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

Profile of Adult Patient Case 01-060

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Profile of Adult Patient Case 01-060

Case summary

This eighty three year old gentleman was admitted to the ward via his GP with a history of passing dark stools and had several episodes of shaking or ‘rigors’. His past medical history includes Arthritis, Atrial Fibrillation (AF), a Myocardial Infarction and Urinary frequency. He is on various medications including warfarin.

On admission, he is found to have bilateral pitting oedema to his feet for which he is treated with medication. Various investigations were undertaken during his stay in hospital and it is suspected that he has had a Gastro intestinal bleed for which an Endoscopy procedure is planned; however this was later deemed not to be necessary. Following some amendments being made to the patient’s medication throughout the period of his stay, his condition improved.

The nursing management for this patient includes a referral to the Occupational therapist and the Physiotherapist and communications with the Continence Nurse.

Following a seven-day stay in hospital the patient was discharged to his home address with home care. An appointment is made for him to attend the Anti-Coagulant clinic.

Profile of Adult Patient Case 01-061

Case summary

This seventy-six year old lady was admitted via the Accident and Emergency (A&E)

Department with dyspnoea and a cough. She had a previous medical history of a recent

Myocardial Infarction (MI) and a Left Hip Replacement for a fractured Neck of Femur for which she was still attending the Orthopaedic Out Patients Department.

Following admission she was treated for a suspected Pulmonary Embolism (PE), this diagnosis was later confirmed following a series of VQ scans. It was proposed that the PE was secondary to a Deep Vein Thrombosis (DVT) however an Ultrasound proved to be negative for a DVT. She was treated with Anti- Coagulant medication and oxygen therapy.

The nursing management for this patient included a referral to the Physiotherapist and the

Liaison Nurse.

There is some evidence within the medical notes that some family members complained about the lack of communication during previous admissions into hospital. They also questioned why the patient had suffered from recurrent chest infections. There is evidence that the doctor responded to this complain by explaining the suspected diagnosis to them and the planed investigations.

There was some confusion regarding whether or not the patient could weight bear on her left leg, however after being seen by the Orthopaedics and the Physiotherapist, it was suggested that she was able to partially weight bear on the left leg.

The patient was expected to be transferred to another ward for rehabilitation once medically well, however she did voice some concerns that she did not want to go for rehabilitation but that she wanted to stay with her daughter. Following a further assessment by the

Physiotherapist it was agreed that once deemed medically well, she could be discharged to her daughter’s house and that she did not require rehabilitation.

Following a period of twenty days in hospital, this lady was discharged to her daughter’s house. Further appointments were arranged for her to attend the Orthopaedic clinic and the

Anti Coagulant clinic as an Out-Patient.

Profile of Adult Patient Case 01-062

Case summary

This eighty-eight year old lady was admitted into hospital via the Accident and Emergency (A&E) Department with a history of headaches for two days. Ten days prior to this admission she had attended A&E after falling and sustaining an Occipital Haematoma.

The previous medical history for this patient included Atrial Fibrillation (AF), recurrent Transient Ischaemic Attacks (TIAs) and a suspected Cerebral Vascular Accident several years earlier.

Following admission into hospital it was suspected that she could have a brain injury, she was initially treated with analgesia and Intravenous fluids. However a Computerised Tomography (CT) scan was performed which revealed no recent changes.

The nursing management for this patient included referrals to the Occupational Therapist, Physiotherapist and Social Worker.

After a ten-day stay in hospital, she was discharged to her home address with support from her family and social services.

Profile of Adult Patient Case 01-063

Case summary

This sixty six year old lady was admitted as an elective admission to the Ear Nose and Throat (ENT) department for a Right Labyrinthectomy. She had a three-month history of dizziness and deafness with transient facial palsy for which she was being treated with Stemetil.

The surgical procedure was performed and post operatively she was treated with Stemetil and Intravenous antibiotics. She initially required some assistance with mobility due to being unsteady when walking. However she successfully recovered during the postoperative period. The nursing management for this lady included a referral to the physiotherapist. The initial planned discharge date was delayed as it was felt that she would not manage at home.

However, as her condition improved, she was discharged following a nine-day stay in hospital. An Out Patient appointment was arranged for two weeks later.

Profile of Adult Patient Case 01-064

Case summary

This eighty-four year old gentleman was admitted as an elective admission to the Ear Nose and Throat (ENT) Department for an Endoscopic Stapling of Pharyngeal Pouch. This procedure was arranged after the patient was experiencing difficulty swallowing food and was only able to tolerate a soft diet.

The past medical history for this patient included a left sided Brain Stem Haemorrhage, Atrial Fibrillation (AF), Ischaemic Heart Disease (IHD), and a Transurethral Resection of the Prostate (TURP). He had also been treated for Methicillin-Resistant Staphylococcus aureus (MRSA) in the past.

During the procedure a Naso-Gastric tube is inserted and following the procedure he is treated with Intravenous fluids and feeding is commenced via the Naso-Gastric Tube. The gentleman suffered from an episode of urinary retention and was therefore catheterised, it was suspected that he had a Urinary Tract Infection and he was commenced on antibiotics.

The nursing management for this patient included a referral to the Dietician and Social Services.

He was discharged home following a ten-day stay in hospital with an Out Patient appointment for three weeks later.

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