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

Profile of Adult Patient Case 00-052

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Profile of Adult Patient Case 00-052

Case summary

Fifty-eight year old lady admitted for Hysterectomy and anterior repair. The reason for the hysterectomy is not explicit in the medical notes or nursing notes.

Mother died from pulmonary embolism and both of her two sisters were blood tested positive for factor V Leiden. In view of the history innohep and the fitting of TED stockings were prescribed. Uneventful postoperative recovery. Nursing care related to general pre & postoperative nursing care including care of the urinary catheter, IV infusion, peritoneal drain and pain management. Discharged on day six on innohep and TED stockings for follow up as an outpatient.

Profile of Adult Patient Case 00-053

Case summary

Thirty two year old female admitted for bilateral ovarian cystectomy.

Discharged without any procedure on first admission because of a sore throat treated with penicillin. Re-admitted six weeks later and underwent surgery.

Uneventful postoperative recovery apart from some urinary retention that required urinary catheterisation. Nursing care relating to general pre & post operative nursing care. Discharged on day five.

Profile of Adult Patient Case 00-054

Case summary

Forty-five year old female admitted for Total Abdominal Hysterectomy [TAH]. Long time sufferer with Dysmenorrhoea and Menorrhagia, inter uterine fibroid noted on examination.

Developed a fever and pyrexia post operatively attributable to a wound infection with staphylococcus and streptococcus. Treated with antibiotics and made a full recovery. Otherwise an uneventful post-operative recovery.

Nursing care relating to general pre and post operative management including management of Intra Venous fluids, indwelling urinary catheter, patient controlled analgesia, wound drain and general wound care.

Discharged home on Antibiotics on day ten post operative.

Profile of Adult Patient Case 00-055

Case summary

Seventy-two year old male admitted to 'AMU' (assume Acute Medical Unit) from outpatients clinic for investigations of increasing shortness of breath and chest pain, subsequently transferred to a medical ward. Ex-smoker (stopped 12 years ago). Has lost 2 stone in weight over last 2 months on a diet (weighs 16stones 10lb [106kg])

Fully investigated including radiological investigations conducted: Chest X-ray CT abdomen CXR shows large left pleural effusion & cardiomegaly some radiological evidence of a cardiac tamponade but no supporting clinical evidence. Possible malignancy of the heart considered and discussed with the patients relative but discounted on subsequent radiological evidence [MRI] that reported a resolving picture.

Generally improved over the duration of his in-patient stay with his shortness of breath resolving. Twenty-two day stay in hospital.

Profile of Adult Patient Case 00-056

Case summary

This forty seven year old lady was admitted into hospital as an emergency admission via her GP with increasing shortness of breath and pyrexia. She was known to have lung fibrosis and is awaiting a heart and lung transplant. She was also known to be allergic to iodine.

The cause of the increasing shortness of breath was believed to be due to infective exacerbation of lung fibrosis. She was therefore treated with a course of oral antibiotics, steroids and nebulised saline and oxygen therapy. There is evidence within the notes that she expresses anxiety regarding the heart and lung surgery that she was awaiting, however there is no evidence to suggest how this was managed.

Over a period of seven days in hospital her condition improved and she was discharged home. Arrangements were made for her to have an oxygen cylinder installed in her home for use when required.

Profile of Adult Patient Case 00-058

Case summary

73-year-old retired male

Planned admission for femoral popliteal bypass surgery

History of claudication in left leg when walks less than 50 yards. Same in right leg when walks 100 yards.

Previous medical history: Cerebra Vascular Accident (CVA) 1 year ago, multiple Transient Ischemic Attacks (TIAs)

Smoker (5-6 per day)

Femoral Popliteal bypass surgery performed under general anaesthetic. Post operative Doppler examinations demonstrated a patent well functioning graft.

Nursing management related to general pre and post operative care including care of wound suction drains, pain management, Intravenous fluid management, and mobilisation.

Profile of Adult Patient Case 00-059

Case summary

Fifty-seven -year-old male

Planned admission for parathyroidectomy

Previous medical history: Removal of pituitary adenoma in 1995 resulted in panhypopituitarism. Entered into a research study [growth hormone depletion] and found coincidentally to be hypercalcaemic. Non-smoker, occasional alcohol, occupation: Engineering instructor.

Developed tingling in his hands and face and a positive Chvostek’s sign suggested hypocalcaemia [tetany] confirmed by a low blood Ca 2+ .Hypocalcaemia treated by oral calcium. Nursing care related to care of the pre/postoperative patient including management of IV fluids, pain management and management of the suction drain.

Discharged on day five for early follow up.

Profile of Adult Patient Case 00-061

Case summary

This sixty two year old gentleman was admitted as a planned admission for an Aortic Aneurysm Repair. His previous medical history includes Ischaemic Heart Disease, and a Cerebral Vascular Accident (CVA) he is also known to be hypertensive and takes various oral medications including Warfarin. He is the main carer for his wife who is known to have Multiple Sclerosis (MS)

Prior to the surgery he is weaned off the Warfarin tablets and commenced on intravenous heparin. The surgical procedure is performed and he is transferred to a High Dependency Unit (HDU) post operatively. During the initial post operative period on HDU there is some evidence that his condition becomes unstable and he is treated for hypovalaemia. His condition is stabilised and he continues to recover successfully throughout the remainder of his hospital stay. He is recommenced on Warfarin therapy.

The nursing management for this patient includes a referral to the Physiotherapist during the postoperative period. He is discharged home following a total of fourteen days in hospital with an appointment one day later to monitor his blood coagulation levels. A further appointment is arranged for him to attend the Out Patients department six weeks later.

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