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

Profile of Adult Patient Case 00-062

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Profile of Adult Patient Case 00-062

Case summary

Thirty-one year old Female admitted with abdominal pain left upper quadrant. Known to have Gall Stones and is currently on the waiting list for cholecystectomy. Recent episode of Pancreatitis caused by a migrating gall stone, recent miscarriage. On admission Serum Pancreatic Amylase raised confirming the diagnosis of Pancreatitis which was treated conservatively with IV Fluids and Nil By Mouth [NBM]. Ultrasound demonstrated a distended Common Bile Duct [CBD], gall stones and ‘sludge’ in the Gall Bladder.

Recovered quickly from her Pancreatatic episode and went to have laparoscopic cholecystectomy during the current admission from which she made an uneventful postoperative recovery, discharged home on day thirteen.

Nursing management related to care of the patient with an acute abdomen including IV fluid replacement, monitoring of pain, NBM management, general pre and postoperative care.

Profile of Adult Patient Case 00-065

Case summary

Eighty-year old male admitted with chest pain and acute shortness of breath (SOB). Known to suffer from angina but pain leading up to admission was the worse ever with no relief. ECG on admission suggested an arteroseptal myocardial infarct [MI] confirmed by follow up ECG’s. Thrombolysed with streptokinase. Developed some disorientation and left sided weakness following thrombolysis that may have been a consequence of his MI or due to treatment [iatrogenic]. Some discussion with his family in the early stages of his treatment regarding resuscitation options, the prognosis was described as ‘guarded’ by the medical team. Son agreed to resuscitation and non invasive ventilation but did not think that his father would want Intensive Care Support including mechanical ventilation.

Chest X-Rays and chest auscultation both confirmed pulmonary oedema treated with high doses of diuretics in the first instance tipping the patient into dehydration requiring gentle rehydration with intravenous Infusions of Normal Saline. Despite his guarded prognosis he went on to make a good recovery and was discharged home on day eleven following his admission.

Nursing management related to intensive systemic monitoring and support in the early admission period to advise on cardiac rehabilitation prior to discharge. Good evidence of family support and communication throughout the inpatient stay.

Profile of Adult Patient Case 00-066

Case summary

This eighty year old lady was admitted as an emergency admission to the medical ward via the Medical Assessment Unit with chest pains. Her previous medical history includes Pulmonary Embolism (PE), Iron deficiency anaemia and Angina. She is known to be allergic to penicillin.

She is initially treated for unstable angina although following investigations do not confirm this diagnosis. There is some evidence that she has postural hypotension whilst in hospital. After several days in hospital her condition improves, although she does expresses some concerns about going home. She lives with her husband whom she is the main carer for. She normally has home care and uses a stair lift.

The nursing management for this patient includes a referral to Social Services, Physiotherapy and Occupational Therapy. Having been seen by the Occupational Therapist and the Physiotherapist, arrangements were made for her to be discharged home with the home care package re commenced. She was in hospital for a total period of fourteen days.

Profile of Adult Patient Case 00-067

Case summary

This seventy nine year old gentleman was admitted into hospital as an emergency admission with a left sided weakness which had left him unable to get up at home. It was initially suspected that the cause of the weakness was a result of a Cerebral Vascular Accident (CVA) or Transient Ischaemic Attack (TIA). Prior to admission, this gentleman lived alone and was fully independent with all activities of daily living.

He is known to be an ex smoker and he is allergic to Augmentin. His previous medical history includes investigations for Haematuria, for which he was under the care of a consultant Urologist. He had undergone a cystoscopy investigation five months prior to this admission.

Throughout the duration of his stay in hospital he has episodes of night incontinence and haematuria; he is therefore referred and seen by an Urologist for assessment. The nursing management for this patient includes a referral to a Speech and Language therapist for assessment and referrals to the Occupational Therapist and Physiotherapist.

Despite being offered some help from the Occupational Therapist, there is evidence within the documentation that the gentleman refuses any intervention or help at home as he feels that he will cope independently when he returns home.

This gentleman is in hospital for a total period of sixteen days, throughout this period his mobility improves and he is able to walk up and down stairs independently. He is discharged to his home address.

Profile of Adult Patient Case 00-080

Case summary

Forty-eight year old female emergency admission via GP with increasing shortness of breath [SOB]. Known chronic chest necessitating frequent admissions for treatment last admission four weeks ago. Cigarette smoker for the past thirty-five years admits to still smoking five cigarettes per day, adamant she will quit smoking this time.

Blood gases were taken frequently and reported raised pCO2 reduced pO2 with associated acidosis. SOB treated with O2 and bronchodilators and she gradually improved over the course of her admission and was discharged on day fourteen.

Nursing management related to care of the breathless patient including O2 therapy and monitoring of arterial blood gases. No record in the nursing notes that advice on smoking cessation techniques were discussed with the patient despite her declared intention and resolve to quit smoking ‘this time’.

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