Thirty-four year old female admitted via GP with ‘flare up’ of eczema. Current episode started three weeks ago with rash to her arms, trunk and legs. Treated by her GP with oral steroids and Flucloxacillin. Rash began to clear but one week ago widespread pustular lesions developed over body, face and scalp. Diagnosed in hospital as Chicken Pox treated with topical emulsifying creams and oils and antibiotics. Responded well to treatments. Noted to be anaemic; this was attributed to her reported Menorrhagia. Anaemia treated with iron supplements.
Nursing management related to observation and monitoring of the rash and treatment with IV antibiotics and topical application of various creams. Discharged on day eight following review by dermatologist.
Interestingly, the patient herself did not think the rash was a flare up of her eczema as it felt different to previous flare ups particularly as there was no associated itching.
Profile of Adult Patient Case 00-082
Eighty-two year old male admitted with acute Shortness of Breath (SOB). Referral letter from AMU read:
This gentleman is complaining of dyspnoea on exertion, sometimes he gets breathless even just sitting down, for the last few days it has worsened. He has no chest pain. There is slight pitting oedema in both legs, BP 130/80 HR 68/mt, chest bilateral diminished air entry.
He suffered from hypertension for many years. He has severe osteoarthritis affecting multiple joints and spine and he has Gout. ECG revealed RBBB and LBBB. I am a bit concerned sending him home though his symptoms are not severe. I would be grateful for your opinion.
Formal diagnosis not recorded but ECG changes and congestion noted.
Nursing management primarily aimed at observation and management of his SOB and monitoring response to treatments.
Profile of Adult Patient Case 00-083
Eighty-four year old male ex-miner; acute admission with chest pain, fine all day then went up to bed and felt cold. Went to get a blanket and had chest pain – lasted twenty minutes. Known to suffer from Angina Pectoris and recently developed Diabetes Mellitus [type 2] controlled with diet and oral hypoglycaemic medication. ECG tracings on admission show right bundle branch block and left anterior hemi block but no evidence of acute Myocardial Infarction. Final impression was that the symptoms were due to infective state query viral infection.
Made an unremarkable recovery, discharged home on day four reporting that he was back “to best.”
Nursing management related to observation and monitoring of treatment regimes, including O2 therapy and nebulisers therapy, management of the breathlessness and monitoring of his Diabetes Mellitus.
Profile of Adult Patient Case 00-090
This fifty nine year old gentleman was admitted into hospital with sudden onset of central chest pains lasting approximately forty minutes and shortness of breath. He has a previous medical history of a Myocardial Infarction (MI), Angioplasty and insertion of a Stent, fractured sternum following a road traffic accident, Renal stones, Osteoarthritis, and Fibromyalgia. He is also known to suffer from Depression and Obsessive compulsive behaviour. He is allergic to Aspirin and Ibuprofen. He does not drink alcohol or smoke; he lives at home with his wife and normally walks with the aid of two sticks.
Various cardiac investigations are performed to determine whether the cause of the chest pain is cardiac related, all of which prove to be normal. There is some evidence that his white cell count is elevated. Throughout the remainder of his stay in hospital there is no evidence of further episodes of chest pain, although he does complain that he feels he has symptoms of a head cold.
He remains in hospital for a period of ten days, after which time he is discharged home. On discharge arrangements are made for him to have a twenty-four hour Electrocardiogram investigation (ECG) performed as an Out-Patient.
Profile of Adult Patient Case 00-091
This patient is a fifty three year old lady who was an elective admission for an open cholecystectomy and exploration of the common bile duct.
Her past medical history includes an illeostomy for Ulcerative Colitis, a reversal of the illeostomy, and a hysterectomy. There is also evidence in the medical notes that this patient has no known allergies although in the multidisciplinary notes there is evidence that suggests that she is allergic to Flucloxacillin.
The procedure is performed which involved the removal of stones from the gall bladder, she later she returns to the ward. There is some evidence to suggest that post operatively her condition declines and she requires further treatment, although following this episode her condition does begin to improve.
She remains in hospital for a period of fourteen days throughout which time her condition improves, she is discharged home under the care of the district nursing team. An Out Patient appointment is made for her for six weeks time.
Profile of Adult Patient Case 00-092
This fifty nine year old lady was admitted into hospital via the Accident and Emergency department with abdominal pain. She was under the care of the surgical consultant and had previously been seen in the Out Patients Department where she was diagnosed with a Paraumbilical hernia. There is evidence that she had been advised by the doctor to lose weight. However the pains had become worse over a period of two weeks after lifting heavy items of shopping.
She was admitted on to the surgical ward and arrangements were made for her to go to theatre for surgery for a suspected strangulated hernia. The procedure was performed and the hernia was repaired, she was transferred back to the ward with a drain in situ. Post operatively as her condition improved she was able to eat and drink and the drain was removed. Having spent a total of four days in hospital, she was discharged home following an uneventful post-operative recovery period.