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

Profile of Adult Patient Case 01-035

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Profile of Adult Patient Case 01-035

Case summary

This patient is a seventy-nine year old man who was admitted to the ward via the Accident and Emergency department with a two-day history of diarrhoea and vomiting. Past medical history includes Hypertension, Ischemic Heart Disease and Peripheral Vascular disease. He was treated for renal impairment, which was caused by gastroenteritis. He was treated with Intravenous fluids and after a four day stay in hospital was discharged home.

Profile of Adult Patient Case 01-036

Case summary

This seventy–eight year old gentleman was admitted via his GP with a history of dizziness and generalised weakness. He has a previous medical history of Ischemic Heart Disease and has had a Cerebral Vascular Accident (CVA) in the past. No previous history of Diabetes although on admission his blood glucose was found to be elevated and treatment was initiated for this. He was found to have a drop in his blood pressure on standing and it was believed that this was due to his medication, this was amended and support stockings were provided to wear. The nursing management for this patient includes a referral to the Diabetic Specialist Nurse, Physiotherapist, Dietician and District Nurses. There is some evidence that the patient’s daughter expressed concerns regarding his discharge, as she felt that his wife would not manage with him at home. However, despite this concern being raised it would appear that his discharge proceeded and he was discharged home after a total of sixteen days in hospital with the district nurses attending to monitor his blood glucose levels.

Profile of Adult Patient Case 01-037

Case summary

This ninety- seven year old gentleman was admitted via the Accident and Emergency Department with epigastric and abdominal pain. His previous medical history includes Ischemic Heart Disease, Atrial Fibrillation, Hiatus Hernia and Pernicious Anaemia. There is some question in relation to whether or not he also has an Aortic Aneurysm, although this has not been confirmed in the past. For the past eighteen months he has required oxygen therapy at home. He is known to live alone with some support with meals and cleaning.

Whilst in hospital various investigations were undertaken, his blood results indicated some renal impairment although it was noted that although abnormal the results were similar to previous results. However, an ultrasound scan of his abdomen confirmed an Aortic Aneurysm, following discussions between the medical staff and the patient regarding the risks and benefits of the surgery to repair the aneurysm the patient decided not to have the surgery. His pain settled whilst he was in hospital and he was discharged home after nine days in hospital.

Profile of Adult Patient Case 01-038

Case summary

This seventy-eight year old lady was admitted via her GP with a sudden onset of dyspnoea and fainting episodes. Five weeks prior to this admission into hospital, she had sustained a fractured neck of femur to her right leg, for which she was treated with surgery. Since the surgery she was mobilizing well with a frame, although she had recently been treated with compression stockings by her GP due to a swollen leg. Her previous medical history includes Myocardial Infarction, Ovarian Cystectomy, Hypertension, Anaemia and Osteoporosis.

On admission she was initially diagnosed with Atrial Fibrillation, and it was later confirmed that she also had a Pulmonary Embolism (PE) and Pneumonia, for which she was treated with medication.

Whilst in hospital she had several short episodes of ‘black outs’ where she became unresponsive. After a prolonged period of stay in hospital her condition deteriorated, she developed cardiac failure and renal failure and her diagnosis was poor. It was therefore agreed that she should not be resuscitated in the event of cardiac arrest. Despite her condition, she requested to be discharged home with support, therefore arrangements were made for her to have oxygen therapy organised for her discharge and a home visit was planned.

However, her condition deteriorated further despite treatment, she collapsed and later died in hospital after a total of fifty-three days. Rest in Peace.

Profile of Adult Patient Case 01-039

Case summary

This eighty-one year old lady was admitted via the Accident and Emergency department with a history of fainting at home, and was observed to have lost consciousness. She was reported to have had similar episodes of fainting prior to this. On admission, there was no history of chest pains or palpitations; she was under awaiting an Endoscopy examination as an Outpatient due to nausea. Initial treatment consisted of Intravenous fluids, which were later discontinued.

Various investigations were undertaken on admission and an Electro Cardiogram (ECG) recording revealed Atrial Fibrillation. However, further ECG’s were reported to be ‘normal’.

A further 24-hour ECG recording was also found to be within normal limits.

Following a negative screen for a Myocardial Infarction the lady was discharged after a three-day stay in hospital as an inpatient.

Profile of Adult Patient Case 01-040

Case summary

This patient is an eighty-six year old gentleman who was admitted into hospital via his GP with a two-week history of a rash and bilateral swelling to his legs. His previous medical history includes two Cerebro-Vascular Accidents (CVA’s) and one convulsion several years ago. He is not known to have any skin conditions apart from Rosacea in the past. He is also known to have Atrial Fibrillation (AF) and Ischemic Heart Disease.

Following his admission he is referred and assessed by the dermatologist and further investigations of the rash are performed. These include a skin biopsy to determine the cause of the rash. Various treatments are prescribed and administered for the rash.

On the same day of admission, an Electrocardiogram (ECG) investigation revealed that he was in complete heart block; he was therefore transferred to the Coronary Care Unit for further observations and monitoring. Having been monitored within the Coronary Care Unit and found to be having episodes of heart block, a decision is made for him to have a permanent pacemaker inserted. This procedure is performed successfully and he is later transferred back to a ward.

Following further reviews and treatment by the dermatologist the rash appears to be gradually improving.

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