This seventy-seven year old gentleman was admitted to the ward from the Accident and Emergency (A&E) department after being found collapsed at home on the floor. He had been discharged from hospital five days prior to this after being treated for a Myocardial Infarction (MI).
On admission into hospital he was confused and it is unclear whether he had lost consciousness and the length of time that he had been on the floor. The initial diagnosis was thought to be related to an infection; a chest Infection or a urine infection, however these were ruled out and he was later found to have had a Cerebral Vascular Accident (CVA).
After one week in hospital he became less confused and his condition gradually improved, although he remained unsteady when mobilising and required assistance.
Whilst in hospital he was reported to be urinary incontinent mainly at night, a bladder scan was undertaken and the patient agreed to have a long term urinary catheter inserted.
The nursing management for this patient included referrals to Social Work Department, Occupational Therapy and Physiotherapist. The Social Worker felt that the patient required twenty-four hour care as he was not managing at home with a care package, however the patient expressed that he wanted to be discharged home. He was therefore transferred to another ward for a period of rehabilitation prior to being discharged home, he was in hospital for a period of thirty-nine days. An Out Patient follow up appointment was arranged for three months time.
Profile of Adult Patient Case 01-056
This sixty-seven year old gentleman was admitted to the ward via the Accident and Emergency department after waking one morning with a right-sided weakness.
His previous medical history includes Diabetes Mellitus (Type 2), Hypertension and raised cholesterol. Following various investigations a diagnosis of a Cerebral Vascular Accident (CVA) is made, for which he is treated with medication and rehabilitation.
The nursing management for this patient includes a referral to the Physiotherapist, Occupational Therapist, Social Worker and Dietician.
There is some evidence to suggest that the patient and his wife are experiencing marital problems which are revealed when the patient is being assessed for discharge. His wife feels that she does not feel able to help him with his hygiene and refuses to do so. There is also one episode within the period of hospitalisation when the patient becomes quite abusive towards a member of nursing staff.
After a period of rehabilitation, totalling to eighty-four days in hospital the gentleman is discharged to his home address, with support from the community rehabilitation team.
Profile of Adult Patient Case 01-057
This seventy-six year old gentleman was admitted to the ward via his GP, the GP reported that the patient needed further investigations for spinal problems and lower back pain. However on admission, the main problem appeared to be his reduced mobility due to a loss of balance. He was admitted following a fall where he had banged his head and lost consciousness for approximately ten minutes.
His previous medical history includes Chronic Renal Failure, Hypertension, Myocardial Infarction, Hypercholesterolemia and Peripheral Vascular Disease. He attends the hospital for Haemodialysis three times per week.
Whilst in hospital various investigations were undertaken to determine the cause of the abdominal pain, including an Abdominal Ultrasound scan. He was later diagnosed and treated with antibiotics for a urine infection. There is some comment in relation to the patient having Parkinson’s disease although there doesn’t appear to be any confirmation of this diagnosis. Whilst in hospital, he was found to have a necrotic toe and there is also evidence to suggest that he had Methicillin-Resistant Staphylococcus Aureus (MRSA).
This gentleman lives alone and although it is apparent that he wishes to go into a Residential home he requests to initially be discharged to his home address so that he can sell his house. The nursing management for this gentleman includes referrals to the Occupational Therapist, Social Worker, Physiotherapist, Infection Control Nurse and Podiatrist.
Following an assessment by the Social Worker, it is felt that he does not require full time care although provisions are made for him to continue to receive ‘Meals on Wheels’ as he was prior to the admission.
On the day of discharge there is some evidence that he refuses to take the medication, however the discharge goes ahead and he is discharged home after a period of twenty-four days in hospital.
Profile of Adult Patient Case 01-058
This seventy-six year old gentleman was admitted from the Anti Coagulant Out-Patient’s clinic with a three day history of Haematuria. He has a previous medical history of Prostrate Carcinoma, a Deep Vein Thrombosis (DVT) several years ago to the right leg and was diagnosed with a DVT six weeks prior to this admission, also to the right leg. He had a resistance to Warfarin and was therefore taking Phenindione.
During his stay in hospital the Haematuria stopped and he was reviewed by an Urologist. It was suggested that the Haematuria was secondary to the anti coagulant therapy. A Kidney and Bladder Ultrasound was arranged to rule out the possibility of any obstruction.
The nursing management for this patient included a referral to the dietician due to raised cholesterol levels.
His condition improved and he was discharged home after a total of fifteen days in hospital.
Profile of Adult Patient Case 01-059
This eighty-four year old gentleman was admitted via the Accident and Emergency department with a history of chest pain and dyspnoea. His past medical history included Epilepsy and Hypertension.
Various investigations were performed which revealed that he was Anaemic for which he was treated with a blood transfusion. He was provisionally diagnosed with a Gastro Intestinal (GI) bleed however an Endoscopy investigation proved to be normal. He was also treated for and Congestive Cardiac Failure (CCF) with medication.
A full blood count (FBC) post transfusion was found to be within the normal limits and he was later discharged to his home address following an eleven-day stay in hospital. A follow up appointment was arranged for him to have a Barium Enema investigation as an Out Patient.