Patient History
A fully functional, independent woman who is nearly 100 years old lives with her 2 daughters. A history finds that she has:
Her medications are lisinopril, furosemide, ASA, and metoprolol.
Presentation and Examination
Patient develops abdominal pain increasing over 5 days; obstipation for 1 day. She is acutely ill and she appeared uncomfortable and volume depleted. On exam, she has abdominal distention, hypoactive bowel sound with no palpable mass. Her heart is enlarged and no S3.
Laboratory Findings:
An abdominal CT scan shows the cecum is very dilated to 13cm and the left image show a possible mass in the descending colon.
She was in the emergency department two hours then admitted to a non-intensive care surgical unit and cared for by a general surgeon and a geriatrician.
Upon Admission to Your Floor
There was an urgency to get her to surgery as delays would likely lead to complications. Prior to surgery, careful anesthesia planning and intra-operative management was designed. A shortened bowel prep was initiated.
A left hemicolectomy was performed on day 2. Pain was controlled with low doses of morphine and fluid management was tightly managed. She was provided a single, quiet room and a family member stayed with her continuously.
The patient was discharged to subacute rehabilitation on day 5, and then to home on day 10.
Pre-op
Assessment:
Subjective data
Objective data
Management
Treatment
Post -op
Assessment
Subjective data
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Treatment
Patient History A fully functional, independent woman who is nearly 100 years old lives with her...
Patient History A fully functional, independent woman who is nearly 100 years old lives with her 2 daughters. A history finds that she has: High blood pressure Congestive heart failure Cataracts Hearing impairments Knee osteoarthritis Her medications are lisinopril, furosemide, ASA, and metoprolol. Presentation and Examination Patient develops abdominal pain increasing over 5 days; obstipation for 1 day. She is acutely ill and she appeared uncomfortable and volume depleted. On exam, she has abdominal distention, hypoactive bowel sound with no...
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