Her vitals were reassessed after 20 minutes showing a decrease in BP to 85/47, HR 130, RR 29, tympanic temperature of 38.9°C, O2 sat. Nursing Case Studies by and for Student Nurses, Creative Commons Attribution-NonCommercial 4.0 International License. We continue to monitor COVID-19 cases in our area and providers will notify you if there are scheduling changes. Low urine output case study with questions and answers - for doctors and medical students exams, finals and OSCEs. Although the Sanguinate was obtained, its use was not necessary since the patient did not exhibit symptoms, despite severe anemia, and responded well to the erythropoietic therapy. She is tachycardic and has a clear S1S2 heartbeat with diminished pedal pulses;  tachypnea is noted, lung sounds are clear in all lobes. 37. Case study level 1 – Ulcerative colitis. 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. Hyperglycaemia case study with questions and answers. 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. Retrieved from Woodhouse, E. (2016). Whether you're crossing the country or the globe, we make it easy to access world-class care at Johns Hopkins. The reason for her visit was due to complaints of severe abdominal pain/swelling and bloody diarrhea over the past four days. What does current medical literature indicate regarding its etiology? Her strengths in both upper and lower extremities are slightly weak and her daughter states that her mother has been “dizzy when getting up and has difficulty walking at times”. His past medical history included hypertension, type-2 diabetes mellitus, mild aortic stenosis, hematuria, and arterio-venous malformations in the gastrointestinal tract. He visited the infusion clinic three times in three weeks, where iron dextran 1 gram IV, and erythropoietin 40,000 units IV, were given during each visit. She was ordered NPO for bowel rest. 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. Medscape. 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. When Mary was stable, she was transferred to the direct observation unit (DOU) floor for observation and case management. Nursing Case Studies by and for Student Nurses by jaimehannans is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted. 38. Celiac Disease Case Study: Liz Galvin, 25. 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. Clinical Cases In Gastroenterology and Hepatology Ahmed Adel Abdelhakeem Amin Internal Medicine Department GI & Hepatology Unit Assiut University Hospital ahmed_adel_1984@yahoo.com 2. 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. Learn about our expanded patient care options and visitor guidelines. Aspirin 325 mg/day, and iron sulfate 325 mg/day were recommended upon discharge. 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. What is inflammatory bowel disease? Learning outcomes. The following is a scenario of a patient with toxic megacolon: Mary Cole, a 50-year-old female with a known history of ulcerative colitis (UC) and anemia, was driven to the emergency department (ED) by her daughter, Cindy, on April 11, 2019, just after 1000. Chronic Obstructive Pulmonary Disease: Jake Dogson, 18. Chronic Kidney Disease: Kevin Ulyses Blanco, 12. Outside of Maryland (toll free) 410-464-6713 Request an Appointment Medical Concierge Services, International Patients +1-410-502-7683 Request an Appointment Medical Concierge Services. Myocardial Infarction (MI): Bob Carlson, 10. Digital Storytelling Project Case Study Summary, 43. Please continue to call your providers with health concerns. Xarelto was discontinued upon admission and he was placed on aspirin 325 mg/day. Congestive Heart Failure (CHF): Mary Lou Poppins, 7. Click the links below for relevant case studies. 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. Low urine output case study with questions and answers. He was recently admitted to another hospital for a pulmonary infection, where he was found to be in atrial fibrillation (AF) and diagnosed with a non-ischemic cardiomyopathy. What other possible diagnoses should be considered and ruled out? Enter the last name, specialty or keyword for your search below. His last hemoglobin was 11.1 g/dL after these three treatments. 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. His treatment plan included the following regimen given daily:  folate 1 mg IV, vitamin B12 1,000mcg SQ, iron sucrose 200 mg IV, and erythropoietin 40,000 units IV. Her face was flushed and her skin felt warm and dry to touch. 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. Level 1 case study: You will be able to: describe the risk factors. Case Study: Gastroenterology Severe Gastrointestinal (GI) Bleed Secondary to Xarelto with a Hemoglobin-based Oxygen Carrier (Sanguinate) Available as Precautionary Measure A 78-year old man who is one of Jehovah’s Witnesses presented with fatigue and weakness along with a 4-week history of maroon colored stools. His hemoglobin upon admission was 4.1 g/dL, which decreased to 3.1 on the 3rd day after admission. Basson, M. D. (2018). Clinical Examination A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, … A 78-year old man who is one of Jehovah’s Witnesses presented with fatigue and weakness along with a 4-week history of maroon colored stools. Her abdomen is visibly distended and tender/firm upon palpation. This was procured within 24 hours after the necessary FDA phone calls and paperwork, along with the Johns Hopkins IRB emergency applications. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Which areas of our nursing assessment should we closely monitor and what are we looking for? The hemoglobin level upon discharge on day #7 was 5.1 g/dL. describe the disease. Digital Storytelling Project: Case Study Summary, 41. Mary’s labs (CBC, CMP, cultures) were drawn, an x-ray and abdominal CT scan were performed, and a stool sample was ordered. Mayo Clinic Proceedings, 89(11), 1553-1563. http:dx.doi.org/10.1016/j.mayocp.2014.07.002. Each student is required to prepare a teaching case to present to his/her colleagues and the course director. Retrieved from https://emedicine.medscape.com/article/183084-workup#showall Feuerstein, J. D., & Cheifetz, A. S. (2014). Toxic megacolon: A review for emergency department clinicians. He was placed on Xarelto, one of the newer anticoagulants, as a preventative measure, due to his AF. 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. Hgb, Hct). We are providing in-person care and telemedicine appointments. She received an additional dose of 2 mg morphine sulfate IV push and reassessed after 15 minutes, stating a pain of 6/10; continuous pain assessment and management were performed. © The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Unbound Medicine, Inc. (2014). A colonoscopy revealed a transverse colon polyp but no active bleeding. Mary was prescribed 400 mg of hydrocortisone IV to decrease inflammation and her pain was being monitored and managed with scheduled IV infusion of acetaminophen (Ofirmev) 1000 mg every 6 hours and 1 mg morphine sulfate IV push for breakthrough pain. Hinkle, J. L., Brunner, L. S., Cheever, K. H., & Suddarth, D. S. (2014). Hematologic Disorder (HELLP): Maggie Richmond, 6. Medical treatment was continued in cooperation with the gastroenterologist, intensivist, and surgeons to monitor for sepsis and the need for surgical intervention. Journal of Emergency Nursing, 42(6), 481-486. https://doi.org/10.1016/j.jen2016.04.007. 2. In 15 minutes, her pain was reassessed and was reported as 8/10 using the numeric pain scale. General Information | Self-Checker | Donate and Lend Support | Staff Appreciation | Get Email Alerts. Case 1 53-year-old male complaining of difficult swallowing for the past 3 years, not so progressive, for both liquids and solids, no weight loss, with nocturnal regurgitation. 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”. Diabetes Ketoacidosis: Maria Fernandez, 35. A. Brunner & suddarth’s textbook of medical-surgical nursing. Notice of Privacy Practices(Patients & Health Plan Members). 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. This exam was significant for an arterial-venous malformation (AVM) in the proximal small bowel, which was not actively bleeding at that time. Gastrointestinal Disorder case studies with information on patient presentation, differential diagnosis, immunology discussion and evaluation on your understanding An upper GI endoscopy, was normal. Case Study for STEMI: Who is Kevin Heart? Other possible diagnosis that needed to be ruled out include: bowel obstruction peritonitis, pancreatitis, peptic ulcer, and kidney stones. The ED nurse administered 500 mg of metronidazole IV to prevent septic complications. 96%, and pain still at 9/10. Clinical Case Study – Gastroenterology & Hepatology Category: Clinical Case Study Serous Microcystic Adenoma of the Pancreas Cystic pancreatic neoplasms represent approximately 15% of all pancreatic tumors.1 Serous microcystic adenomas account for up to … 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.) Once in the ICU, an NG tube was placed for gastric decompression due to the CT result of a 6 cm dilation of the colon. Nursing Central (1.22) [Mobile application software]. Given his very low hemoglobin, and his risk factors for coronary artery disease, our team decided to obtain a hemoglobin-based oxygen carrier (Sanguinate), in case he developed congestive heart failure or symptomatic myocardial ischemia. 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