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

Profile of Adult Patient Case 01-046

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Profile of Adult Patient Case 01-046

Case summary

This sixty nine year old lady was an elective admission for a right total knee replacement. She was admitted to the ward after being assessed in the Pre Op clinic. Her previous medical history included a left total knee replacement, hypertension, hypothyroidism, Appendecectomy, hysterectomy, mirodiscectomy, and a thyroidectomy.

The operation was performed successfully and the patient began to mobilise soon after the surgery. There is some concern several days post operatively that there is swelling to the operated knee area although this later appears to be improving.

The nursing management for this patient includes a referral to the Pain Nurse, Physiotherapist and the District nurses.

This lady was discharged home following a period of nine days in hospital.

Profile of Adult Patient Case 01-047

Case summary

This sixty-year old lady was an elective admission for a right Total Knee Replacement.

Her previous medical history consists of Hysterectomy, Appendecectomy, Tonsillectomy and a fractured wrist.

The operation was performed and the patient’s mobility improved throughout her stay in hospital. There is some concern regarding her leg being swollen several days post operatively however an ultrasound scan was performed which was reported to be normal.

The nursing management for this patient includes referral to the Pain Nurse, District Nurse and Physiotherapist.

This lady was discharged home on day 13.

Profile of Adult Patient Case 01-049

Case summary

This seventy-nine year old lady was admitted into hospital following a fall at home whilst gardening. She sustained a fracture to the right neck of femur and required surgery.

Her previous medical history includes angina and hypertension. She also had previous surgery for a right total knee replacement and a cholecystectomy.

An operation was performed to pin the joint, however the patient later developed Methicillin- Resistant Staphylococcus Aureus (MRSA) in the wound, which prolonged her treatment.

The nursing management for this lady included a referral to the Occupational Therapist, District Nurse and Physiotherapist.

Throughout her stay in hospital her condition gradually improved and she was discharged home after eighteen days.

Profile of Adult Patient Case 01-050

Case summary

72 Year old female admitted to the orthopaedic ward via A&E with dislocation of right hip. Past history of bilateral hip replacement twelve years ago. Previously three episodes of the hip ‘feeling like it was coming out’ but not clear if the hip actually dislocated or not. This time when arising from sitting on a chair the hip dislocated, painful with shortening of the right leg. Hip manipulated under anaesthesia easily reduced but noted to be unstable in adduction, flexion & internal rotation also loose on longitudinal traction. Patient informed that she will require further arthroplasty to stabilise the hip joint. Evidence of multi agency involvement in discharge planning and preparation. The patient is not confident that she will be able to cope with caring for herself after discharge and refuses to be discharged when deemed to be suitable for discharge. Discharged home on day twelve in care of a friend.

Profile of Adult Patient Case 01-051

Case summary

Eighty –seven year old lady admitted with dislocation of right hip. Total hip replacement six years ago since then one other episode of hip dislocation three months prior top this admission. The lady spent all night laid on the floor at home in severe pain could not get herself up to standing. On admission, in pain over hip area with any movement, right leg externally rotated. X-ray confirmed posterior dislocation of the hip. Dislocation reduced by Manipulation under Anaesthesia. Uneventful post operative recovery. Gently mobilised with Zimmer frame and nursing assistance to gain confidence discharged home on Day four.

Placed on waiting list for Augmentation of right hip.

Profile of Adult Patient Case 01-052

Case summary

Thirty-one year old male admitted to the orthopaedic ward via A&E with history of a severe fracture of his right Talus sustained in a Road Traffic Accident [RTA]. Fracture reduced and fixed with screw and K-wires under general anaesthesia. Developed acute retention of urine post-operatively [confirmed by bladder scan – 850ml residual urine] for which he was catheterised. Catheter was removed on the third day and the patient passed urine without difficulty. Some worries expressed by the patient regarding potential complications, osteonecrosis, arthritis etc. Mobilised on crutches non weight bearing and was discharged home on day eight.

Profile of Adult Patient Case 01-053

Case summary

Eighty-two year old lady admitted to Medical Assessment Unit [MAU] with history of pain on eating and difficulty in swallowing, queried pulmonary aspiration. Initially managed by Intravenous Infusion [IVI], Nil By Mouth [NBM] and the passing of a Naso Gastric Tube [NGT] to decompress/aspirate the stomach.

Had a right Cerebral Vascular Accident [CVA] three years ago that left her with a left sided hemiplegia. Several extensions to her CVA since initial, resulting in moderate dysphagia. Speech and Language Therapist [SALT] has been advising on management of the patient’s dysphagia and the Dietician advising on diet including dietary supplements.

Transferred to the rehabilitation unit for monitoring and rehabilitation including mobilisation and diet. Noted to have a pressure sores on her left heel and left external malleolus. Pressure sores managed by mechanical and chemical debridement and various dressings recommended for the management of malodorous wounds. Occasional urinary incontinence particularly nocturnal diurnally appears to be continent.

Ability to mobilise severely affected by her hemiplegia requiring the aid of a Zimmer frame plus person to mobilise and two people for transfers. The team recommend discharge to a care home as she deemed unsuitable for discharge to her home as she would no be able to manage self care. Initially reluctant to agree to the care home suggestion preferring instead to be discharged home. Ultimately, agrees to be discharged to a local nursing home and is discharged on day seventy-six.

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