Eighty-five year old male emergency admission via GP presenting with absolute constipation for the past four days. Diagnosed as a bowel obstruction secondary to adhesions [previous Appendecectomy] CT scan of the abdomen demonstrated/confirmed a small bowel obstruction.
Treated conservatively and his abdominal symptoms settled down quickly. Passing flatus and tolerating free fluids by day 4. Developed acute retention of urine that required urinary catheterisation, known to have Prostatism. Trial without catheter unsuccessful requiring re-insertion.
Nursing management related to monitoring and observation of treatment regimes, care of the patient: when nil by mouth, with intravenous infusion in situ, with urinary catheter in situ.
Discharged home on day eighteen care of GP and social services. For readmission in six weeks for further trial without catheter.
Profile of Adult Patient Case 00-094
Eighty year old female admitted via GP with a twenty-four history of intermittent right sided abdominal pain associated with low grade pyrexia. Ultrasound scan demonstrated a gall stone.
Treated conservatively with nil by mouth, Intravenous Fluids, Intravenous Antibiotics. Responded well to treatment and quickly progressed to diet and fluid intake. Developed itchy skin, the aetiology of which was not determined, treated with Piriton.
Nursing management related to observation and monitoring of treatment regimes, care of the patient who is nil by mouth and having Intravenous fluid replacement.
Discharged home on day six care of daughter with social services and dietician referrals.
Profile of Adult Patient Case 00-095
Twenty-three year old female. Acute admission via emergency doctor with history of abdominal pain localised in the right iliac fossa. Diagnosed as acute appendicitis and treated by Appendecectomy.
Nursing management related to observation and monitoring of treatment regimes, care of the pre and post operative patient including intravenous fluid replacement and intravenous antibiotics. Settled quickly following surgery and was discharged home on day four.
Profile of Adult Patient Case 00-120
Case summary This sixty three year old lady was admitted as an emergency admission with increasing shortness of breath and apyrexia. She has a past medical history of Chronic Obstructive Pulmonary Disease (COPD), Anterior Myocardial Infarction and a Hernia repair.
Her condition is normally well controlled with medication including home oxygen when required. She is an ex smoker and she lives alone in a flat.
She was diagnosed with exacerbation of COPD for which she was treated with oxygen therapy, antibiotics and nebulised medication. The nursing management for this particular patient includes a referral to the Occupational Therapist for assessment.
Following an eight day period of stay in hospital she is discharged home with a follow up appointment to attend the Out Patients Department.
Profile of Adult Patient Case 01-001
Fifty eight year old female admitted as an emergency with severe abdominal pain in the Right Upper Quadrant radiating to her back associated with nausea. Known to suffer from ME and usually feels unwell.
Diagnosed as an acute Cholecystitis. Ultrasound scan demonstrated a solitary gall stone impacted in the gall bladder neck. Reported has having a high body mass index and the patients weight was recorded [on the TPR Chart] as 87.2kg but no height measurement is recorded.
Medical treatment consisted of intravenous Anti Biotic therapy, pain relief. She made an uneventful recovery apart from one episode of chest tightness treated with Salbutamol. Discharged on day seven with follow up cholecystectomy in the near future. Nursing care related to monitoring of response to treatments, management of pain, management of Intravenous infusion.
Profile of Adult Patient Case 01-002
Seventy-four year old female elective admission for sub-total Gastrectomy. Endoscopy revealed prominent antral lesion and biopsies at the time showed abnormal cells histological examination reported high grade dysplasia. CT scan one prior to admission reported no intra abdominal spread of gastric lesions. There was no overt evidence of carcinoma but in view of the histology the MDT felt it appropriate to recommend sub-total gastrectomy.
A D2 sub-total gastrectomy was performed was performed on day two of the admission and the patient was recovered in ICU for twenty four hours prior to transfer back to the surgical ward. Medically the patient made an uneventful post operative recovery. Seen by dietician on three occasions regarding advice on meals content and portion size, recommended small nutritious meals regularly.
Nursing care related to monitoring of condition and general post operative nursing care including: care of the catheterised patient, care of the patient with Naso Gastric tube, care of the patient with IV fluid replacement, care of the wound, diet control and monitoring.
Patient made an uneventful all round recovery and was discharged home on day seventeen following admission care of district nurse and GP.
Profile of Adult Patient Case 01-003
Sixty-one year old female acute admission with pyrexia, rigors, nausea and a discharging wound. Diagnosed as having developed enterocutaneous fistulae.
Recently discharged from the surgical ward after having had a reversal of Hartmann’s procedure and two further laparotomies to a leak at the anastomosis site. What is confusing is that the patient still has a colostomy.
Treated conservatively with antibiotics, restricted fluids and low residue diet in the first instance, later TPN via long line. The fistulae failed to close spontaneously leading to surgical intervention to formalise the enterocutaneous tract followed later by laparotomy and direct closure. Post operatively the wound broke down and was discharging faecal fluid. Faecal fluid oozing via the wound was thought to be secondary to constipation and this was treated with enemata via the stoma leading to some improvement in the amount of faecal discharge.
Nursing management was complex and required input from stoma therapists, tissue viability nurses and pain specialists. Discharges from the wound and fistulae were very caustic to the surrounding skin leading to marked excoriation and pain caused by a rawness of the skin. Dehiscence of the wound complicated the management of the discharging fistulae through application of protective flanges and stoma bags as it was difficult to maintain adherence to the skin leading to frequent failure of the seal and fistula discharge onto the skin.
Not surprisingly, the patient became very low and depressed at the protracted progress towards recovery. However, she did eventually make a recovery with the wound intact and apparently healed. She was discharged seventy-seven days after admission to the care of district nurse for daily dressings.