Reference no: EM133446316
Emma returns from theatre at 1745, following an open reduction and internal fixation (ORIF) of her fractured wrist, and a fasciotomy (a surgical incision into the fascia tissue to release pressure). Any surgery, however well performed, is an insult to the body and results in trauma and potential complications.
- In addition to pain, what two complications of surgery is Emma at greatest risk of, and how would they most likely manifest (list at least two (2) signs of each complication)?
Scenario 2:
Judith Mason is a previously well 79-year-old woman who has been living independently at home. According to her son, who has brought her into the hospital, she was her usual self when he spoke with her last night, but when he visited her this morning she was confused, disoriented, and hallucinating.
Her vital signs are: T° 37.8C, RR 18, SaO2 97% on air, PR 88, BP 105/70
Her GCS is 13: she obeys directions, and spontaneously eye-opens, but is disoriented to time and place; her pupils are equal and reactive, her limbs have equal strength, and she has no difficulty speaking or swallowing. Mrs. Mason's medical history is confined to four healthy pregnancies, an appendectomy when she was 20, and a fractured ankle in 2005 after a mechanical fall. She takes no regular medication or supplements, was a light smoker until 1974 (when she quit), and she drinks a glass of wine most days. She has been diagnosed with a urinary tract infection.
- Think about the information given in the case study and identify test/s that would confirm this diagnosis of urinary tract infection?
- Mrs. Mason is usually very well for her age, with no comorbidities or regular medication. Does this mean she is less vulnerable to age-related complications this admission? What kinds of complications are more common in patients aged above 60 during an acute admission? Name a minimum of two age-related complications.
- When you help Mrs. Mason to transfer from the emergency trolley to her bed, you notice that she is unsteady on her feet, Who should you refer her to? List two (2) healthcare professionals
Scenario 3:
Vikram Kaur presents to the emergency department with 24/24 of nausea, vomiting, abdominal cramps, and diarrhea; he is 23, has no significant history, and is not taking any medications or supplements.
His vital signs are: T 37.4, HR 110, RR 16, BP 105/70, SaO2 97% on air.
His girlfriend Jasmine is with him and tells you she had the same symptoms a day or so ago, though not as severely, and feels fine now.
What is the main issue for Vikram? How would you assess this?
Alvin Floyd, a 53-year-old man presented with symptoms of uncontrolled diabetes mellitus (polyuria, polyphagia, polydipsia, and unexplained weight loss).
He had been in good health until about two months ago when he started to feel weak and tired more rapidly than usual. On questioning, he admitted to getting up two or three times a night to urinate. He also is often thirsty at those times and drinks a glass of water each time.
His weight had been average through high school, where he had been on the football team. After leaving school, he had gradually gained weight over the years. His appetite remained excellent but he now was losing weight and becoming weak.
On questioning, Alvin reports that noticed cuts on his hands are taking much longer than usual to heal, his vision is blurry, and he's developed dark patches under his arms.
Medical history
Appendectomy 1972, hypertension, gastroesophageal reflux
Nil known allergies
Has never smoked, social drinker (<2/week)
Note: BMI 33
Medications
Esomeprazole 40mg, oral, mane
Ramipril, 10mg, oral, mane
No supplements or complementary therapies
Family/social history
- Both parents are deceased - father at age 69 (stroke), mother aged 62 (ESRF, 3y of HDx)
- Mother Dx T2DM age 48, Cx by renal failure and R) forefoot amputation
- Alvin was her primary carer for her later years
- Married, lived at home with wife and one adult child
- Two other adult children (family is supportive and close)
- Works as an auto mechanic
On admission Alvin's vital signs are: T° 36.5, PR 76, RR 18, BP 142/78, SaO2 97%, BGL 26mmol/L
Lab results
- Urinalysis: glucose ++++ otherwise NAD
- HbA1C 16.4%
Total cholesterol 243 mg/dL, HDL 20mg/dL, triglycerides 416 mg/dL
- Based on the information provided, does Alvin have type 1 or type 2 diabetes? Why do you think that
-Name three aspects of his post-discharge management that Alvin needs education about.