This eighty one year old lady was admitted via her GP with a history of increasing dyspnoea on exertion and hypertension. Known to have a history of Hypertension, Congestive Cardiac Failure, Asthma and Iron Deficiency Anaemia. This lady had been unwell for two weeks prior to admission with abdominal pain, diarrhoea and a reduced appetite. Initially diagnosed with acute renal failure, secondary to dehydration and medication she was later discovered to have a raised white cell count and was commenced on Intravenous (IV) fluids and antibiotics. Whilst in hospital this lady developed a widespread rash to which the cause was unknown it was questioned whether this was a reaction to some medication. The diarrhoea settled and the lady was diagnosed with sepsis. Her condition improved whilst in hospital and her symptoms resolved, she was discharged to her home address after a six day stay in hospital.
Profile of Adult Patient Case 01-024
This patient is a seventy-two year old lady admitted with increasing shortness of breath and diarrhoea. She had been discharged from hospital 4 weeks prior to this admission after being treated for exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Her medical history includes COPD and angina. Following an initial diagnosis of infective exacerbation of COPD, suspected infected diarrhoea and oral candidosis, she was treated with Intravenous (IV) fluids, IV antibiotics and oxygen. A diagnosis of pneumonia was confirmed. The nursing management of this lady includes referral to the Occupational Therapist. There are some concerns raised by the Occupational Therapist in relation to whether this lady was being discharged on home oxygen although it would appear that she is not.
Within the documentation there is also evidence of a disagreement between the patient and a nurse following the patient adjusting the oxygen when she felt breathless.
This lady was discharged home after seventeen days in hospital.
Profile of Adult Patient Case 01-025
This seventy-three year old lady was admitted into hospital with a one week history of headaches, nausea, weakness to her legs and numbness to the right side of her face. She had recently (within the six months prior to this admission) been treated for B-Cell lymphoma for which she had received chemotherapy and radiotherapy treatment, and the lymphoma was reported to be in remission. There is a detailed list from the GP with the details of previous medical history. She had previously attended the Accident and Emergency department 3 days prior to this admission and was treated with antibiotics and anti- emetics. On admission she was unable to walk due to weakness in her legs and had been ‘dragging’ herself around at home with her husbands help. It was questioned whether this lady may have a brain lesion and a CT scan was performed which was found to be negative. An MRI scan later unveiled a tumour to the brain stem which was initially believed to be due to lymphoma, the patient was informed of the results of the scan and commenced on medication. The lady was referred to the neuro-surgeon and it was felt that the lesion was not due to lymphoma but due to an infarct to the brain stem.
The patient improved whilst in hospital, she was referred and seen by a dietician due to raised cholesterol. After a total of seventeen days in hospital she was discharged home without the need for any additional support.
Profile of Adult Patient Case 01-026
This 83 year old lady was admitted via her GP following a history of weight loss, she was extremely low in energy and unable to get out of bed due to fatigue. She had previously been diagnosed with iron deficiency anaemia which responded well to treatment, although she had declined further investigations. On admission into hospital she appeared quite confused and was diagnosed with sepsis secondary to a urinary tract infection. A chest x-ray also revealed some shadowing there was some consideration whether this was a mass; however she was initially diagnosed and treated for pneumonia.
Blood results revealed that the liver function tests were elevated; the medical staff suspected that the lady had metastatic bronchial carcinoma and a bronchoscopy was performed. Within the notes it was documented that this lady should not be for resuscitation in the event of cardio respiratory arrest. However, the bronchoscopy and abdominal ultrasound investigations did not detect any abnormal masses. The patient was discharged home after 7 days.
Profile of Adult Patient Case 01-027
This gentleman was admitted via his GP after waking one morning to find that he had a weakness to his left arm and left leg. He has a previous history of Chronic Obstructive Pulmonary Disease (COPD). The patient is the main carer for his wife who is known to have Alzheimer’s disease. Initial diagnosis was that he had suffered from a stroke. Although his mobility was affected and he had some facial drooping, he was able to swallow and within 5 days following admission, he was able to dress himself. After being informed that he was able to go home the patient expressed his concern about this, he felt that he wouldn’t be able to cope at home with his wife. He was later referred to the Occupational Therapist. Following a period of rehabilitation, his condition improved. Communications were held between the Occupational Therapist and the Community Social worker to arrange his discharge home and arrangements for his wife so that they will be supported once he is discharged home. The patient was discharged home after a 14 day stay in hospital.
Profile of Adult Patient Case 01-028
This 87 year old female was admitted into hospital via her GP with a history of vomiting overnight and increased shortness of breath. According to the patient she has 2 episodes of ‘blood stained’ vomiting throughout the night. This lady lives alone and is independent for most activities of daily living. She has a previous medical history of Iron deficiency anaemia, congestive cardiac failure, Myelodysplasia. Treated one year ago for ‘coughing blood’ and pneumonia. No evidence of malaena whilst in hospital, no change to her haemoglobin level. Although she was found to be pyrexial on admission, treated for a urinary tract infection (UTI) and discharged home following a 3 day stay in hospital.