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

Profile of Adult Patient Case 00-041

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Profile of Adult Patient Case 00-041

Document summary

Thirty year old Female admitted for laparoscopic Cholecystectomy.

Post operative recovery complicated by internal bleeding and urinary retention. The internal bleed resolved itself without any need for operative intervention. Haemoglobin levels fell sufficient to require blood transfusion with two units of whole blood and Fe medication. It is not clear from the medical or nursing record what explained the urinary retention. Treated with urinary catheterisation the urinary retention apparently resolved in twenty-four hours.

Discharged home on day six.

Profile of Adult Patient Case 00-042

Document summary

This fifty-nine year old gentleman was admitted to the surgical ward as a planned admission for an Open Cholecystectomy. His previous medical history included a bowel resection thirteen years ago.

The operation was performed and post operatively the patient’s condition remained stable, although there is evidence that the patient complained of extreme pain to the wound site. An ultrasound scan of the patient’s abdomen was performed and it is presumed that the result of the scan was normal as the patient was later discharged after a period of eight days in hospital. A follow up appointment is arranged for him to return to the ward six days later for a wound check and removal of sutures.

Profile of Adult Patient Case 00-043

Document summary

This sixty three year old gentleman was admitted into hospital as a planned admission for an

anterior resection of the bowel. Having initially visited his GP four months earlier with a history

of passing blood suspected as bleeding haemorrhoids, further investigations confirmed a

diagnosis of recto-sigmoid carcinoma.

His previous medical history included a Transient Ischaemic Attack (TIA) three months earlier,

hypertension he has also recently been treated for bronchitis. He recently gave up smoking,

after previously smoking fifteen to twenty cigarettes per day. He normally drinks

approximately one litre of spirits per week.

The procedure was performed, however several days following the procedure he began to

experience abdominal pain and his abdomen was reported to be distended. Following a

review by the medical team, a laparotomy was performed which confirmed a leakage to the

anastomosis following the surgery. The operation resulted in the patient having a colostomy;

post operatively he was transferred to a High Dependency Unit (HDU). Post operatively, his

condition appeared to improve and he was later transferred to a ward. Following further

treatment he was eventually discharged home with follow up care after a period of thirty-seven

days in hospital.

Profile of Adult Patient Case 00-044

Document summary

Acute admission with Right Iliac Fossa pain (RIF). Sudden onset RIF pain constant dull ache; intermittent sharp pain; Pain increases when laying flat; vomited coffee ground; nauseated occasionally. Diagnosed with acute appendicitis.

Appendecectomy performed moderately inflamed appendix found, terminal ileum caecum normal. Uneventful post operative recovery. Home on antibiotics.

Profile of Adult Patient Case 00-046

Document summary

Acute admission with intermittent Right Upper Quadrant pain (RUQ) for past four days increasingly severe on day of admission. Pain associated with bilious vomiting that relieved the symptoms. Pain radiates to the back and she has been shivering ? Rigors.

Has had Ultrasound Scan (USS) recently that reported a Gall Bladder (GB) full of calculi and a soft tissue mass within Common Bile Duct thought very unlikely to be a tumour.

Symptoms settled on conservative treatment including antibiotics. Underwent uneventful open Cholecystectomy on day sixteen. Uneventful post operative recovery apart from one episode of fluid overload causing oedema (requiring rings to be removed) treated with diuretics.

Histology of the gall bladder reported an adenocarcinoma completely enclosed and therefore excised with the gall bladder. Discharged circa day twenty-five.

Profile of Adult Patient Case 00-047

Case summary

Admitted from clinic. Three month history of intermittent burning/crushing epigastric pain. One episode of bilious vomiting and diarrhoea, several weeks of severe itching. Ten day history of increasing jaundice, dark urine, pale stools.

A battery of tests and investigations are performed to establish the aetiology for the jaundice. Ultrasound Scan is reported as normal particularly with no biliary obstruction. Liver biopsy is performed and reported as ….cholestasis and focal lobular inflammation. Extrahepatic (large duct) obstruction and a drug reaction should be considered in the first instance.

Discharged home on day twenty-two with no definitive diagnosis and for follow up in clinic.

Profile of Adult Patient Case 00-050

Case summary

Booked Admission for Right Radical Nephrectomy.

Previous history of Deep Vein Thrombosis (DVT) currently taking anti-coagulants, Warfarin tablets. Made an uneventful post operative recovery, catheter removed on day ten.

Histological examination of the excised kidney reported a tumour …The tumour is a conventional clear cell renal cell carcinoma (Fuhrman grade 2). The tumour is confined to the kidney and no further evidence of sarcomatoid change or vascular invasion is seen. No lymph nodes are identified.

Summary: Right kidney renal cell carcinoma.

Profile of Adult Patient Case 00-051

Case summary

Seventy-year old man, elective admission. Admitted for right Nephrectomy due to carcinoma of the kidney, and incisional hernia repair. Right hemicolectomy two years ago for Ca bowel. Known to suffer from Atrial Fibrillation, treated with Digoxin and Warfarin.

Developed hypotension associated with oliguria in the immediate post operative period, challenged with IV fluids, plasma expanders and blood transfusion. Urine output improved following Frusemide administration. Reported to have bilateral lung creps

Nursing care aimed at general postoperative care for the surgical patient [including wound drain management], care of the urinary catheterised patient, and management of pain using Patient Controlled Analgesia [PCA], blood transfusion/IV fluid maintenance.

No indication from nursing or medical entries if the diagnosis and/or prognosis were discussed with the patient or his relatives.

Discharged from hospital on day twelve, clips removed from a healthy wound. Follow up for INR blood test and referred to haematologist for further management of his Warfarin therapy.

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