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

Profile of Adult Patient Case 01-018

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Profile of Adult Patient Case 01-018

Case summary

This male patient was admitted following a domiciliary visit by the consultant. The patient was unable to walk for three weeks prior to admission. He had a poor appetite and had recently developed constipation. The patient also complained of having shakes to his hands and ‘flickery’ eyes, he also had difficulty in swallowing. The GP had organised for the patient to have a wheelchair. Previous history of Polyneuropathy. The patient was unable to manage at home and was admitted into hospital for further investigations.

Initially diagnosed with polymotorneuropathy, it was also considered whether the symptoms may be a result of a stroke or a space occupying lesion in the brain. After a short length of time in hospital the patient requested to change consultant and this was accepted. Various investigations were performed, findings from an Endoscopy revealed lesions in the oesophagus. Nursing management of the patient included Speech and Language assessment, physiotherapy, dietician and occupational therapist.

Initially treated with Intravenous Fluids and Nil by Mouth due to swallowing difficulties, the patient was later treated with Naso Gastric feeding. This was removed when the condition improved and diet was tolerated. The patient was transferred to a rehabilitation ward where his condition continued to improve, he was gradually able to mobilise short distances with a walking aids and foot supports.

Following a 28 day stay in hospital the patient and his wife requested that he be discharged home, although they were satisfied with his care they felt that he would improve within his home environment with support from the community rehabilitation team. Although the nursing staff advised that the patient remain in hospital for further rehabilitation, the patient insisted that he wanted to go home. The patient was discharged home with a care package in place.

Profile of Adult Patient Case 01-019

Case summary

This patient is a 96 year old gentleman who was admitted via his GP after being found collapsed at home by his daughter, unable to weight bear. He is known to have angina, hypothyroidism and heart failure. He also has a colostomy in place due to a history of bowel cancer six years ago. He is initially treated for Left Ventricular Failure (LVF) and Cardiomegaly.

Following several episodes of haematuria, he is treated with antibiotics for a possible urinary tract infection. Following the acute phase, he is later transferred to another hospital for rehabilitation. The nursing management for this patient includes referral to the Physiotherapist, Occupational Therapist and Social Worker. Whilst in hospital he develops a swelling in his right leg which is treated as a potential Deep Vein Thrombosis (DVT). A decision is made that the patient should not be for resuscitation in the event of Cardio Pulmonary Arrest. Following further investigations, there is no apparent DVT of the leg and following a period of rehabilitation, the patient is discharged home after 28 days.

Profile of Adult Patient Case 01-020

Case summary

Acute admission with sudden onset of chest and abdominal pain. The past medical history for this patient is complex, including a history of Alcoholic Liver disease, Congestive Cardiac Failure (CCF), Aortic valve disease, Coronary Artery Bypass Graft (CABG), Type 2 Diabetes Mellitus and leg ulcers. Initially diagnosed with Oesophageal spasm but to rule out the possibility of a Myocardial Infarction (MI).

Treated for Hyperkalaemia with oral medication and intravenous fluids. Whilst in hospital was seen by the dermatologist due to leg ulcers. This patient had various investigations performed including an Endoscopy and abdominal Ultrasound. The ultrasound revealed gall stones and an enlarged liver. There are some references made to his mood being low whilst in hospital, it is unclear whether or not any treatment was given for this. Discharged home on day 18.

Profile of Adult Patient Case 01-021

Case summary

This is an eighty-nine year old lady who was admitted via her GP with increasing dyspnoea and a cough for 3 weeks; she had a recent hospital admission prior to this admission with left sided abdominal pain to which no cause was found. Having completed two courses of antibiotics prescribed by her GP her condition was not improved.

This patient is an ex smoker, she lives alone in a bungalow and her family help to assist her. There is a query in relation to whether this lady has had Tuberculosis in the past. There are reports that she had been previously diagnosed with asthma although no treatment was given. Diagnosed with severe exacerbation of asthma, and treated with steroids and bronchodilators. Nursing management for this patient included a referral to the Occupational therapist, Physiotherapist and Social Worker. This lady was treated as an inpatient for 10 days until she was discharged home.

Profile of Adult Patient Case 01-022

Case summary

This forty-one year old gentleman was an elective admission via the Out-Patients Dermatology Clinic with severe exacerbation of eczema mainly affecting his right thigh and buttocks. This patient has a life long history of dermatitis; he is unemployed and lives alone. His previous history also includes an above knee amputation to his right leg. He was unable to apply his prosthesis due to his skin being affected by eczema, which therefore affected his mobility. Known to be allergic to Penicillin and reported to be sensitive to dairy products, which exacerbated his condition. During his stay in hospital he was tested for specific allergies. His treatment consisted of the application of various ointments, lotions and the use of specific bath oils to reduce the condition. This patient was in hospital for a total of seven days during which his condition gradually improved and he was discharged home with the District Nurses visiting twice weekly. A follow up appointment was arranged for him to attend the Dermatology clinic 6 weeks later.

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