95 year old gentleman Elective admission for repair of Lt Inguinal hernia. For the past ten years had been managing the hernia with a truss, now uncomfortable.
Multiple pathology including Abdominal Aortic Aneurysm, Carcinoma of the Prostate, Left Ventricular failure and dependent upon cardiac pace maker, but remarkably well in himself.
Hernia repaired under spinal anaesthesia using a surgical mesh because of the general weakness of the abdominal wall.
Post operatively developed an extensive wound haematoma extending down to the scrotum. Hypotensive for a time and Hb dropped to 7 g/dl requiring transfusion of two units of whole blood. Noted also to be Thrombocytopenic [Plts 92 X109/L]
Nursing management related to preparation for surgery, monitoring post-operatively, wound care, monitoring haemodynamic. Remarkably the patient remained relatively well in himself throughout his hospital stay, self caring for much of his ADL’s.
Discharged on day eight for follow up in surgical and haematology outpatients.
Profile of Adult Patient Case 01-010
Medical History: Acute Admission via A&E with severe abdominal pain. Diagnosed as suffering from Acute Pancreatitis diagnosis confirmed by a raised serum amylase of 3040 U/L (range 25 –125). Pancreatitis secondary to gallstone migration confirmed by ultrasound.
Managed conservatively Nil orally and Intravenous Infusion Fluids, Catheterised. Insulin Sliding Scale prescribed Known to suffer from Diabetes Mellitus controlled by diet
Past history of anterior resection of rectum for Ca Colon – Illeostomy formed but reversed.
Two Incisional hernia one arising from anterior resection and second from? Illeostomy site.
Discharged on day nine for with referral for open cholecystectomy.
Nursing Needs Identified as relating to:
An acute admission, information giving for patient and family, communication on plans.
Management of pain including assessment, evaluation, and recording reviewing analgesia
Care of the urinary indwelling catheter, prevention of ascending infection, accurate monitoring of volume and nature of urine output including and recording same.
Care of the diabetic patient including monitoring of blood sugars, administering sliding scale, education and general support for the patient.
Care of the fasting patient to include mouth care, management of fluid replacement by Intravenous infusion, and equipment cannula, line etc.
General care including hygiene needs and other activities of living.
Profile of Adult Patient Case 01-011
This is a ninety-one year old lady who was admitted with lower back pain.
She had a fall three weeks prior to this admission when she sustained an injury to her lower back. She was originally treated by her GP for back pain with analgesia which she was unable to tolerate due to nausea.
The past medical history for this patient is Osteoarthritis. Prior to this admission into hospital, this lady was fully independent and she lives alone. She is normally quite active and enjoys painting and exhibits her paintings at local art shows. In addition to the injury to her lower back resulting from the fall, there was also evidence that she had sustained a burn to her lower back from a hot water bottle. She was initially treated with analgesia and it was planned that she would be transferred to another hospital for rehabilitation, although this was delayed as there was an out break of diarrhoea and vomiting on the rehabilitation ward where she was scheduled to be transferred to.
Her condition improved whilst on the ward awaiting transfer and she requested to go home. She was seen by the Discharge Coordinator who reported that she was known to the social services department and therefore did not need to be referred. The lady’s daughter agreed to support her at home over the bank holiday period until home support could be commenced, she was therefore discharged home after sixteen days in hospital.
Profile of Adult Patient Case 01-012
Seventy-six year old man, known with severe COPD, was admitted as an emergency with an infective exacerbation. He was producing increasing amounts of purulent green sputum and had some associated left sided chest pain. Chest X ray on examination showed previous asbestos related changes, but no new abnormality. Arterial blood gases on 24% oxygen showed a pO2 of 9.6 and pCO2 of 4.72 (he is normally on a long term oxygen therapy at 2litres/minute) Sputum grew Serratia Marcescens, which was sensitive to Ciprofloxacin and Gentamicin, but resistant to Amoxycillin, Coamoxiclav and Cefuroxime.
He was treated with Levofloxacin, nebulised bronchodilators, oral steroids, oxygen and intravenous Aminophylline and made a slow but steady improvement. He was troubled by an episode of sinus tachycardia, thought to be precipitated by his Aminophylline and his dose of Salbutamol was temporarily reduced. His peak flow on discharge was 210litres/minute. He will be followed up at his existing appointment in two months.
Nursing management related to monitoring of treatment regimes and observations. Nursing management included Oxygen therapy, collection and safe disposal of body fluids [sputum].
Discharged on day seventeen.
Profile of Adult Patient Case 01-013
Eighty-year old Female - A&E referred. Known Hypertension on Atenolol 50mg OD for 2-3yrs. Recent episode of diarrhoea four weeks back, seen by GP for loose stools yesterday started on Dicyclomine 20mg OD. Had breakfast had Dicyclomine and Atenolol, felt dizzy. Collapsed, loc – 30’s – 1 minute. Came around in few minutes. No recall of events. No C/o headache, chest pains, slurred speech. Paramedics found her to be Bradycardiac had 500mcg of Atropine. Impression collapse? Cardiac Arrhythmia - side effect from of medications?
Made an unremarkable recovery. Atenolol discontinued and commenced on Bendrofluazide for her hypertension. Diagnosis collapse with side effect of medication being the favoured explanation. Nursing management related to acute admission, monitoring of treatment regimes and observations.