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

Profile of Adult Patient Case 01-029

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Profile of Adult Patient Case 01-029

Case summary

Admitted with a history of centralised chest pain radiating to both arms and back, used her GTN spray with good effect. History of angina for several years - also had triple by-pass surgery nine years ago. This lady is a 79 year old ex-smoker; she lives alone and is normally very active and independent. Her angina is well controlled following the coronary artery bypass grafts until 2 weeks prior to admission when she has had frequent episodes of chest pain. Diagnosed with unstable angina, although further episodes of chest pain mislead the diagnosis of cardiac chest pain or epigastric chest pain as this patient is also known to have a hiatus hernia.

Throughout her stay in hospital, various investigations were undertaken and she was treated with medication for angina. There is also evidence that she was visited by the Elderly Care Co-ordinator who noted that the patient wanted to go home and that she was disappointed after being advised to stay in hospital due to recurrent episodes of chest pain. This lady was discharged home after an 11 day stay in hospital with an Echocardiogram test to be arranged as an Out-Patient.

Profile of Adult Patient Case 01-030

Case summary

Admitted via the Accident and Emergency department with a two week history of excessive vomiting and abdominal pain. Reported to also have a two month history of weight loss

This lady is normally chair bound at home and lives with her husband who is her full time carer. Her previous medical history is complex and includes Crohn’s Disease, Illeostomy, Type 2 Diabetes Mellitus, Cholecystectomy, Congestive Cardiac Failure, Ischemic Heart Disease and Pernicious Anaemia. Initially diagnosed with acute renal failure, Endoscopy procedure performed which appeared to be normal. Some amendments made to medication. Condition appeared to resolve and she was discharged home after a seven day stay in hospital.

Profile of Adult Patient Case 01-031

Case summary

This patient is a seventy-nine year old lady admitted via the Accident and Emergency Department with palpitations and left sided chest pain whilst playing bowls. Her previous medical history includes Hypertension and Ischemic Heart Disease. This lady lives at home with her husband; she is normally active and independent. Whilst being examined by the doctor she lost consciousness for a brief period of time which resolved. An Electrocardiogram was performed which revealed fast Atrial Fibrillation for which she was treated with medication. Investigations were undertaken to rule out a Myocardial Infarction which proved to be negative.

After responding well to treatment, she was discharged home following a four day stay in hospital; a follow up appointment was arranged for her to attend the Out-Patients Department two weeks after discharge.

Profile of Adult Patient Case 01-032

Case summary

This eighty-three year old gentleman was admitted via the Accident and Emergency department following one episode of vomiting ‘coffee ground’ vomit. He was also reported to have a reduced appetite and weight loss in recent weeks. His past medical history consisted of Hypertension and he is allergic to Penicillin. He was initially treated with Intravenous (IV) antibiotics and IV fluids following a diagnosis of pneumonia. After four days as an in-patient he had no episodes of vomiting and as his condition improved he was able to tolerate diet and fluids. During his stay in hospital he was also found to be incontinent of urine which was noted to be a long standing problem. The nursing management for this patient included a referral to the Occupational Therapist for assessment as he is the main carer for his wife. In addition, he was referred to the District Nurses prior to discharge. There is some evidence that concerns were raised by his daughter regarding his planned discharge as she felt that her father was breathless, although it is noted by the doctors that he did not appear to be breathless. Therefore he was discharged home following a nine day stay in hospital. Arrangements were made for him to return for a follow-up appointment in the Out-Patients Department and a bladder scan was arranged to investigate the reasons for his urinary incontinence.

Profile of Adult Patient Case 01-033

Case summary

This sixty year old gentleman was admitted via his GP with reduced mobility, increasing dyspnoea and diarrhoea. This patient is known to have Parkinson’s disease for which he takes medication. Two days prior to this admission he was discharged from hospital but was unable to cope at home despite having home care visits three times per day.

Whilst in hospital on the previous admission he was found to have Clostridium Difficile for which he was treated. On admission into hospital he appears confused, he does not understand what medication he takes and why. He also has a sacral sore. Initially, he is treated with medication for the chest infection and diarrhoea. His past medical history

The nursing management for this patient includes a referral to the Parkinson’s Nurse and referral to the Social Work department to be assessed for Residential Care. Although medically well, he is unable to be discharged until arrangements are made for him to be suitably accommodated. The case goes to a panel which is delayed and results in a prolonged discharge. Following the case going to panel, he is eventually discharged to a Residential Home following a forty-four day stay in hospital.

Profile of Adult Patient Case 01-034

Case summary

This patient is an eighty-three year old gentleman, admitted to the ward via his GP with a history of vomiting and rigors, symptoms that were initially suspected to be due to a urinary tract infection (UTI). This patient had attended the Accident and Emergency department on the day prior to admission and was discharged home with antibiotic treatment for a UTI. Following deterioration in his condition he was admitted into hospital. Further investigations revealed a diagnosis of pneumonia for which he was treated with intravenous antibiotics.

Previous medical history included, Myocardial Infarction, Cerebro vascular accident, Parkinson’s disease, Osteoarthritis and a hiatus hernia. There is evidence within the nursing notes that the patient complains that his chair is uncomfortable and asks for the nurse in charge. The patient’s daughter asks for an apology for the way that her father was spoken to by one of the nurses; the nurse assures the daughter that this will be resolved although it is unclear whether this happened.

The patient’s daughter also reported to staff that her father had some episodes of diarrhoea whilst in hospital and it was suspected that this was a result of the antibiotic therapy. In conclusion the patient responded well to his treatment and was discharged home after a ten-day stay in hospital without the need for any services to be implemented.

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