Which areas of our nursing assessment should we closely monitor and what are we looking for? He visited the infusion clinic three times in three weeks, where iron dextran 1 gram IV, and erythropoietin 40,000 units IV, were given during each visit. Ulcerative colitis: Epidemiology, diagnosis, and management. outline the formulation, including … When Mary was stable, she was transferred to the direct observation unit (DOU) floor for observation and case management. Diabetes ketoacidosis: Maria Fernandez. An upper GI endoscopy, was normal. What is inflammatory bowel disease? This was procured within 24 hours after the necessary FDA phone calls and paperwork, along with the Johns Hopkins IRB emergency applications. Primary nursing diagnoses for Mrs. Cole include: Risk for decreased cardiac tissue perfusion. Once in the ICU, an NG tube was placed for gastric decompression due to the CT result of a 6 cm dilation of the colon. Notice of Privacy Practices(Patients & Health Plan Members). He was not symptomatic from this anemia (his heart rate was 50 bpm). While in the ED, the nurse inserted an 18-gauge intravenous (IV) to the left antecubital fossa (AC) and administered a 1 L normal saline (NS) bolus. Each student is required to prepare a teaching case to present to his/her colleagues and the course director. describe the pharmacology of the drug. Given his very low hemoglobin, and his risk factors for coronary artery disease, our team decided to obtain a hemoglobin-based oxygen carrier (Sanguinate), in case he developed congestive heart failure or symptomatic myocardial ischemia. His treatment plan included the following regimen given daily: folate 1 mg IV, vitamin B12 1,000mcg SQ, iron sucrose 200 mg IV, and erythropoietin 40,000 units IV. Digital Storytelling Project Case Study Summary, 43. He was recently admitted to another hospital for a pulmonary infection, where he was found to be in atrial fibrillation (AF) and diagnosed with a non-ischemic cardiomyopathy. We continue to monitor COVID-19 cases in our area and providers will notify you if there are scheduling changes. Gastrointestinal Disorder case studies with information on patient presentation, differential diagnosis, immunology discussion and evaluation on your understanding His past medical history included hypertension, type-2 diabetes mellitus, mild aortic stenosis, hematuria, and arterio-venous malformations in the gastrointestinal tract. She claims to have been having diarrhea that “looks kind of bloody” and hasn’t been voiding as often as she “normally does”, approximately twice a day over these past few days. He was sent home on all his prior medications except for Xarelto. Diabetes Ketoacidosis: Maria Fernandez, 35. Clinical Case Study – Gastroenterology & Hepatology Category: Clinical Case Study Serous Microcystic Adenoma of the Pancreas Cystic pancreatic neoplasms represent approximately 15% of all pancreatic tumors.1 Serous microcystic adenomas account for up to … Phlebotomy blood loss was minimized using neonatal tubes, which require about 10% of the blood volume compared to the full adult sized tubes. Mary states, “my stomach hurts so much I can barely take the pain”. Chronic Obstructive Pulmonary Disease: Jake Dogson, 18. The ED nurse administered 500 mg of metronidazole IV to prevent septic complications. Digital Storytelling Project: Case Study Summary, 41. Case Study: Drug-Induced Acute Interstitial Nephritis, 42. shock from perforation, sepsis). Areas of nursing assessment we want to closely monitor include a focused GI assessment, signs and symptoms of shock, and pain (related to dilation of colon).We would also monitor our lab values for any further indications that may show infection, fluid/electrolyte imbalances, and decrease in Hct/Hgb. Outside of Maryland (toll free) 410-464-6713 Request an Appointment Medical Concierge Services, International Patients +1-410-502-7683 Request an Appointment Medical Concierge Services. Enter the last name, specialty or keyword for your search below. Lastly, she met with case management and was educated on ulcerative colitis support groups and an appointment was schedule in May with her primary healthcare provider for follow-up. Congestive Heart Failure (CHF): Mary Lou Poppins, 7. 38. Her strengths in both upper and lower extremities are slightly weak and her daughter states that her mother has been “dizzy when getting up and has difficulty walking at times”. Medical Student Case Studies. 30 Gastrointestinal Case Study. Digital Storytelling Case Study Summary: Brian Smith, 20. The following is a scenario of a patient with toxic megacolon: Mary Cole, a 50-year-old female with a known history of ulcerative colitis (UC) and anemia, was driven to the emergency department (ED) by her daughter, Cindy, on April 11, 2019, just after 1000. She received an additional dose of 2 mg morphine sulfate IV push and reassessed after 15 minutes, stating a pain of 6/10; continuous pain assessment and management were performed. Request your next appointment through MyChart! Xarelto was discontinued upon admission and he was placed on aspirin 325 mg/day. Case Study: Gastroenterology Severe Gastrointestinal (GI) Bleed Secondary to Xarelto with a Hemoglobin-based Oxygen Carrier (Sanguinate) Available as Precautionary Measure A 78-year old man who is one of Jehovah’s Witnesses presented with fatigue and weakness along with a 4-week history of maroon colored stools. There was slight skin tenting at her clavicle and she admitted to not being able to “eat or drink very much over the past few days” due to her abdominal pain and discomfort. Hgb, Hct). describe the disease. What are the primary nursing diagnosis for Mrs. Cole? Mayo Clinic Proceedings, 89(11), 1553-1563. http:dx.doi.org/10.1016/j.mayocp.2014.07.002. Low urine output case study with questions and answers - for doctors and medical students exams, finals and OSCEs. Vital signs were taken in the ED showing a blood pressure (BP) of 96/50, heart rate (HR) 113 bpm, respiratory rate (RR) of 29, tympanic temperature of 38.9°C, oxygen saturation (O2 sat.) All rights reserved. Her abdomen is visibly distended and tender/firm upon palpation. General Diagnostic Case Studies. Upon further assessment, Mrs. Cole appeared uncomfortable and was quietly crying and lying on her left side with her knees flexed and arms holding her abdomen. What other possible diagnoses should be considered and ruled out? Although the Sanguinate was obtained, its use was not necessary since the patient did not exhibit symptoms, despite severe anemia, and responded well to the erythropoietic therapy. A. Inflammatory bowel disease (IBD) is an autoimmune disease characterized as a chronic inflammatory condition of the gastrointestinal tract. His hemoglobin upon admission was 4.1 g/dL, which decreased to 3.1 on the 3rd day after admission. Other possible diagnosis that needed to be ruled out include: bowel obstruction peritonitis, pancreatitis, peptic ulcer, and kidney stones. Basson, M. D. (2018). Case study level 1 – Ulcerative colitis. She is tachycardic and has a clear S1S2 heartbeat with diminished pedal pulses; tachypnea is noted, lung sounds are clear in all lobes. Biggest concern related to bowel perforation from toxic megacolon is infection from bacteria being released into abdomen; this places the patient at risk for septic shock. Mary was prescribed 400 mg of hydrocortisone IV to decrease inflammation and her pain was being monitored and managed with scheduled IV infusion of acetaminophen (Ofirmev) 1000 mg every 6 hours and 1 mg morphine sulfate IV push for breakthrough pain. Mary’s labs revealed the following: elevated C-reactive protein of 16, positive antineutrophil cytoplasmic antibodies (ANCA), Hgb: 7.8, Hct: 23%, Platelets: 100,000, WBC: 13000, potassium: 3.3, sodium: 128, pH: 7.26, HCO3: 18, CO2: 31 (metabolic acidosis), lactic acid of 3.8, and the stool showed presence of blood and WBCs. Lactic acid was monitored every two hours until the levels fell below 2; she received Zosyn IV running at 25 mL/hr every four hours.
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