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

Profile of Adult Patient Case 00-023

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Profile of Adult Patient Case 00-023

Document summary

Eighteen year old male, elective admission with hyperthyroidism, for Thyroidectomy.

Noticed weight loss three months ago and associated palpitations. Visited GP who diagnosed Thyrotoxicosis (Grave’s). Started on Carbimazole – initially good response.

Last 2-3/52 – feels tired/weak.

No palpitations; ↑ tremor;

Heat intolerance ++; No double vision;

No discomfort; No grittiness. Sore throat settled now.

Weight ↑ by approximately 2 stone since two months.

No real improvement or response to Rx therefore admission for surgery.

Swallowing poor -difficult with solids. ‘Bread’ feels stuck ½ way down. Large goitre and thyroid bruit noted.

Underwent total Thyroidectomy. Uneventful poet operative recovery with no signs of tetany, Chvostek’s sign negative, Trousseau’s sign negative; no hoarseness. Felt his strength was returning, noted abdominal and chest acne developed post operatively.

Profile of Adult Patient Case 00-024

Document summary

List case admission for Aorta Bifemoral Bypass.

He suffers from Claudication pain bilaterally at ten yards for the past twelve months or more; stopped smoking one year ago.

Had a routine stay in High Dependency Unit (HDU) immediately post op and then transferred back to the surgical unit for further recovery and rehabilitation.

Post recovery complicated by groin and abdomen wound haematomas that ultimately caused the wounds to become necrotic requiring mechanical and chemical debridement with Eusol and Paraffin.

Finally discharged on day forty four on antibiotics and care of the district nurse for continued management of the wound break down.

Profile of Adult Patient Case 00-026

Document summary

Acute emergency admission via AE. Presenting Complaint: woken from sleep – 02.00hrs with burning central chest pain radiating into throat. Similar pain yesterday, burning. Settled sufficiently with Gaviscon to allow sleep. Also describes similar problems previously.

Known sufferer from Ischemic Heart Disease, Angina and had previous suffered a Myocardial Infarction (MI).

Fully investigated for MI including series of Electrocardiograms (ECG) that showed no new changes. Diagnosed as oesophagitis or gastritis and treated conservatively with Antacids.

Discharged on day eight.

Profile of Adult Patient Case 00-028

Document summary

Acute admission with history of sudden onset of Shortness of Breath (SOB) about 1½ hours ago; dull ache in chest before breathlessness. No nausea / vomiting / sweating. Has had admissions in the past for ‘water round the heart.’

Diagnosed as Left Ventricular Failure (LVF) and cardiac dysrhythmia. Treated with diuretics and settled quite quickly. Echocardiogram showed moderate LVF.

Threatened to sue NA because he developed a large haematoma on the dorsum of his hand following removal of a Venflon. Patient became very upset about this and told the N.A to “cover herself because his solicitor was going to hear about this”. The doctor saw the patient and explained that the haematoma formation was unfortunate but occasionally happened. When asked about his concerns he said that it looked awful and would take months to go away. He was worried about what people would think had happened to him in hospital and that he would be left with a black hand forever. No indication of how this resolved.

Discharged home on Day 11 on Ramipril 2.5 mg to be increased to 5mg over the next three to four weeks.

Profile of Adult Patient Case 00-031

Document summary

Acute admission with left sided weakness and drooping on left side of face, slurring of words.

Diagnosed as hypertension and left hemiparesis.

CT scan of the brain revealed infarct in the thalamus region, carotid artery Doppler detected no abnormalities (NAD).

Patient made steady progress with the left sided weakness resolving. Fully assessed by Occupational Therapy staff for transfer capabilities, bed to chair, toilet etc, dressing and washing and kitchen skills. Fully independent in all activities of daily living (ADL).

Discharged home on day eleven with anti hypertensive medication (ACE inhibitor).

Profile of Adult Patient Case 00-033

Document summary

Fifty-eight year old lady acute admission. Chest pain for past 2 hours compressing type of pain, radiating to shoulders and jaw; associated with sweating and nausea. History of palpitations no history of SOB / cough with expectoration / fever.

She is a known patient with lateral wall ischemia diagnosed by Thallium scan two weeks ago and hypertension. ECG on arrival; at A&E showed some heart block and ectopics (unfortunately ECG not available to the study). No evidence of an myocardial infarct, symptoms thought to be attributable to underlying Ischemic Heart Disease

Treated conservatively and discharged home on day seven with follow up in cardiology clinic.

Profile of Adult Patient Case 00-039

Document summary

71 year old male - Elective admission for sigmoid colectomy. Sigmoidoscopy revealed large sessile polyp; Metaplastic / hyperplastic polyp; No dysplasia/malignancy. Histological examination of the resected sigmoid colon reported Diverticular disease including diverticular abscess.

Did well early post operative period but then developed a swollen right on day eight. No evidence of cellulitis and a good pedal pulse led the medical staff to investigate for Deep Vein Thrombosis (DVT). Patient underwent Doppler Venogram Right Lower Limb: that was reported as no evidence of DVT. Around this time developed a wound swelling that was thought to be possibly a haematoma or fluid collection but the wound remained intact. Became acutely short of breath on day fifteen, chest X-Rays at the time suggested pleural effusions in both lung bases and she was treated as chest infection Augmentin prescribed.

Apart form some wound pain investigated by Ultrasound Scan she made steady and good progress and was discharged home on day twenty-four.

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