Question

Catherine is a 35 year old mother of three young children. She was admitted to the hospital with multiple enterocutaneous fistulas 3 weeks ago, at which time she weighed 52 kg (116lbs). She is 165 cm (5ft 5in) tall. Catherine has a history of recurrent cervical cancer for which she had a hysterectomy 4 months before admission. During chemotherapy that followed, she had regular bouts with nausea and anorexia. Surgery was performed again. Her fistulas continued to drain for 2 weeks postoperatively, during which she tolerated clear liquids only. An intravenous drip of 10% glucose and 45% normal saline was ordered to supplement fluids and kcal. This week she developed peritonitis and has had a fever with a maximum temperature of 39 C (102 F) over the past 24 hours. Her weight has dropped to 41 kg (90lbs); drainage from the fistulas has become odorous. The patient was placed in isolation today and was advised by her physician that he intended to start her on total parenteral nutrition (TPN) and conduct some more tests to determine her progress.

Questions for Analysis:

What personal concerns would you expect Catherine to have? What resources would you use to help her obtain the personal and physical support she probably needs?

Answer 1

Some of the personal concerns which Catherine could expect to have are

• To get all necessary treatment to come out of the ailments
• the children will be a main concern for Catherine if she is ill for a prolonged period of time
• for doing and assisting in her daily activities
• How to meet the cost of medical expenses

Some of the resources which she can use to obtain the personal and physical support which she needs are

• Counselling to support her emotionally to avoid mental stress
• She can be connected with the support groups
• undergoing the necessary procedures to close her fistula
• meeting the metabolic needs and nutritional needs with the support of the healthcare team
• fluid balance to be maintained
• Infection control practices followed by health care team to avoid infection
• using the comfort devices to have a easeful environment