TASK 54:
Mrs. Anita Ramamurthy, a 59-year-old woman, is a patient in the (IPD) In-patient- department of a hospital in which you are charge nurse.
Hospital : Sydney Women’s Hospital
Patient Details
Marital status : Married
Height : 5’4” Weight : 87 kg
BM1 : 33-Obese
Address for correspondence: #648, Bourke Street, Sydney
Admitted : 18/06/2017
Date of discharge : 23/06/2017
Diagnosis : Acute appendicitis with appendicular lump
Treatment: Conservative management with IV antibiotics (Planned for interval appendectomy in 6 weeks).
Social background : Business woman (Education Consultant) – Hectic life, travels a lot due to work. Lives with her husband, Mr. Krishnan Ramamurthy, Two daughters both married. Elder daughter stays in India- about three hours away, works as an Entrepreneur; younger daughter in Canada, works as a dentist. Husband primary caregiver, elder daughter visits with husband once in a year, Scared of hospitalization, prone to anxiety related to this food of eating our, rarely cooks at home, sedentary lifestyle, complains of no time to exercise due to work, does not drink or smoke.
Diet: Whole Milk, Ice-cream shakes, Fruit drinks, Doughnuts,Pancakes, Waffles, Pizzas, Cheeseburgers, Biscuits, muffins, Cajun Fries, Hash brown
Medical background: Known case of Essential Hypertension (2014) and Diabetes Mellitus type-2 (2010) (not compliant with diabetic medication)
Admission diagnosis: Complaints of pain in abdomen in right iliac fossa since 17/06/2017 Pain was sudden onset, acute in nature and was non-radiating fever (documented up to 101-degree F), aversion to food, evaluated outside where USG Abdomen revealed Acute Appendicitis, admitted for further evaluation and management.
Physical examination: Conscious, oriented, No pallor, or icterus, No Clubbing, No Lymphadenopathy, no pedal Oedema BP: 126/84, Temp-afebrile, Pulse 72/tnin, RR 22/min SP 02 98%, CNS-NAD, Chest – Bilateral entry equal, No added sounds.
Nursing management and progress
18/06/2017: Abdomen CT (plain) 18/06/2017 – acute appendicitis with hypoclensearea in the region of base of appendix at its attachment with vacuum? Phlegtnonous collection.
Possibility of scaled perforation cannot be ruled out; total leucocyte count- 21,000/cumin. 1/V Fluids, broad spectrum antibiotics (Intipenem), PPI, Analgesics, antipyretics, other supportive treatment (6/6), Regular Blood Sugar Monitoring (6/6)
19/06/2017: TLC – 8,000/cumm; complaints of considerable pain in abdomen, headache, sips of water, extremely distressed, constipation, unable to pass gas.
20/06/2017: TLC-14,000/cumin; complaints of insomnia, headache, tenderness in abdomen, weakness, tolerating sips of coconut water and tea.
21/06/2017: TLC-11,000/cumin; tolerating soft diet, can ambulate with assistance, complains of weakness, Rev. Dietician re diabetic diet.
22/06/2017: TLC-8,000/enmm, able to ambulate slowly, independent with ADÇs.
23/06/2017: Pt. stable, accepting orally well, adequate urine output, TLC showing improving trend. Pt. stable, Rev. Endocrinologist – regular chart BSL, INJ Human Mixtard. Subcutaneously bd (12 hourly) 8 units (1 wk.) AC Breakfast and 6 units AC dinner.
Assessment : Pt. stable with plan for interval appendectomy (6 weeks).
Medications TAB Ddlo (Paracetamol) 650 mg, t.i.d. (8 hrly) for 3 days then PRN. TAB Pantocid (Pantoprazole) 40 mg mane for 10 days.
Tab Tenorid 25 mg (Ateno 101) mane. Tab Supradyn (multivitamin) mane Tab Farobact 200 b.d.
Discharge Plan: Avoid strenuous activities/Travel. Advised to lose weight (exercise program to start after appendectomy). Normal Diabetic diet and low-fat diet – Pt. requests more information, esp. simple recipes that can be easily prepared at home. Monitoring of tinting and postprandial blood sugars (Present chart during Follow- up consultation). Follow up in OPD on 30/06/2017 at 3 PM. Husband advised to contact us immediately in case of persistent high grade Fever/pain (at 03492250); Pt. concerned re monitoring of blood glucose levels and insulin injections Husband requests home visit for demonstration
WRITING TASK 1: Using the information given in the case notes, write a referral letter to Ms. Prabha, Shrishti Nursing Home Care Agency, Sydney, requesting a home visit to provide instructions on self-monitoring of blood glucose levels and administering insulin injections following Mrs. Ramamurthy discharge.
WRITING TASK 2: The patient has requested advice on simple recipes for low-fiat diabetic diet. Write a letter to Ms. April, Dietician, 258, George Street, Sydney on the patient’s behalf. Use the relevant case notes to explain Ms. Ramamurthy’s condition and information he needs. Include medical history, BMI, and lifestyle. Information should be sent to her home address.
WRITING TASK 3: Using the information provided in the case notes, write a letter detailing the post- discharge care required for the patient to the patients husband, Mr. Krishnan Ramamurthy, #648, Bourke Street, Sydney
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