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Stan Jordan is a 64 year married man. Stan has been admitted to hospital for a laparoscopic cholecystectomy following a 6 month history of symptomatic cholecystitis. Initial attempts to remove the gall bladder via laparoscopic cholecystectomy proved difficult due to severe adhesions. The surgeon Dr. Katter proceeded to remove the gall bladder via an open cholecystectomy. Stan is transferred to recovery room where morphine using a Patient Controlled Analgesia (PCA) via a syringe pump is commenced as ordered by the anaesthetist. The client also has a peripheral IV line with Sodium Chloride 0.9% infusing. Stan returns to the ward where his initial postoperative observations were satisfactory.
Pulse 86bpm, BP 142/78, Temp 37 º RR 18. 30 minutes later another set of postoperative observations are attended. His observations are as follows:
Pulse 110 bpm
Blood pressure - 155/96
Temperature - 37.6º
Respiratory rate - 22
Stan states his pain is increasing and he is becoming noticeably anxious.
- As you are attending to Stan’s 30 minutely vital signs you note the change in them. Outline the possible reasons and rationale for the altered vital signs
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- Danielle, a CST at an inner city hospital, is advised of an add-on case of diagnostic laparoscopy for lower abdominal pain in a 28-year-old female. As the surgeon inspected the peritoneal cavity, she found that the appendix was normal; however, there were numerous adhesions involving the adnexal structures. What might the post-operative diagnosis be for what the surgeon found?Stan Jordan is a 64 year married man. Stan has been admitted to hospital for a laparoscopic cholecystectomy following a 6 month history of symptomatic cholecystitis. Initial attempts to remove the gall bladder via laparoscopic cholecystectomy proved difficult due to severe adhesions. The surgeon Dr. Katter proceeded to remove the gall bladder via an open cholecystectomy. Stan is transferred to recovery room where morphine using a Patient Controlled Analgesia (PCA) via a syringe pump is commenced as ordered by the anaesthetist. The client also has a peripheral IV line with Sodium Chloride 0.9% infusing. Stan returns to the ward where his initial postoperative observations were satisfactory. Pulse 86bpm, BP 142/78, Temp 37 º RR 18. 30 minutes later another set of postoperative observations are attended. His observations are as follows: Pulse 110 bpm Blood pressure - 155/96 Temperature - 37.6º Respiratory rate - 22 Stan states his pain is increasing and he is becoming noticeably…Jeanette is a 46-year-old woman who has visited her general practitioner (GP) today, brought in by her husband, Steve, with a 5-day history of nausea, mild abdominal pain and constipation. She decided to see the doctor today, as the pain and nausea were much worse when she woke up this morning and she has vomited twice in the past 3 hours. She also reports her abdomen feels distended and bloated. Jeanette says she had tried to drink more water and eat more fruit and was having bran for breakfast for the past 3 days, as she initially thought she was simply constipated. With the increased generalized abdominal pain and vomiting this morning, she thought she should get a medical opinion. Jeanette has a past medical history of hypercholesterolemia, hypertension, atrial fibrillation and type 2 diabetes mellitus (T2DM) and her BMI is 32 kg/m2. She experienced appendicitis 6 months ago,for which she had an appendectomy. Her current medications are simvastatin, warfarin, and metformin. The GP…
- A 55 year old females patient who is positive for MRSA is having laparoscopic cholecystectomy. During the procedure, the surgeon encounters unexpected bleeding from the liver bed and decides to covert to an open cholecystectomy. Which category of medication will be used during the intraoperative cholangiography segment of the procedure? Name 3 medications from this category.A 55-year-old woman with a prior history of partial colectomy w/colostomy and small bowel obstruction three months ago that resolved with bowel rest and required no surgical intervention. Three days ago Mary developed a sudden onset of sharp generalized abdominal pain with nausea, vomiting and decreased output from her colostomy bag. She has had two small glasses of water today. Mary is admitted to the medical/surgical unit and you will be the nurse caring for her. You receive the following highlights of report from the emergency department (ED) nurse: CT of her abdomen/pelvis revealed high-grade small bowel obstruction. Lactate 2.8, WBC 14.7, Sodium 143, Potassium 3.7, Creatinine 1.35 An NG was placed and she is on low intermittent suction. She had NG output of 225 mL of bile green liquid. Received hydromorphone 0.5 mg IV for pain one hour ago. Abdominal pain decreased from 9/10 to 3/10 and she is resting more comfortably. Abd. is firm, slightly distended, with tympanic bowel sounds.…A 62-year-old man came to the ED (emergency department) with complaints of fatigue, weight loss, jaundice, and anorexia. Diagnostic studies including abdominal CT with contrast, ERCP, and EUS were performed. The CT scan showed a resectable 4-cm mass at the head of the pancreas, and ERCP revealed evidence of bile duct obstruction; a stent was placed to open the duct. Examination of a tissue biopsy specimen obtained under U/S guidance confirmed an adenocarcinoma of the head of the pancreas. Additional studies showed no evidence of hepatic or other metastases. Surgical treatment with a Whipple procedure was recommended. This procedure was performed and included pancreatoduodenectomy, choledochojejunostomy, and gastrojejunostomy. Lymph node removal and cholecystectomy were part of the operative procedure. During surgery, it was determined that the tumor was confined to the head of the pancreas. Despite removal of the tumor, the chance of recurrence is high, with a cure rate of only about…
- A 62-year-old man came to the ED (emergency department) with complaints of fatigue, weight loss, jaundice, and anorexia. Diagnostic studies including abdominal CT with contrast, ERCP, and EUS were performed. The CT scan showed a resectable 4-cm mass at the head of the pancreas, and ERCP revealed evidence of bile duct obstruction; a stent was placed to open the duct. Examination of a tissue biopsy specimen obtained under U/S guidance confirmed an adenocarcinoma of the head of the pancreas. Additional studies showed no evidence of hepatic or other metastases. Surgical treatment with a Whipple procedure was recommended. This procedure was performed and included pancreatoduodenectomy, choledochojejunostomy, and gastrojejunostomy. Lymph node removal and cholecystectomy were part of the operative procedure. During surgery, it was determined that the tumor was confined to the head of the pancreas. Despite removal of the tumor, the chance of recurrence is high, with a cure rate of only about…A 62-year-old man came to the ED (emergency department) with complaints of fatigue, weight loss, jaundice, and anorexia. Diagnostic studies including abdominal CT with contrast, ERCP, and EUS were performed. The CT scan showed a resectable 4-cm mass at the head of the pancreas, and ERCP revealed evidence of bile duct obstruction; a stent was placed to open the duct. Examination of a tissue biopsy specimen obtained under U/S guidance confirmed an adenocarcinoma of the head of the pancreas. Additional studies showed no evidence of hepatic or other metastases. Surgical treatment with a Whipple procedure was recommended. This procedure was performed and included pancreatoduodenectomy, choledochojejunostomy, and gastrojejunostomy. Lymph node removal and cholecystectomy were part of the operative procedure. During surgery, it was determined that the tumor was confined to the head of the pancreas. Despite removal of the tumor, the chance of recurrence is high, with a cure rate of only about…A 62-year-old man came to the ED (emergency department) with complaints of fatigue, weight loss, jaundice, and anorexia. Diagnostic studies including abdominal CT with contrast, ERCP, and EUS were performed. The CT scan showed a resectable 4-cm mass at the head of the pancreas, and ERCP revealed evidence of bile duct obstruction; a stent was placed to open the duct. Examination of a tissue biopsy specimen obtained under U/S guidance confirmed an adenocarcinoma of the head of the pancreas. Additional studies showed no evidence of hepatic or other metastases. Surgical treatment with a Whipple procedure was recommended. This procedure was performed and included pancreatoduodenectomy, choledochojejunostomy, and gastrojejunostomy. Lymph node removal and cholecystectomy were part of the operative procedure. During surgery, it was determined that the tumor was confined to the head of the pancreas. Despite removal of the tumor, the chance of recurrence is high, with a cure rate of only about…
- The patient is male, 50 years old. Chronic liver disease for 15 years. Sudden vomiting 400ml blood. Physical examination: chronic disease appearance, mild yellow discoloration of the sclera. The abdomen was soft without tenderness, the liver and ribs cannot be palpable, and the shifting dullness was positive. The most likely diagnosis is ( ) Biliary bleeding Duodenal ulcer bleeding Bleeding from gastric cancer Esophageal variceal bleeding Hemorrhagic gastritis A 62-year-old male, his back has been red and swelling for 1 week. At first it was a small piece of skin induration of about 3×2cm, with multiple pus spots, then the skin swelling area expanded, infiltrating edema appeared, local pain increased, the surface skin was purple-brown with area about 6×5cm, the body temperature was 39.2℃, and he had diabetes history for 10+ years. The following treatment measures are incorrect for this patient: Remove pus and inactivated tissue The incision line should exceed the edge of the…From your presentation above, list ten (10) differential diagnoses of a 32-year-old woman with a 3-day history of abdominal pains and vomiting.SCENARIO Identifying Data: This 72-year-old female presents with a biopsy proven adenocarcinoma of the sigmoid colon at 20 cm. History of Present Illness: The patient has been noted to have some bright red bleeding intermittently for approximately 8 months, initially presumable of a hemorrhoidal basis. She recently has had intensification of rectal bleeding but no weight loss, anorexia, or obstructive pain. No significant diarrhea or constipation. Some low back pain, probably unrelated. Recent colonoscopy by Dr. Scoma revealed a large sessile (attached by a broad base) polyp, which was partially excised at 20-cm level, showing infiltrating adenocarcinoma at the base. The patient is to enter the hospital at this time after home antibiotic and mechanical bowel prep, to undergo sigmoid colectomy and possible further resection. 1. Using the scenario above, answer the following questions: A. What chronic symptoms did this patient have? Describe the symptoms using medical…