Celiac Disease Case Study: Liz Galvin, 25. Contact us or find a patient care location. Unbound Medicine, Inc. (2014). Ulcerative colitis workup: approach considerations, serologic markers, other laboratory studies. Basson, M. D. (2018). Aspirin 325 mg/day, and iron sulfate 325 mg/day were recommended upon discharge. What are the major concerns with toxic megacolon related to bowel perforation? Myocardial Infarction (MI): Bob Carlson, 10. Please continue to call your providers with health concerns. 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. Upon auscultation, she has hypoactive bowel sounds in all four quadrants and her pain is noted to be in the left lower quadrant. Case study level 1 – Ulcerative colitis. Nursing Case Studies by and for Student Nurses, Creative Commons Attribution-NonCommercial 4.0 International License. Chronic Kidney Disease: Kevin Ulyses Blanco, 12. A colonoscopy revealed a transverse colon polyp but no active bleeding. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. 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. He was not symptomatic from this anemia (his heart rate was 50 bpm). describe the pharmacology of the drug. An upper GI endoscopy, was normal. Hinkle, J. L., Brunner, L. S., Cheever, K. H., & Suddarth, D. S. (2014). 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.) 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. She was administered 1 mg of morphine sulfate IV push at 1115 for her pain. Primary nursing diagnoses for Mrs. Cole include: Risk for decreased cardiac tissue perfusion. 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. Chronic Obstructive Pulmonary Disease: Jake Dogson, 18. Her labs were closely monitored for electrolyte imbalance and further decline due to possible perforation of the colon (i.e. Once results were in from the labs, x-ray, and CT scan, Mary was diagnosed with toxic megacolon resulting from a flare-up of UC and sent to the intensive care unit (ICU) for close observation and monitoring. Digital Storytelling Case Study Summary: Brian Smith, 20. It is important to remain cognizant of further deviations from the norm in order to prevent bowel perforation and/or treat the patient in a timely manner to reduce the chance of further complications (i.e. His past medical history included hypertension, type-2 diabetes mellitus, mild aortic stenosis, hematuria, and arterio-venous malformations in the gastrointestinal tract. His last hemoglobin was 11.1 g/dL after these three treatments. 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. Each student is required to prepare a teaching case to present to his/her colleagues and the course director. 2. She is tachycardic and has a clear S1S2 heartbeat with diminished pedal pulses; tachypnea is noted, lung sounds are clear in all lobes. Clinical Examination A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, … of 97% on room air, and a pain of 9/10 (using the verbal numeric pain scale) located in her left lower abdominal quadrant that is sharp, constant, and aggravated by movement. Enter the last name, specialty or keyword for your search below. Ulcerative colitis: Epidemiology, diagnosis, and management. Hematologic Disorder (HELLP): Maggie Richmond, 6. His hemoglobin upon admission was 4.1 g/dL, which decreased to 3.1 on the 3rd day after admission. 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. Diabetes Ketoacidosis: Maria Fernandez, 35. Medical treatment was continued in cooperation with the gastroenterologist, intensivist, and surgeons to monitor for sepsis and the need for surgical intervention. Learning outcomes. 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 also had a video capsule endoscopic exam where a small “pill camera” is swallowed and video pictures of the entire GI tract are recorded. Nursing priorities included focused assessments, monitoring for signs/symptoms of shock (perforation) such as rigid abdomen, severe abdominal pain, nausea/vomiting (N/V), fever, chills, and rectal bleeding. Radiology Pathology Correlation Case Studies The ED nurse administered 500 mg of metronidazole IV to prevent septic complications. Retrieved from Woodhouse, E. (2016). Since the half-life of these compounds is relatively short, the concept is to use them as a temporary measure while the erythropoietic regimen is given to promote red blood cell production. We are providing in-person care and telemedicine appointments. Case Study: Drug-Induced Acute Interstitial Nephritis, 42. Gastrointestinal Disorder case studies with information on patient presentation, differential diagnosis, immunology discussion and evaluation on your understanding Diabetes ketoacidosis: Maria Fernandez. She was ordered NPO for bowel rest. 37. Digital Storytelling Project: Case Study Summary, 39. outline the formulation, including … Epigastric pain case study with questions and answers - for doctors and medical students exams, finals and OSCEs . What does current medical literature indicate regarding its etiology? General Information | Self-Checker | Donate and Lend Support | Staff Appreciation | Get Email Alerts. Case Study Summary: Michelle Audrey Guila, 29. Gastrointestinal case studies Karen Baxter. This was procured within 24 hours after the necessary FDA phone calls and paperwork, along with the Johns Hopkins IRB emergency applications. Clinical Cases In Gastroenterology and Hepatology Ahmed Adel Abdelhakeem Amin Internal Medicine Department GI & Hepatology Unit Assiut University Hospital firstname.lastname@example.org 2. What are the primary nursing diagnosis for Mrs. Cole? Notice of Privacy Practices(Patients & Health Plan Members). shock from perforation, sepsis). Brunner & suddarth’s textbook of medical-surgical nursing. These measures were required given that Sanguinate (and all other hemoglobin based oxygen carriers) are not yet FDA approved, and are only available for “compassionate use”. Phlebotomy blood loss was minimized using neonatal tubes, which require about 10% of the blood volume compared to the full adult sized tubes. Center for Bloodless Medicine and Surgery, Johns Hopkins Awarded Level I Certification in Blood Management. Other possible diagnosis that needed to be ruled out include: bowel obstruction peritonitis, pancreatitis, peptic ulcer, and kidney stones. 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