CASE STUDIES FOR MANAGEMENT OF MED-SURG PATIENTS.Case 1Doris Lochan, is a 54-year-old female admitted to the Accident & Emergency Department at the San Fernando General Hospital on Thursday January 30th, 2021 at Sam. On arrival to the Accident and Emergency department inthe San Fernando General Hospital, she was alert and oriented to time, person, and place, she was in distress due to severe pain, she complained of fever, nausea and vomiting, abdominal pain 8 out of 10 on pain scale,protruding hernia, constipation. Patient vital signs Temp 38.8 Celsius Pulse 136 bpm Respiration 22bpm Blood Pressure 160/102 mmHg Blood Sugar 306 mg/dl Spo2 97 % Urinalysis Blood + Glucose ++Patient was examined by Dr. R who found that her bowel sounds were normoactive on auscultation, abdomen was generally soft. but a firm, focally tender mass was noted in the left lower quadrant. Local examination revealeda 4 cm mass palpable in the navel region. Plan ordered as follows:L.Abdominal ultrasound 2. Morphine stat 3.Nifedipine 60mg stat 4. Regular insulin 10 units stat 6. For Urinary Cather insertion 7. IV access insertion 8. Ringers Lactate 2L/24_(9). Monitor vitalsUltrasound findings indicate that the patient has a Strangulated Hemia, free fluid was noted between the loops of bowel within the hernia sac. Patient was sent to the surgical unit (Ward 3) for further management.Admission NotesPatient was admitted to Ward 3 from Accident and Emergency department on January 30, 2021 at 2pm. Patient came on a trolley accompanied by her daughter and an attendant. Patient came in with complaints of pain, nausea.vomiting, and fever. PMH Type 2 Diabetes, Hypertension, Hypothyroidism, and Rheumatoid arthritis PSH Total knee replacement. Allergies: no known food or drug allergies. Family History Patient's father had a history oftype 2 diabetes; patient mother had a history of type 1 diabetes, pancreatitis, and cerebrovascular accident. Obstetrics History Gravida – 2 Para gravida -1, Patient last period was on - June 2015 Social History Ms Lalchan statesthat she doesn't smoke and use illicit substances and verbally reports very occasional alcohol use mostly wine.On Admission Patient respiratory rate is normal, IVI in progress on right arm 600ml of ringers lactate in bag, 20ml of light yellow urine in bag. Patient is oriented to time place and person. Vitals upon Admission P 110bpm R20bpm T 37,6 CB.P 150/77mnhg Spo2: 100% RBS: 255mg/dL Patient was seen by the surgical doctors and diagnosed as strangulated hernia. Plan as follows: (1.) Admit of surgieal ward 3 (2). 2L in 24 hours Ringers Lactate(3.) insulin sliding scale (4.) morphine 10mg PRN (5.) Nifidipine 60mg (6.) in case of fever administer 1000mg of Pandol (7.) chnse blood reports (8.) prep for emergency surgery (9.) Patient is to sign consent form (10.) NPOstatus; Diabetic diet after surgeryEvents leading to adımission.Prior to coming into the hospital, Ms. Lalchan claimed that she was tiling her kitchen while everyone was out on Christmas eve day. She stated that she wanted to finish the project and no one was aroundoffloaded five bags of thinset from her truck and she carried all the tiles herself She finishod the job of laying down all the tiles in one evening. On Christmas Day, Ms. Lalehan said it still bad a few things to do around thehouse like cutting the grass, so she picked up the weed wacker like she nomally does and she cut the grass early in the morning. Ms. Lalchan states that because she lives aloue she does the outside work as well as inside choreson her own. The daughter visits of and on but works in Port of Spain so she doesu't have much time to help her. Ms. Lalchan also goes to the gym, lifts small weights wlule working out and likes to go on hikes and runmarathons, After the holidays Ms. Lalchan started to feel strange she thought it was due to all the work she did and the food she ate during the holidays so she didn't pay any attention to it. A few days after Ms. Lalchan startedo help so she 2361011213marathons. After the holidays Ms. Lalchan started to feel strange she thought it was due to all the work she did and the food she ate during the holidays so she didn't pay any attention to it. A few days after Ms. Lalchan startedto get a pain near her belly button and groin area, she realized she wasn't able to use the bathroom for a few days which she found was strange so she took two Ducolax tablets and when she did use the bathroom she found bloodcoming out. As the days went by Ms Lalchan symptoms became more intense with fever and vomiting as well as swelling and tenderness to the abdomen area these signs lead her to come into the Accident and Emergency.1415Laboratory TestNormal RangePatient ValuesBlood glucose60-100mg/dl90Serum Sodium133-145mmol/1128Serum Potassium3.5- 5.3mmol/L2.3Neutrophils2-7 x 109 /L7.8Platelets150-410 x 10^9 L298Haemoglobin12-15 g/dl11.4White cell count4-10 x 109/L11.7Post OperationMs. Lalchan had laparoscopic hernia repair surgery done under general anaesthetics during surgery minimal blood loss. vital signs was stable, Ringers Lactate 1000mls was infused. Patient returned to ward and was placed inbed and positioned in a left lateral position. Patient vitals were monitored every 30min till stable then q4hrly. Patient was drowsy from anaesthetics but oriented to time, place, and person. Medical officer plan for patient: I.Pethidine 75mgs and Gravol 50 mgs g6h x 1 day 2. Liquid paraffin 15mls daily 3. monitor vitals 4. If any complications such as bleeding, swelling, or fever notify medical officer. Pt. verbalizes that she couldnot understand whysuch complications can occur since she already had surgery.QuestionsPart A. Medical /Surgical Management.Part B. Nursing Management1. What is the surgery done on this patient and why was it needed?|1. Recommendations: Explain what the patient should do in the future to contirue recovery improve his or her condition.

Hernia It is a protrusion of an organ or tissue outside its normal body or through an abnormal…

Answered: Post Operation Ms. Lalchan had…

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ