outline the formulation, including … 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. Retrieved from https://emedicine.medscape.com/article/183084-workup#showall Feuerstein, J. D., & Cheifetz, A. S. (2014). shock from perforation, sepsis). Brunner & suddarth’s textbook of medical-surgical nursing. Ulcerative colitis workup: approach considerations, serologic markers, other laboratory studies. 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 … 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. Hematologic Disorder (HELLP): Maggie Richmond, 6. The hemoglobin level upon discharge on day #7 was 5.1 g/dL. Inflammatory bowel disease (IBD) is an autoimmune disease characterized as a chronic inflammatory condition of the gastrointestinal tract. 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. Case Study for STEMI: Who is Kevin Heart? Mayo Clinic Proceedings, 89(11), 1553-1563. http:dx.doi.org/10.1016/j.mayocp.2014.07.002. Congestive Heart Failure (CHF): Mary Lou Poppins, 7. 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. We continue to monitor COVID-19 cases in our area and providers will notify you if there are scheduling changes. 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. 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. Phlebotomy blood loss was minimized using neonatal tubes, which require about 10% of the blood volume compared to the full adult sized tubes. 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. This exam was significant for an arterial-venous malformation (AVM) in the proximal small bowel, which was not actively bleeding at that time. Low urine output case study with questions and answers - for doctors and medical students exams, finals and OSCEs. Digital Storytelling Case Study Summary: Brian Smith, 20. Epigastric pain case study with questions and answers - for doctors and medical students exams, finals and OSCEs . 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. 2. 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. 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. 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. Case Study Summary: Michelle Audrey Guila, 29. © The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Learn about our expanded patient care options and visitor guidelines. 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. 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. 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”. Mary’s abdominal CT revealed colonic dilation of more than 6 cm in the transverse colon. Mary’s labs revealed the following: elevated C-reactive protein of 16, positive antineutrophil cytoplasmic antibodies (ANCA), Hgb: 7.8, Hct: 23%, Platelets: 100,000, WBC: 13000, potassium: 3.3, sodium: 128, pH: 7.26, HCO3: 18, CO2: 31 (metabolic acidosis), lactic acid of 3.8, and the stool showed presence of blood and WBCs. Philadelphia, PA: Lippincott Williams & Wilkins. Aspirin 325 mg/day, and iron sulfate 325 mg/day were recommended upon discharge. What is inflammatory bowel disease? His hemoglobin upon admission was 4.1 g/dL, which decreased to 3.1 on the 3rd day after admission. She was administered 1 mg of morphine sulfate IV push at 1115 for her pain. Enter the last name, specialty or keyword for your search below. Notice of Privacy Practices(Patients & Health Plan Members). Medical Student Case Studies. Diabetes Ketoacidosis: Maria Fernandez, 35. 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. Which areas of our nursing assessment should we closely monitor and what are we looking for? Digital Storytelling Project: Case Study Summary: Denise Garcia. 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. Mary’s labs (CBC, CMP, cultures) were drawn, an x-ray and abdominal CT scan were performed, and a stool sample was ordered. 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. 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.