Operative Case Study : Patient Data

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

Mr BW had a surgical history of anterior resection for bowel cancer and had undergone a colectomy post iatrogenic perforation. He had known hypertensive and non-compliant with his medication. At the same time, he was known to be alcoholic abuse, seizure and had prostate cancer, which was treated with brachytherapy that was well controlled.

A visit note from Renu Mehta, MD (Family Medicine), dated 08/02/2017, indicated that the claimant presented with complaints of lower extremity pain and stomach pain. She continued to have abdominal discomfort. She had a history of hematuria and continued to have a 1+ blood. Objective findings showed a BMI of 31.89 with a blood pressure of 105/72. She was diagnosed with an abdominal pain and hematuria. A series of laboratory tests were recommended.

On admission to ICU, the patient should be positioned in fowler 's position, vital signs checked, oxygen is very important since her saturation is 82%. A non-rebreather mask is advisable at this time. Reassurance is very important to calm the patient and the plan of care explained to allay anxiety, calm the patient and ease breathing. Cardiac activities should be monitored continuously in every 10 to 15 minutes with pulse oxymeter, IV assess initiated, medications Beta blockers (Lopressor), Angiotensin-converting enzyme (ACE) inhibitors (Vasotec), diuretics (Lasix), and Morphine Sulphate giving. Laboratory work should be done such as levels of electrolyte, serum creatinine levels, weight and fluid balance. Other serum tests such as BNP, liver function, D-dimer, and CBC should also be done. Telemetry monitoring maintained continued for 24-48 hours after entrance into ICU. Signs and symptoms of congestion should also be monitored daily, intake and output, weight, if there is fluid restriction it should be adhered to, and diet should be according to dietician order such as 2g sodium and no added salt, turn and repositioned to avoid tissue breakdown, exercise according to patient tolerance.

Patients should prepare to have a higher health insurance cost or a higher “out of pocket” costs so they don’t freak out when they get their bill. Patients need to know and understand their health insurance policy, for example brand and generic drug costs, co-pay for doctor visits and etc. They should be assertive in dealing with their own insurers, providers, and case managers. I agree that many of the changes that have led to a managed care system are rooted deeply with the economic realities. Furthermore, I agree that while hospital closings and mergers create many issues and concerns, both the declining number of beds and the declining number of admissions is related to a decline in the number of in-patient

Patient F.C. is a 63-year-old African American male, who presents to the emergency department with intense left upper quadrant pain that radiates to his back and under his left shoulder blade; stating, “It feels like I have a knife in my stomach”. He reports the upper abdominal pain is intermittent, onset 3 weeks ago; however, the pain has been increasing in severity for the past four days. He states “he has been feeling very warm with episodes of nausea for the past 4 days” with a noted an 8-10 pound weight loss in the past 45 days. He denies any diarrhea or blood in his stool; however, he notes a reduction in the frequency of his bowel movements.

Twelve-year-old Hispanic male D.C. presented to Advocate Illinois Masonic Medical Center Emergency Department the morning of May 14, 2015, accompanied by his mother, for complaints of abdominal pain and vomiting that began that morning at 0100. While in the ED, D.C. complained of abdominal pain which he rated ten out of ten, so he was given a GI cocktail with Pepto-Bismol, as well as morphine for pain and Zofran for nausea, and his pain decreased to seven out of ten. Due to D.C.’s complaints of abdominal pain, which included his right lower quadrant, the ED physician caring for him ordered an ultrasound of his appendix. This ultrasound was non-diagnostic, as D.C.’s appendix was not visualized. Because he had a clinical

The patient is a 41-year-old gentleman who was recently discharged from the hospital 2 days ago. He presented back to the ED complaining of nausea, vomiting, abdominal pain and he presented here instead of going to his regularly scheduled hemodialysis. He also stated that he thought he had blood in his stools. He was also complaining of abdominal pain and constipation and requesting IV Dilaudid and IV Benadryl. CAT scan of the abdomen showed wall thickening around the rectum and distal sigmoid, procto-colitis was not excluded. Initially the attending physician has hoped to keep the patient in outpatient status, however he was admitted inpatient. The case was discussed with Dr. Lasheen, it was decided in view of his multiplicity of comorbidities

Client’s abdomen on inspection looks flat and symmetric, without bulging, or visible masses, or any asymmetric shapes. Umbilicus is in midline and inverted without any sign of discoloration, inflammation, or hernia. Further, skin is smooth with even homogenous color, and multiple pigmented circumscribed brown macular and popular nevi (smaller than 1 cm), there are no visible veins, and when skin gently pinched and released, it was immediately returning to original position. No any pulsation observed, like from aorta in the epigastric area, no respiratory movements of any waves or peristalsis are visible. Pubic hair was distributed evenly, in diamond shape. The client observed with benign facial expression and slow even respiration.

A referral to the cardiologist was made to exclude any cardiac causes since the pain Mr. A.M felt was epigastric. Physical examination along with ECG as the preferred test by the cardiologist did not reveille any abnormalities. CBC count and LFT’s were ordered. Mr. A.M was later on referred to a gastroenterologist for focused examination on the gastrointestinal system.

Joan Middleton was presented to the emergency department with acute cholecystitis. It is important to understand the patient’s condition to figure out the underlying cause of the situation. Acute cholecystitis is an inflammation of the gallbladder that involves swelling and irritation in the area due to a gallstone blocking the cystic duct (Schaider, Barkin and Barkin, 2015). A gallbladder is an organ that is located below the liver. Its primary function is to store bile, which the body uses to digest fat in the small intestines. When the bile becomes too concentrated, it begins to form insoluble minerals and salt and these deposits are called gallstones. Small gallstones do not cause any problems if they can be flushed down the bile duct and

The individualized surgical draft was planned for each patient based on detailed scritinization of extensions and vascularity in preoperative imaging .This classification system takes into consideration complex deep-seated anatomical subsites such as quadrangular space and Meckel’s cave that can be accessed endoscopically.The authors noted no inconsistencies between CT and endoscopic findings.It was concluded that preoperative high quality assessment of imaging aids in drafting a step by step surgical strategy to approach

The following case involves 33- year old female patient that presented with signs and symptoms of acute cholecystitis. An early emergency laparoscopic cholecystectomy was performed for this patient within