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Case Study For Discussion

This document describes 5 cases involving patients admitted to the hospital: 1. Joyce Red Wing, 44, is admitted for a laparoscopic cholecystectomy to treat cholelithiasis manifested by abdominal pain after eating fatty foods. 2. William Cunningham, 65, is found to have rectal adenocarcinoma on biopsy and is scheduled for surgery involving removal of part of the colon and formation of a colostomy. 3. A 68-year-old man with COPD is admitted in respiratory distress due to an exacerbation from cold, rainy weather and started on oxygen, IV fluids and medications. 4. George Harvey, 61, is diagnosed with

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137 views3 pages

Case Study For Discussion

This document describes 5 cases involving patients admitted to the hospital: 1. Joyce Red Wing, 44, is admitted for a laparoscopic cholecystectomy to treat cholelithiasis manifested by abdominal pain after eating fatty foods. 2. William Cunningham, 65, is found to have rectal adenocarcinoma on biopsy and is scheduled for surgery involving removal of part of the colon and formation of a colostomy. 3. A 68-year-old man with COPD is admitted in respiratory distress due to an exacerbation from cold, rainy weather and started on oxygen, IV fluids and medications. 4. George Harvey, 61, is diagnosed with

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Siti nur Kholifatus samsiyah
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© © All Rights Reserved
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CASE 1: A Client with Cholelithiasis

Joyce Red Wing is a 44-year-old married mother of three children. A member of the
Chickasaw tribe, she is active in tribal activities and works part time as a cook at a
community kitchen. Recently Mrs. Red Wing has noticed a dull pain in her upper abdomen
that gets worse after eating fatty foods; nausea and sometimes vomiting accompany the pain.
She had a similar pain after the birth of her last child. She is diagnosed with cholelithiasis,
and is admitted for a laparoscopic cholecystecomy.
ASSESSMENT
David Corbin, RN, takes Mrs. Red Wing’s admission history. It includes intolerance to fatty
foods and intermittent “stabbing” abdominal pain that radiates to her back. Her usual diet
includes tacos or fried bread and biscuits with gravy for breakfast. She reports “not wanting
to eat much of anything lately.” She states she has never had surgery before and hopes
“everything goes well.” Physical assessment includes T 100° F (37.7° C), P 88, R 20, and BP
130/84. She has had a recent 5 lb weight loss, currently weighing 130 lb (59 kg). She is 63
inches (160 cm) tall. Abdominal examination elicits tenderness in the right upper abdominal
quadrant. She has no jaundice, chills, or evidence of complications.

CASE 2: A Client with Colorectal Cancer


William Cunningham is a 65-year-old retired railroad employee, husband, and father of three
grown children. For the past 3 months, Mr. Cunningham has noticed small amounts of blood
in his stools and occasional mucus. He has a sensation of pressure in the rectum, and notices
that his stools are smaller in diameter, about the size of a pencil.After palpating a mass on
digital examination of the rectum, the physician orders a colonoscopy. A large sessile lesion
is found in the rectum and biopsied.The pathology report shows the lesion to be
adenocarcinoma. Mr. Cunningham is scheduled for an abdominoperineal resection and
sigmoid colostomy.
ASSESSMENT
Madonna Hart, RN, completes the admission assessment. Mr. Cunningham states that his
bowel habits have recently changed, but denies pain or other symptoms. Physical assessment
findings include T 98.4 F (36.9° C), P 82, R 18, and BP 118/78. He is 70 inches (178 cm) tall
and weighs 185 lb (84 kg). Laboratory findings are normal except for the previous pathology
report of adenocarcinoma of rectal lesion. Mr. Cunningham states,“I really don’t want a
colostomy, but if that is what it takes to get rid of this, I’m ready to get it over with.”
CASE 3: A Client with COPD
Data A 68-year-old man was admitted to the hospital for severe shortness of breath and
inability to care for himself at home. He was diagnosed with chronic obstructive pulmonary
disease (COPD) about 9 years ago, most likely related to his 40-year history of cigarette
smoking. He is widowed, lives alone, and ordinarily manages his care and disease without
difficulty. The patient states that the cold, rainy weather has made his breathing much worse
over the past couple of days. He complains of being
severely fatigued and short of breath. Physical examination reveals a thin appearing man who
is diaphoretic, leaning forward in a sitting position, and in obvious respiratory distress.
Vital signs are temperature, 100.8° F orally; heart rate, 104 beats/min; respiratory rate, 36
breaths/min and labored; and blood pressure, 146/92 mm Hg. He has wheezing and crackles
throughout all lung fields. Humidified oxygen is initiated at 2 L/min via mask, 5% dextrose
in water (D5W) is started at 75 ml/hr, and 125 mg of methylprednisolone (Solu-Medrol) is
administered intravenously. The respiratory care department is notified to provide the patient
with an immediate breathing treatment as the nurse initiates
an aminophylline drip.

CASE 4: A Client with Gastric Cancer


George Harvey is a 61-year-old estate attorney who lives with his wife, Harriet. For the last 3
months,Mr.Harvey has had increasing anorexia and difficulty eating. He has lost 10 pounds.
His physician has diagnosed gastric cancer, and Mr. Harvey is admitted for a partial
gastrectomy and gastrojejunostomy.The oncologist has recommended postoperative
chemotherapy and radiation. Mr. Harvey reports that the doctor told him “that will give me
the best chance for cure.”
ASSESSMENT
On admission before surgery, Mr. Harvey tells his nurse, Lauren Walsh, that he has eaten
very little in the past few weeks. He asks, “What will happen to my wife if something
happens to me? I’m afraid this cancer will get me.”Mr.Harvey weighs 147 lb (67 kg) and
is 72 inches (183 cm) tall. He is pale and thin; his vital signs are BP 148/86, P 92, R 18, and
T 97.8° F PO. A firm mass is palpable in the left epigastric region.The rest of his physical
assessment data are within normal limits. Mr.Harvey’s hemoglobin is 12.8 g/dL, hematocrit
is 39%, and serum albumin level is 3.2 g/dL, indicating that he is mildly malnourished. All
other preoperative laboratory and diagnostic studies are within normal limits.
CASE 5: A Client with Alcoholic Cirrhosis
Richard Wright is a 48-year-old divorced father of two teenagers. Mr.Wright has been
admitted to the community hospital with ascites and malnutrition.He has had three previous
hospital stays for cirrhosis, the most recent 6 months ago.
ASSESSMENT
Mr.Wright is lethargic but responds appropriately to verbal stimuli. He complains of “spitting
up blood the past week or so” and says,“I’m just not hungry.” He has lost 20 lb (9 kg) since
his previous admission. He is jaundiced and has petechiae and ecchymoses on his arms and
legs. Liz Mowdi, Mr.Wright’s nurse, notes pitting pretibial edema. Abdominal assessment
reveals a tight, protuberant abdomen with caput medusae. The liver margin is not palpable;
the spleen is enlarged. Vital signs are T 100°F (37.7°C), P 110, R 24, and BP 110/70.
Abnormal laboratory results include WBC 3700/mm3 (normal 4300 to 10,800/mm3); RBC
4.0 million/mm3 (normal 4.6 to 5.9 million/mm3); platelets 75,000/mm3 (normal 150,000 to
350,000/mm3); serum ammonia 105 μm/dL (normal 35 to 65 μm/dL); total bilirubin 4.9 μ
g/dL (normal 0.1 to 1.0 μg/dL); and serum sodium 150 mEq/L (normal 135 to 145
mEq/L).Potassium, hemoglobin, hematocrit, total protein, and albumin levels are markedly
decreased. Hepatic enzymes are elevated. Blood urea nitrogen and creatinine levels are
marginally elevated. Oxygen saturation (O2 sat) is 88% (normal range: 96% to 100%) per
pulse oximetry. Endoscopy shows bleeding from gastric ulcer, and the diagnosis of alcoholic
cirrhosis with gastritis is made. Mr. Wright is started on Aldactone, 25 mg PO q8h; Riopan,
30 mL 2 hr p.c. and hs; lactulose, 30 mL q h until onset of diarrhea, then 15 mL t.i.d.; and
low-protein, 800 mg sodium diet; fluid restriction of 1500 mL/day.

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