Wednesday, May 29, 2013

CASE: 96 years old woman, previously healthy

I'll be starting doing case studies, just in case you can help me with these. There will be a lot of loopholes, not all of these cases have management and follow ups. Names are fictional and I will write any name that pops in my head. So the hospital and name of patients will be coincidental if it the same with a real place or person. Oh well, here it goes.

Patient EG, 96 years old is a healthy woman living in the bario with her daughter's family. She usually plays with her granddaughter who is just 3 years old. They usually walk around the place and plays ball with him. She usually have vegetable and meat for meals. She has no known disease and was never hospitalized or been into an accident.

2 days prior to admission, she woke up feeling a bit weak to walk on her own. Her daughter gave her some medication called "Skelan (naproxen)" thinking that EG might be having some joint problem. After a few hours the patient felt relieved and was able to walk on her own again.

1 days prior to admission, the weakness was more severe and generalized unabling her to even get up from the bed. She was given again the medication Skelan but provided no relief. She stayed sitting on her bed for that whole day while her daughter cared for her, giving her small amount of food (because the patient can't tolerate to eat more than 3spoonfuls) and assisting her to the toilet. A few minutes after having her dinner, the patient vomited a small amount of blood. She said not to worry about it and she feels fine aside from the weakness she's experiencing.

Morning prior to admission, the patient become lethargic and would only respond when being talked to. Few hours later, she become stuporous and would just be awaken by vigorous shaking. And they remembered that This prompted them to bring her to the nearest primary hospital in the bario. At the emergency, a military doctor was on duty. After assessing the condition, she asked if the patient is a smoker because of the vomiting of blood and would like to order a chest X-ray to check if the patient has TB. The daughter thinking that TB is least likely, she took the patient and brought her to the hospital at the town proper. 

The patient was brought to the emergency room. Vital signs where checked (BP= 110/70, Temp=36.5C, RR=14, PR=80), CBC came out normal, Urinalysis is insignificant. The patient hasn't passed stool for almost 2 days now. LOC is still stuporous. The patient was then brought to a private room and was regularly checked by student nurses and staff nurses.

The patient is unable to eat even with a soft diet so the daughter gives her "Ensure" Milk supplement. Daughter insists on giving her Ensure because she doesn't want her mother to be intubated. Intubation will mean that the patient will soon depend on machines to live. It's been a 3 days since the patient passed bowel so the doctor requested for a laxative. He gave an enteric coated tablet to the nurse to be given to the patient immediately. And since the patient can't eat foods, she crushed the enteric coated tablet and let the patient drink it. After a few hours the patient passed a great amount of stool.

The neurologist visited as requested by the family. The neurologist as described by the family was unprofessional. The lady doctor kept shouting at the patient, shaking her head, and even raising her voice to the relatives of the patient. After that incident, the family requested to the doctor not to visit them again due to her rude behavior. No assesment and instructions was received by the family after that.

That night, the patient's O2 sat fluctuated from 98 to 27 and it goes on. The breathing was noisy and labored. The pulse was weak and the BP is 70 palpatory. The patient was immediately brought to the ICU for close monitoring. The nurse then informed the family that the patient needs to be intubated in order to proceed with life support. The family decided to just let the patient rest in peace and avoid extreme interventions to prolong life. They perceive that it will just make the patient suffer more. After a few hours, the nurse informed the family that the patient died.



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