This is a complicated case of a lady who was originally admitted into hospital with a history of diarrhoea and abdominal pain, unable to cope at home. Her past medical history included Gout, Parkinson’s disease and Diverticulitis. In admission into hospital she was initially diagnosed with Gastro-enteritis and monitored for signs of sepsis. The diarrhoea persisted whilst she was on the ward, and a urinary catheter was inserted to monitor the hourly urine output. Blood samples were taken daily for Urea and Electrolyte levels. She was treated with Intravenous fluids and antibiotics. An Echocardiogram was performed which indicated abnormalities, these were discussed with the patient and the option of surgery to improve the cardiac function was offered, the patient agreed that she would consider this.
Although the diarrhoea settled after several days, she began to feel nauseous and the blood results indicated deterioration in the renal functions. She was then treated with Intravenous fluids and anti-emetics. An abdominal x-ray was performed and the possibility of a bowel obstruction was ruled out. The nursing management included a referral to the dietician due to poor appetite, nausea and weight loss. The lady began to develop oedema and was treated with diuretics. Stool cultures proved to be negative for infection, therefore a flexible Sigmoidoscopy investigation was performed which did not reveal any specific abnormalities. A CT scan of the abdomen was then arranged to explore the possibility of diverticular abscess. The patient then began to pass diarrhoea and had several episodes of vomiting. A rash was noted to both shins, the cause of which appeared to be unknown. Following deterioration in the patient’s condition, she was given diamorphine to settle her. However this was later discontinued due to a drop in her blood pressure and a reduced early warning score.
After 24 days in hospital the patient’s condition began to deteriorate rapidly and the Vasculitic rash to the legs became widespread, the diagnosis remained unknown. In light of the lady’s poor prognosis it was decided that she should not be resuscitated in the event of cardiac arrest and this was discussed with her daughter. It was explained to her daughter that although there was no clear diagnosis it was likely to be renal failure secondary to diarrhoea and vasculitis. The family were in agreement with the decision regarding resuscitation.
The patient’s condition continued to deteriorate rapidly following this discussion and she died after 26 days in hospital. Rest in peace.
Profile of Adult Patient Case 01-042
This seventy-three year old gentleman was transferred from another hospital after being in hospital for twelve days with pain and swelling to his left shoulder. He was diagnosed and treated for septic arthritis of his shoulder joint with an arthroscopic washout. Although this had resulted in some improvement to his symptoms, he then developed severe back pain and weakness with altered sensations to his legs. An urgent MRI scan revealed discitis with vertebral osteomyelitis. A spinal biopsy was performed which was negative, although the shoulder aspirate grew Staph Aureus for which he was treated with antibiotics.
Throughout the period of treatment, he regained some power in his legs and his blood results indicated an improvement in his condition. He spent a prolonged period of time on bed rest and was eventually able to sit out of bed as his condition improved. A diagnosis of Chronic Osteomyelitis was confirmed.
The nursing management for this patient included a referral to the Physiotherapist and a referral to the Occupational Therapist.
As his condition improved he was able to mobilise with assistance and with the use of a walking frame. After a prolonged period of seventy-three days in hospital it was arranged for the gentleman to go home for weekend leave, however he failed to return to hospital after the weekend visit and he was therefore officially discharged on day seventy-six.
Profile of Adult Patient Case 01-044
This fifty-year old lady was an elective admission for conversion of a right Halifax nail to a total right hip replacement for the treatment of Osteoarthritis.
Her previous medical history includes alcoholic liver disease, partial Gastrectomy, Appendecectomy and Hysterectomy.
During the operation the Halifax nail was found to be infected and was removed. The conversion to a total hip replacement was therefore delayed until a later stage. The lady was treated for the infection with intravenous antibiotics via a central catheter, which was later removed due to the patient developing pyrexia. A conversion operation was subsequently undertaken to replace the right hip joint.
The nursing management for this patient includes a referral to the Physiotherapist.
This patient was discharged home following a seventy-four day stay in hospital with an Out-Patient follow up appointment for three months time.
Profile of Adult Patient Case 01-045
This fifty-eight year old gentleman was admitted into hospital as an elective admission for a right Total Hip Replacement. His previous medical history includes a Coronary Artery Bypass Graft (CABG), Hypertension and two Hernia Repairs. The surgical procedure is performed as planned, however two days later the patient is found to be pyrexial. Although investigations were undertaken to determine the cause of the pyrexia the outcome of the cause of the pyrexia remains unclear. However, the gentleman gradually begins to mobilise independently as his mobility improves.
The nursing management for this patient includes referrals to the Physiotherapist, Pain Nurse and the District Nurse.
This gentleman is successfully discharged home following a total of seven days in hospital.