty nine year old gentleman was admitted to the ward with a two-week history of increasing dyspnoea and a cough. He has no known documented medical history although he is on medication. Following a diagnosis of Pneumonia of the left lung, he is treated with Intravenous and Oral antibiotics, nebulised bronchodilators and oxygen therapy.

This patient is reported to have smoked between thirty to forty cigarettes per day over a period of approximately forty years and he has developed a chronic productive cough.

Following treatment throughout the period of hospitalisation his condition improves and there is evidence that he expresses a desire to stop smoking and the medical team prescribe nicotine patches. He is discharged from hospital after a period of six days.

Profile of Adult Patient Case 00-006

Document summary

This gentleman was admitted into hospital via the Accident and Emergency department after

collapsing. He had a history of collapsing with no loss of consciousness.

He is described as obese, with a complex history of Ischaemic Heart Disease (IHD),

Hypertension, Type 2 Diabetes Mellitus (DM), Hernia Repairs and a previous Myocardial

Infarction (MI).

Whilst in hospital he is monitored on a heart monitor, which shows irregularities in his heart

rate and rhythm. Further investigations also reveal a postural drop in blood pressure. Some

amendments are made to his medication.

He is a smoker and smokes between thirty and forty cigarettes per day, there is evidence that

he is advised to smoke smoking although there is no evidence that he is supported to do so

despite requesting for nicotine patches. There is evidence that the relatives are concerned

that the patient regularly has angina pains but does not inform anyone or seek help.

After a period of fourteen days in hospital he is discharged home with a follow up appointment

two months later.

Profile of Adult Patient Case 00-007

Document summary

This fifty-seven year old gentleman was admitted into hospital via his GP with increasing shortness of breath, a cough and abdominal pains.

His previous medical history is complex and includes Ischaemic Heart Disease, a Coronary Artery Bypass Graft (CABG), Aortic Aneurysm Repair and Insertion of an Internal Defibrillator. He previously smoked twenty cigarettes a day up until twelve months before this admission.

Whilst in hospital he is placed on a cardiac monitor and a series of investigations are performed but each proves to be negative. His medication is amended to increase the diuretic medication, which he takes.

After several days in hospital his breathing improves and the pain appears to resolve. He is discharged home following an eleven-day stay in hospital, an Abdominal Ultrasound scan is arranged on an Out Patient basis.

Profile of Adult Patient Case 00-008

Document summary

Acute emergency admission via A&E. History of chest pain and fluttering sensation in the chest. Assumed to be a myocardial Infarction but this was discounted on ECG tracings and negative Trop I blood tests.

Main complaint of liquid diarrhoea associated with severe stomach cramps/spasms. Recently underwent Heller’s Myotomy for oesophageal stricture requiring further surgical revision for dysphagia. Caught Norwalk Virus following surgery.

The diarrhoea is intractable with only short periods of relief with Octreotide medication, but leading to constipation, withdrawal and return of symptoms. A battery of tests including barium studies, pancreolauryl test, microbiological studies all fail to demonstrate aetiology for the diarrhoea. One suggestion is that the diarrhoea is attributable to vagus nerve damage during surgery for his oesophageal stricture.

Known sufferer of Rheumatoid Arthritis with associated mobility problems requiring him to use a Zimmer Frame.

Patient discharged without a firm diagnosis or explanation for the diarrhoea. Sense of the patient is ‘fed up’ and low and wants discharge with or without resolution for his diarrhoea.

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