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

Profile of Adult Patient Case 01-004

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Profile of Adult Patient Case 01-004

Case summary

Sixty-four year old female acute admission with abdominal pain that originally thought to be non Specific Abdominal pain [NSAP]. Abdominal X-Ray demonstrated free air under the hemi-diaphragm that confirmed the diagnosis of perforated Duodenal Ulcer. Taken to operating theatre for overseeing of the ulcer. Medical plan included: Urinary catheter passed to monitor urinary output, IV fluids + antibiotics, Naso Gastric Tube [NGT] and Nil By Mouth [NBM]. Cared for in the immediate post operative period in High Dependency Unit [HDU].

Nursing care/management related to support for a patient undergoing abdominal surgery, monitoring of vital signs including urine output, management of the patient with intravenous infusion, management of the surgical wound. The patient had some mobility problems on the ward that were managed by the use of a Zimmer frame and later with walking sticks for post discharge. Evidence of input from several health care professionals including Occupational Therapy [Ot], Medical Social Worker [MSW], Physiotherapy and Dietician.

Made an uneventful post operative recovery and was discharged home on day twelve.

Profile of Adult Patient Case 01-005

Case summary

Sixty-eight year old female admitted via A&E with history of acute, severe abdominal pain. Complex medical past history including total right and partial left Nephrectomy for Ca, metastatic papillary thyroid Ca, Colectomy, Cholecystectomy, Hysterectomy known Angina and COPD sufferer.

A raised serum Amylase of 1026 confirmed the primary diagnosis of Pancreatitis [reported by the admitting doctor as being secondary to alcohol] chest infection and anaemia [Hb 7.8] also noted [diagnosed]. Medical plan included Nil By Mouth [NBM] IV fluids, IV antibiotics, urinary catheterisation, steroids and analgesia.

Ultrasound and CAT scan both reported a retroperitoneal mass probably inflammatory arising from the pancreas.

Nursing management included care of the acutely ill patient, monitoring of urine output, monitoring blood glucose levels. Care of the patient undergoing oxygen therapy [nebulisers], IV therapy including IV antibiotics and blood transfusion. Evidence of family support.

Patient made a good recovery and was discharged on day twelve for follow up in outpatients and repeat CT scan of abdomen in two weeks.

Profile of Adult Patient Case 01-006

Case summary

Thirty-nine year old man admitted as an emergency via A&E with severe abdominal pain. The patient was discharged from hospital recently [two days prior to this admission] following an episode of severe epigastric pain similar to the pain causing this admission. Admitting doctor’s impression was gastritis or pancreatitis with a significant functional overlay.

Steadily at first and then more rapidly he deteriorated over a three-day period confused, disorientated, sweating. Taken to theatre for a laparotomy where he was found to have an infracted small bowel, which was resected. Unfortunately 10 days after his first operation he developed an anastomotic leak requiring a second laparotomy. He spent a long time ventilated and breathing spontaneously on the intensive Care Unit. The underlying cause for the intestinal infarction was never fully determined although it was highly suspicious that this was due to some form of thrombophilia. He was therefore, anti-coagulated.

The surgeon notes in his discharge letter: “At all times he made massive efforts to help himself to get better and I believe that he may not have survived if he had not exhibited such strength of character”…… “He is truly a remarkable man.”

Nursing care relates to the management of the patient in pain, monitoring and recording vital signs and responses to treatments, catheterised patient and intravenous infusion. Records of care from ICU are missing.

Patient was discharged approx fourteen weeks following admission on Warfarin and for follow up CT scan as an outpatient.

Profile of Adult Patient Case 01-007

Case summary

This patient is a fifty-seven year old gentleman who was admitted into hospital via the Accident and Emergency Department with abdominal pain and distension. His previous history consisted of an Illeostomy for Ulcerative Colitis and Insulin Dependent Diabetes Mellitus (IDDM).

On admission into hospital he was found to have a reduced output to the stoma and a reduced urine output. He was also unable to tolerate diet and fluids due to vomiting. He was reported to have some weight loss over a period of several months.

He was initially treated with Intravenous (IV) fluids and medication. A naso-gastric tube was inserted due to vomiting and a urinary catheter was inserted. Whilst in hospital various investigations and procedures were undertaken which included a Laparotomy and small bowel resection and anastomosis.

Post operatively he developed a chest infection and was transferred to a High Dependency Unit for intensive monitoring and the insertion of an arterial line. His condition stabilised and he was transferred back to the ward twenty-four hours later.

The nursing management for this patient includes a referral to the Dietician, Physiotherapist, Tissue Viability Nurse, Social Worker and Diabetic Specialist Nurse.

His condition gradually improved and he was discharged to his sister’s address after forty- four days in hospital.

Profile of Adult Patient Case 01-008

Case summary

Thirty-nine year old male admitted as an emergency via A&E with a one-day history of sudden onset of abdominal pain [thirty minutes after taking food] associated with vomiting.

Diagnosed as biliary colic confirmed by ultrasonic evidence of presence of gallstones in a tender gall bladder.

Treated conservatively by nil by mouth, intravenous infusion and intravenous antibiotics.

Nursing management related to care and management of the patient: in acute pain, acute emergency admission, nil orally, Intravenous infusion and antibiotics, fluid balance monitoring.

Patient made an unremarkable recovery and was discharged on day five with follow up appointment and referral for laparoscopic cholecystectomy.

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