The document discusses a case study of a 24-year-old female patient named Kalpana Pandit who was admitted to the hospital for cholelithiasis (gallstones). It provides details of her medical history, symptoms, physical examination findings, diagnosis, and treatment plan. The causes and risk factors for cholelithiasis are also briefly explained.
this is the comparative case study on Choledocholithiasis with the patient admitted in TUTH Mahargunj. this presentation provide comprehensive knowledge on choledocholithiasis including its causes, pathophyisiology, clinical presentations as well as treatment modalities and nursing management.
this is the comparative case study on Choledocholithiasis with the patient admitted in TUTH Mahargunj. this presentation provide comprehensive knowledge on choledocholithiasis including its causes, pathophyisiology, clinical presentations as well as treatment modalities and nursing management.
This is a case study done by me as a part of my in-service education progamme in my institution...hope this may help all nurses who wants to do a case study.
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
Thyrotoxicosis- complete review of anatomy, physiology, types and clinical fe...Surjeet Acharya
this presentation covers extensive pictures for clear explanation. this includes the anatomy & physiology of thyroid gland, a case review, types, clinical features and treatment of thyrotoxicosis. and the most intersting part it, it also includes Recent Advances in field of thyrotoxicosis
This is a case study done by me as a part of my in-service education progamme in my institution...hope this may help all nurses who wants to do a case study.
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
Thyrotoxicosis- complete review of anatomy, physiology, types and clinical fe...Surjeet Acharya
this presentation covers extensive pictures for clear explanation. this includes the anatomy & physiology of thyroid gland, a case review, types, clinical features and treatment of thyrotoxicosis. and the most intersting part it, it also includes Recent Advances in field of thyrotoxicosis
Dr. Guy Nicastri, Associate Professor of Surgery and Family Medicine at the Warren Alpert School of Medicine at Brown University takes us through some of the pearls of the Acute Abdomen Examination in the Adult
Cholelithiasis (calculi or gallstones) usually form in the gallbladder from the solid constituents of bile and vary greatly in size, shape and composition.
Digital Clinical Experience Comprehensive (Head-to-Toe) Physi.docxmecklenburgstrelitzh
Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment
Week 9 SOAP NOTE
Doris Ofodile
Walden University
Nurs 6512
Advanced Health Assessment & Diagnostic Reasoning
Dr Kristin Curcio
July 31st, 2022
Patient Initials: T.J Age: 28 Gender: Female
SUBJECTIVE DATA:
Chief Complaint (CC): " I came in because I'm required to have a recent physical exam for the
health insurance at my new job"
History of Present Illness (HPI): Miss Jones is currently employed by Smith, Steven, Stewart,
Silver & Company. Before she begins work, a pre-employment physical must be completed.
Despite having a history of type 2 diabetes, in which she is able to control it by taking metformin,
dieting, and doing physical activity. For the past 4-5 months, she has been compliant with
metformin. By eating yogurt, Metformin has no longer caused any side effects for her. The last
time she saw a doctor was for her gynecology appointment four months ago in which the doctor
prescribed oral birth control pills to her after she was diagnosed with the polycystic ovarian
syndrome. Although, according to her, she is in good health and does not have any acute health
issues, or stressful events, and is looking forward to starting her new job.
Medications: Metformin 850mg PO BID, the last dose taken this morning.
Fluticasone propionate (Flovent) was 110 milligrams twice daily.( taken last in
Albuterol (Proventil) 90mcg 2 puffs every four hours PRN.( taken three months )
Drospirenone/ethinyl estradiol (dosage unknown). It was taken this morning.
Tylenol 500 mg PO PRN for headache, medication was taken last week.
Ibuprofen 600mg PO TID PRN to alleviate period cramps, was taken six weeks ago.
Zantac was taken for GERD (completed)
Tetracycline was taken because of acne (completed)
Allergies: Miss Jones is allergic to penicillin which causes an allergic reaction characterized by
hives and a rash. She is also allergic to cats and dust which triggers an asthma attack causing her to
itch, wheeze and sneeze. She denies allergic reactions to latex and foods.
Past Medical History (PMH): During her second and a half years of life, Miss Jones was
diagnosed with asthma. Her medication regimen includes Proventil and Flovent.
A diagnosis of diabetes was made at the age of twenty-four. Metformin is the medication she uses
to manage her diabetes, but she had trouble complying because she had side effects like gassiness,
which was later relieved with yogurt. As a result, she is better able to monitor her blood sugar
levels daily, which last read at 90. The patient also reports losing 10 pounds in four months. Also,
she reported that she slipped and hit her right foot, resulting in a healed wound.
At the age of 28, she was diagnosed with the polycystic ovarian syndrome which she manages by
taking birth control pills. Miss Jone’s menstrual cycle flows for five days and is regular. No
Sexually transmitted diseases or pregnancies have been reported.
At 38.
It is a case study report of mucopolysaccharidosis, I did when I was posted in Kanti Children's hospital
Prepared by:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health Sciences
Dr.Tamanna Habiba presentation over Acute Hepatitistamannahabiba1
This is my first presentation.
Acute hepatitis is a common medical condition.Here is all you need to know about acute hepatitis.It will be very much helpful for medical students,they don't need to open books.
SOAP NOTE
Name: J.D.
Date: 03/26/2020
Time: 2:00 pm
Age: 25 y/o
Sex: F
SUBJECTIVE
CC:
” I have a lot of pain on my left side, in my lower belly”
HPI: J.D. is a 25-year-old white female that came to the office today complaining of pain in her lower abdomen. The patient has always had painful cramps with her periods but this time it is much worse being described as a 6 out of 10 and lasting up to 5 hours. The pain started 2 days ago. The pain is described as more painful cramps. It is debilitating and prevents the patient from performing most daily activities. It is localized in the lower abdominal area, and sometimes radiates down her legs, and to her lower back. The patient uses hot compresses to relieve the pain as Tylenol does not work. The patient also states that she has been feeling nauseous ever since the pain started. She also urinates more frequently and pain on urination. Denies fever, vomiting, or chills.
Medications:
2 Tylenol as needed for her pain
PMH (include-immunization status including Gardisil, GTPLA).
Current or past illnesses: No current or past illnesses
Immunizations: All vaccines updated including flu vaccine and Gardasil.
Allergies: NKDA
Medication Intolerances: None.
Chronic Illnesses/Major traumas: None.
Hospitalizations/Surgeries (include delivery of pregnancies here)
No hospitalizations.
G0P0
Family History
Mother: 49 years old, no significant health problems
Maternal Side: No significant health problems
Father: 50 years old, hypertensive
Paternal Side: no significant health problems
Social History
Patient works full-time as a research assistant at a local university. A full-time student seeking a master’s degree in biochemistry at a local university. Married. Sexually active only with husband. Always uses male condoms as contraceptive device. Does not use recreational drugs, tobacco, or electronic cigarettes. Devout follower of Christianity. Denomination: catholic.
ROS
General Patient denies fever or chills, no weight changes.
Cardiovascular Denies chest pain, or discomfort. Denies palpitations, dyspnea, or orthopnea.
Skin: Denies presences of moles, rash, or itching.
Respiratory: Denies dyspnea, cough, hemoptysis, or pleuritic pains.
Eyes Denies problems or changes in her vision; denies double or blurred vision.
Gastrointestinal Positive for nausea.Denies hemorrhoids, constipation, or diarrhea. No variation in bowel habits. Denies vomiting.
Ears Denies difficulty or changes in his hearing. Denies tinnitus, or discharges.
Genitourinary/Gynecological Menarche 11 years old. Regular menstrual periods starting around the 3rd week of every month. LMP: 03.
Comment by Morgan, Dorothy Tali Do not forget to include a runniLynellBull52
Comment by Morgan, Dorothy Tali: Do not forget to include a running head to follow APA guidelines
Health History
Yensi Aguilar
Benjamin Leon School of nursing
NUR1060C: Adult Health Assessment
Professor Dorothy Morgan
April 7, 2021
Health History
Identifying data
Date of history: 28/02/2021
Examiner: Yensi Aguilar
Name: L.P.
Address: 3403 SW 6h Street
Phone Number: 786-597-3071
Age:46
Sex: Female
Race: White
Place of Birth: Honduras
Marital Status: Married
Significant Other: Husband
Occupation: Teacher
Religion: Christian
Primary Language: Spanish
Secondary Language: English
Source of referral: The patient found the hospital’s address on the internet
Source of history: Documents with the patient’s health history gave information concerning the patient. The patient also talked concerning her health status.
Reliability: Currently, the patient seems to have a stable mental and physical state.
Chief Complaints/Reasons for Visit: According to the patient, she started experiencing high fever, blood-stained sputum, night sweats, coughing, and weight loss.
Present Illness
Time of onset: according to the patient, she started experiencing symptoms two weeks ago.
Type of onset: The patient says that she started by occasionally sweating, mild cough, headache, and pain in the abdomen area. Over time, these conditions became severe.
Original Source: The patient complains of pain in her chest and respiratory tract.
Severity: During the day, the patient does not feel many discomforts, but it becomes worse at night due to lower temperatures. Hence, the condition does not deter the patient from executing tasks during the day. The severity of her state is at 5 out of 10 on a 0-to-10-point scale.
Radiation: At night, the patient feels severe pain throughout her chest region
Time Relationship: At first, this condition was still developing and was easy to handle. However, it has evolved and has gotten worse.
Duration: It has been two weeks since the patient started experiencing the symptoms.
Association: The symptoms experienced by the patient are similar to those of flu.
Source of Relief: According to the patient, she feels better when resting after doing some light physical exercise.
Source of Aggravation: The symptoms become worse during the night. Again, exposure to allergens such as dust or cold increases the symptom’s severity.
Past History
General State of Health: The patient’s general condition is fair, considering she is suffering from a chronic illness.
Childhood Illnesses: She suffered from smallpox and measles as a child
Adult Illnesses: Hypertension, Anemia, and asthma
Psychiatric Illnesses: She has experienced mild depression in the past
Accidents and Injuries: Never had an accident or injuries
Operations: The patient denies any surgical operations
Hospitalizations: After visiting the hospital, the patient got an admission to the Jackson Hospital for one week to undergo treatment for asthma and hyper ...
Mohamed Anwer Naleef, I am Nurse at Hemas Hospital,
This is about care of patient with Cirrhosis Disease Condition. As a Nurse three days my Nursing Process, observation, Nursing care Plan, Nursing Care and Help to patient manage and adjust the disease condition. Because the Cirrhosis is majority of male patients are facing the srilanka due to Alcohol. Even developing countries people also facing this problem due to uncontrolled Alcohol Consumption.
In my Case Studies, I briefly explained about Liver Alcoholic Cirrhosis, Treatment Complaience , medical management, Nursing Care, Nursing assessment, Nursing diagnosis, Nursing Planning, Nursing Intervention, Health Education for a Patient when patient Discharge.
12SOAP Note Patient with UTIUnited StateEttaBenton28
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. To gain in-depth knowledge about the study
subject/disease condition.
To gain the confidence in handling such cases in
future.
To fulfill the partial course objective of M.N.
curriculum.
To share experience and knowledge to friends,
juniors and seniors.
3. Cholelithiasis is one of the common problems
encountered in Nepal.
In the United States, about 20 million people
(10-20% of adults) have gallstones.
Every year 1-3% of people develop gallstones
and about 1-3% of people become symptomatic.
To provide holistic nursing care to the patient
using the nursing process by Appling different
nursing theories.
4. History taking and interviewing to the
patient and his visitors.
Observation and, physical examination to the
patient
Discussion with teachers, senior staffs and
doctors
Using various text books and references of
Medicine and related internet search
technology
5. Patient’s Name : Ms. Kalpana Pandit
Age/ sex :-24yrs/female
Marital status : - Married
Education : - Literate
Occupation : - house wife
Religion : - Hindu
Address :-Khaireni , Parsa-7, Chitwan
Ward :- surgical ward
Bed No. : - 28
6. Contd…
IP No. :- 48870
Provisional Diagnosis :- cholelithiasis
Date of admission :- 2068/07/29
Date of operation :2068/07/30
Interview date :- 2068/07/30
Date of discharge :- 2068/08/3
Final Diagnosis :- cholelithiasis
Operative procedure : laproscopic
cholesystectomy.
Attending physician :- Dr Chandra Prakash
Pandey
Informants Obtained From :- Patient (self) & his
husband
8. C. Present Illness/ Health Status
Ms. Kalpana Pandit had Fever, vomiting, indigestion,
diarrhea was occurred before 15th of hospitalization and
Pain on the right side was from about 2 months but pain
was dull. Then she used to take pain killer from medical
hall. Pain gradually increased. She came to the hospital
when there was fever, vomiting and diarrhoea. She took
the medical treatment from OPD of medical ward 15th
before. She was advised to admit on 2068/7/29 for
surgery.
9. Past health history
No history of any childhood illness.
No history of hospitalization
No history of psychiatric problem.
No history of past illness of any kind of Injuries
and Accidents.
Family history
No history of Hypertension, Diabetes, TB or
asthma.
Socio economic history
Middle class family.
9
10. Allergies:- no allergies to any food, Drugs and
others
Medication Taken at Home: she used to take
medicine from medical hall in minor cases.
Traditional Healer’s Prescription: she
believes on traditional healer and obeys them
but give emphasize to hospital also
11. Medical Practioner’s prescription:- if they
get health problem they use to come to
hospital and take the prescribed medicine.
Self prescription: she use to take certain
drugs like cetamol when suffering from
fever.
12. Client’s Reaction to illness:
she was worried about the pain that occur during
surgery.
Client’s Coping Pattern:
she copes illness by expressing her feelings to her
husband.
13. Client’s Value of Health:
She things health is important.
Client’s Perception of the Care Giver:
She things that nurses are caring and giving
health education effectively.
14. Family Relationship:
Client’s Position in the Family: she use to help in the
family. she is not head of the family.
Person Living With Client (Support System) : her
husband was caring her in hospital.
Recent Family Crisis or Changes: there is family crisis,
she is unable to care her son as he is of 5years and her
child is with his grandmother.
15. Menstrual history
Regular menstrual period
Obstetric history:
Antenatal checkup: done in hospital
Postnatal checkup: done in hospital
Place of Delivery: hospital
Type of Delivery: Spontaneous Vaginal delivery
Any complication: No
16. Personal history
Smoking :-No smoking habit
Alcohol : - No alcohol habit
Food habit : - 3 times a day
Food allergy : - Not known
Drugs allergy : - Not known
Bowel and bladder : - Regular bowl habit
Sleeping Pattern : - 6-8 hrs. per day
16
17. Environmental history
Type of family :- joint Family
No. of family :- 5 members
Type of house :- cement house
NO. of rooms :- 4
Kitchen :- Separated
Fuel used :- Firewood , Gas
Drinking Water :- tap water
Toilet :- pit latrin
Drainage System :- open
drainage
17
19. General Inspection:
Gait : Normal
Body Build : fat
Consciousness : conscious and alert
Facial expression : looking anxious
Vital signs
Temperature : 980 f
Pulse :78 b/minute and regular
Respiration : 18b /minute, regular
Blood Pressure : 100/60 mm Hg in both arms (supine)
Height : 5' 2"
Weight : 65kg
19
20. Examination of head ,face and neck
Inspection of head-
Hair color and texture normal, clean hair no any
injury
Inspection of eyes- No discharge and redness of
the eye
Inspection of ears- No discharge and pain
Nose- No discharge , bleeding and smelling
problem.
Mouth- Poor oral hygiene, no bleeding,
Neck- No enlarged lymph node and thyroid gland
normal neck mobility is present
20
21. Inspection; symmetrical shape, sternum is
located at the midline, expansion of the
chest , lateral diameter wider than
anteriposterior diameter.
Palpation : no tenderness, no lump or
depression along the ribs, expansion of the
chest on both sides
Percussion : deep resonent sound over the
lungs
Auscultation : breath sounds are heared in all
areas of lungs, no rales ronchi wheezing sounds.
21
22. Inspection: no enlargement of neck vein,
Palpation - Non tender, no thrill
Auscultation - clear and regular heart rate
between 60-80 beats per minute. No murmur
sound present.
22
23. Higher mental function normal
Motor examination e.g. position of limbs normal
no atrophy.
No abnormal movement.
Normal muscle tone.
Normal power in all limbs.
Deep tendon jerk (bicep, tricep, knee and
ankle)normal
23
24. localized pain in the right upper quadrant,
usually with rebound.
Comfort sleep ,rest
Slightly anxious about the operation.
25. In Books In patient
1. Selecting a mate She had selected mate for her life
partner to form marital relationship.
2. Learning to live with a marriage
partner
She is married since 7 Yrs and live
with her husband with happy life
3. Starting a family She has one children and stayed with
joint family
4. Rearing children She is house wife. She was rearing
her children very well and now she is
unable to do due to illness.
26. In Books In Patient
5. Managing a
home
She was Establishing and maintaining a home and managing a
time schedule.
But now her physical and cognitive capacity is decreased due to
illness.
6. Getting started
in an occupation
She has no other job, she manage home, caring and rearing her
children as well as older parents.
7. Taking on civic
responsibility
She has housewife of the family and is taking care of all family
members and also taking part in some social activities, e.g. in
festivals, marriage etc.
8. Finding a
friendly social
group
She has good relation in her neighborhoods and friendship group.
She also involved in social activities.
27. Cholelithiasis is the medical term for
gallstone disease.
Gallstones are concretions that form in the
biliary tract, usually in the gallbladder.
Calculi, or gallstones, usually form in the
gallbladder from the solid constituents of
bile; they vary greatly in size, shape, and
composition.
28. Cystic duct obstruction, if it persists for more
than a few hours, may lead to acute
gallbladder inflammation (acute cholecystitis).
Common bile duct stone (choledocholithiasis)
29. In the United States, about 20 million people
(10-20% of adults) have gallstones.
Every year 1-3% of people develop gallstones and
about 1-3% of people become symptomatic.
Each year, in the United States, approximately
500,000 people develop symptoms or
complications of gallstones requiring
cholecystectomy
Gallstones may be present at any age but are
unusual before the third decade
30. The prevalence is two to three times higher
in women than in men, although this
difference is less marked in the sixth and
seventh decade.
At this age the prevalence ranges between
25% and 30%.
31. 1.Cholesterol gallstones:
Liver cells secrete cholesterol into bile along with
phospholipid (lecithin) in the form of small
spherical membranous bubbles, termed unilamellar
vesicles.
Liver cells also secrete bile salts, which are
powerful detergents required for digestion and
absorption of dietary fats.
Bile salts in bile dissolve the unilamellar vesicles to
form soluble aggregates called mixed micelles.
This happens mainly in the gallbladder, where bile
is concentrated by reabsorption of electrolytes and
water.
32. Compared with vesicles (which can hold up to 1
molecule of cholesterol for every molecule of
lecithin).
mixed micelles have a lower carrying capacity for
cholesterol (about 1 molecule of cholesterol for
every 3 molecules of lecithin).
If bile contains a relatively high proportion of
cholesterol to begin with, then as bile is
concentrated, progressive dissolution of vesicles
may lead to a state in which the cholesterol-
carrying capacity of the micelles and residual
vesicles is exceeded.
At this point, bile is supersaturated with
cholesterol, and cholesterol monohydrate
crystals may form
33. Bilirubin, a yellow pigment derived from the breakdown of
heme, is actively secreted into bile by liver cells.
Most of the bilirubin in bile is in the form of glucuronide
conjugates, which are quite water soluble and stable, but
a small proportion consists of unconjugated bilirubin.
Unconjugated bilirubin, like fatty acids, phosphate,
carbonate tends to form insoluble precipitates with
calcium.
Calcium enters bile passively along with other electrolytes.
In situations of high heme turnover, such as chronic
hemolysis or cirrhosis, unconjugated bilirubin may be
present in bile at higher than normal concentrations.
Calcium bilirubinate may then crystallize from solution and
eventually form stones.
34. Gallstone formation is multifactorial, and the
factors involved are related to the type of
gallstone .
Risk factors for cholelithiasis:
Obesity
Women, especially those who have had
multiple pregnancies .
Frequent changes in weight
35. Rapid weight loss (leads to rapid development
of gallstones and high risk of symptomatic
disease)
Treatment with high-dose estrogen.
Low-dose estrogen therapy—a small increase in
the risk of gallstones
Cystic fibrosis
Diabetes mellitus
36. Impaired gallbladder emptying
Pregnancy
Gallbladder stasis
Fasting
Total parenteral nutrition
Spinal cord injury
PATHOGENIC FACTORS LEADING TO THE PRODUCTION
OF LITHOGENIC BILE
Defective bile salt synthesis
Excessive intestinal loss of bile salts
Excessive cholesterol secretion
Abnormal gallbladder function
37. According to book According to patient
Gallstones may be silent, producing no
pain and only mild gastrointestinal
symptoms.
Epigastric distress, such as fullness,
abdominal distention
The patient may have biliary colic with
excruciating upper right abdominal pain
that radiates to the back or right
shoulder, is usually associated with
nausea and vomiting, and is noticeable.
several hours after a heavy meal.
The patient develops a fever and may
have a palpable abdominal mass.
Pain on the right side of the
abdomen.
No abdominal distention.
Vomiting, undigestion and
diarrhea present.
fever
Not present
38. According to book According to patient
Jaundice occurs in a few patients with
gallbladder disease and usually occurs with
obstruction of the common bile duct. .
The excretion of the bile pigments by the
kidneys gives the urine a very dark color.
The feces, no longer colored with bile
pigments, are grayish, like putty, and
usually described as clay-colored
Obstruction of bile flow also interferes with
absorption of the fatsoluble vitamins A, D,
E, and K.
Therefore, the patient may exhibit
deficiencies (eg, bleeding caused by
vitamin K deficiency,
Not present
Urine normal colour
Presence of diarrhea
No any sign of bleeding
39. Choledocholithiasis
Pancreatitis
Fistulae between the gallbladder and
duodenum or colon
Pressure on/inflammation of the common
bile duct by a gallstone in the cystic duct
Cancer of the gallbladder
40. According to book According to my patient
History taking
Asymptomatic gallstones
without causing symptoms or complications
evidence to support a causal association
between gallstones and chronic abdominal
pain, heartburn, postprandial distress,
bloating, flatulence, constipation, or
diarrhea.
Biliary colic
pain resolves over 30 to 90 minutes as
the gallbladder relaxes and the
obstruction is relieved.
indigestion, dyspepsia, belching, bloat, and
fat intolerance
Fever, vomiting, indigestion, diarrhea.
Pain on the right side
41. physical examination:
asymptomatic gallstones have no abnormal
findings on physical examination.
In acute cholecystitis
localized pain in the right upper quadrant, usually
with rebound and guarding.
a positive Murphy sign (inspiratory arrest on deep
palpation of the right upper quadrant during deep
inspiration)
Tachycardia and diaphoresis may be present as a
complications of cholelithiasis consequence of
pain
In severe cases of acute cholecystitis, ascending
cholangitis, or acute pancreatitis, bowel sounds
are often absent or hypoactive.
Choledocholithiasis with obstruction of the
common bile duct produces cutaneous and scleral
icterus.
Acute gallstone pancreatitis is often characterized
by epigastric tenderness
Fever, vomiting, indigestion,
diarrhea.
Pain on the right side
42. According to book According to my patient
Blood Studies
complete blood cell (CBC) count
with differential
, liver function panel, and
amylase and
lipase.
CBD) obstruction initially
produces an acute increase in
the level of liver transaminases
(alanine and aspartate
aminotransferases), followed
within hours by a rising serum
bilirubin level.
•Liver function test done in my
patient and values are normal.
•alkaline phosphatase done in my
patient and slight low value.
43. According to book According to my patient
If obstruction persists, a progressive
decline in the level of
transaminases with rising alkaline
phosphatase.
. Prothrombin time may be
elevated in patients with prolonged
CBD obstruction,
Concurrent obstruction of the
pancreatic duct by a stone in the
ampulla of Vater may be
accompanied by increases in serum
lipase and amylase levels.
•Prothrombin time is done and it is
normal.
• Not done.
44. According to book According to my patient
Abdominal Radiography
Black pigment or mixed gallstones may contain
sufficient calcium to appear radiopaque on
plain films
Ultrasonography
useful investigation for the diagnosis of
gallstone-related disease:
(a) gallstones within the gall bladder,
particularly when these are obstructing the
gall bladder neck or cystic duct
(b) focal tenderness over the underlying gall
bladder
(c) thickening of the gall bladder wall.
Computed Tomography
CT can be used in diagnostic challenges or to
further characterize complications of gallbladder
disease
•Abdominal radiography not done in
my patient.
•Utrasonography done in my patient:
Two calculi noted in the GB lumen,
largest one measuring 10mm.
46. According to book According to my patient
•Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) with
magnetic resonance cholangiopancreatography
(MRCP) has emerged as an excellent imaging
study for noninvasive identification of gallstones
anywhere in the biliary tract, including the
common bile duct
•Endoscopic Retrograde
Cholangiopancreatography
•Not done in my patient
•Not done in my patient
48. Date Test In Patient Reference Range
068/7/27
INR
Bleeding time
Clotting time
Biochemistry
SGOT/AST
SGPT
Bilirubin Total
Bilirubin direct
Blood sugar (R)
Creatinine
alkaline phosphate
Blood group/Rh type
HIV 1 &11
HbsAg
Anti Hcv
1.20
2min
10min
34U/L
36u/L
0.61mg/dl
0.21mg/dl
110mg/dl
0.8 mg/dl
81.0 IU/L
o+ve
Non reactive
Non reactive
Non reactive
2-7min
6-12min
M-<37 F <31
<40
0.4 - 1.4
0.1 – 0.4
70-120
0.4-1.4mg/dl
( M-64 -306 F: 84-306
49. Differentials diagnosis:
Appendicitis
Bile Duct Strictures
Bile Duct Tumors
Cholecystitis
Gallbladder Cancer
Gastritis and Peptic Ulcer Disease
Gastroenteritis
Pancreatic Cancer
50. Treatment of Asymptomatic Gallstones:
Surgical treatment
Surgical treatment of asymptomatic gallstones
without medically complicating diseases is
discouraged.
cholecystectomy for asymptomatic gallstones may
be indicated in the following patients:
Patients with large gallstones greater than 2 cm in
diameter
51. Patients with risk factors for complications of
gallstones may be offered elective
cholecystectomy.
52. Medical dissolution of gallstones
Ursodeoxycholic acid (ursodiol) is a gallstone
dissolution agent.
In humans, long-term administration of
ursodeoxycholic acid reduces cholesterol
saturation of bile, both by reducing liver
cholesterol secretion and by reducing the
detergent effect of bile salts in the gallbladder
(thereby preserving vesicles that have a high
cholesterol carrying capacity).
Desaturation of bile prevents crystals from
forming and, in fact, may allow gradual extraction
of cholesterol from existing stones.
53. In patients with established cholesterol gallstones,
treatment with ursodeoxycholic acid at a dose of
8-10 mg/kg/d PO divided bid/tid may result in
gradual gallstone dissolution.
This intervention typically requires 6-18 months
and is successful only with small, purely
cholesterol stones.
The recurrence rate is 50% within 5 years.
Moreover, after discontinuation of treatment, most
patients form new gallstones over the subsequent
5-10 years.
54. Cholecystectomy
Removal of the gallbladder (cholecystectomy) is
generally indicated in patients who have experienced
symptoms or complications of gallstones
Open versus laparoscopic cholecystectomy
Currently, laparoscopic cholecystectomy is commonly
performed in an outpatient setting. By reducing
inpatient stay and time lost from work, the
laparoscopic approach has also reduced the cost of
cholecystectomy.
Cholelithiasis patients whose laparoscopic
cholecystectomy was uncomplicated may be sent
home the same day if postoperative pain and nausea
are well controlled
55. Stone Removal by Instrumentation. Several
nonsurgical methods are used to remove
stones that were not removed at the time of
cholecystectomy or have become lodged in
the common bile duct (Fig. 40-4A, B).
56. A catheter and instrument with a basket
attached are threaded through the T-tube
tract or fistula formed at the time of T-tube
insertion; the basket is used to retrieve and
remove the stones lodged in the common
bile duct.
A second procedure involves the use of the
ERCP endoscope (see Fig. 40-4C).
57. After the endoscope is inserted, a cutting
instrument is passed through the endoscope into
the ampulla of Vater of the common bile duct.
It may be used to cut the submucosal fibers, or
papilla, of the sphincter of Oddi, enlarging the
opening, which may allow the lodged stones to
pass spontaneously into the duodenum.
Another instrument with a small basket or
balloon at its tip may be inserted through the
endoscope to retrieve the stones (see Fig. 40-4D–
F ).
58. Although complications after this procedure
are rare, the patient must be observed
closely for bleeding,
perforation, and the development of
pancreatitis or sepsis.
61. Extracorporeal Shock-Wave Lithotripsy.
Extracorporeal shockwave therapy (lithotripsy or
ESWL) has been used for nonsurgical fragmentation
of gallstones. The word lithotripsy is derived from
lithos, meaning stone, and tripsis, meaning rubbing
or friction.
After the stones are gradually broken up, the stone
fragments pass from the gallbladder or common
bile duct spontaneously, are removed by
endoscopy, or are dissolved with oral bile acid or
solvents.
62.
63. Intracorporeal Lithotripsy
Stones in the gallbladder or common bile
duct may be fragmented by means of laser
pulse technology.
A laser pulse is directed under fluoroscopic
guidance with the use of devices that can
distinguish between stones and tissue.
64. Endoscopic sphincterotomy
If surgical removal of common bile duct stones
is not immediately feasible, endoscopic
retrograde sphincterotomy can be used.
In this procedure, the endoscopist cannulates
the bile duct via the papilla of Vater.
Using an electrocautery sphincterotome, the
endoscopist makes an incision measuring
approximately 1 cm through the sphincter of
Oddi and the intraduodenal portion of the
common bile duct, creating an opening through
which stones can be extracted.
65.
66. laparoscopic cholecystectomy
2068/7/30
Inj Cifran 200mg IV BD
Inj Aciloc 50mg IV BD
Inj tramadol 50mg IM SOS
Inj phenargan 25mg IM SOS
Tab Becto 500mg O BD
Tab Rloc 150mg O BD
Tab Nise 100mg O BD
67. The mortality rate for an elective
cholecystectomy is 0.5% with less than 10%
morbidity.
The mortality rate for an emergent
cholecystectomy is 3-5% with 30-50% morbidity.
Following cholecystectomy, stones may recur in
the bile duct.
68.
69. Mrs. Kalpana Pandit was admitted for the first time
She was anxious about outcome of disease as well
as adjusting in new environment.
She was fully conscious, alert and she can do care
herself by minimal assistance.
So, I applied Peplau’s Theory: Interpersonal
Relationship with the mutual understanding of
patient and family members while caring her.
70. Peplau’s Theory: Interpersonal Relationship
According to Peplau, nursing is therapeutic in that it
is a healing art, assisting in individual who is sick or
in need of health care.
Nursing can be viewed as an interpersonal process
because it involves interaction between two or more
individuals with a common goal.
In nursing, this common goal provides the incentive
for the therapeutic process in which the nurse and
patient respect each other as individuals, both of
them learning and growing as a result of the
interaction.
72. Orientation phase:
Nurse and patient come together as strangers;
meeting initiated by patient who expresses felt
need; work together to recognize, clarify and
define facts related to need. It is also called
problem defining phase.
Identification phase:
Interdependent goal setting, patient has feeling of
belonging and selectively responds to those who
can meet needs. Each patient responds differently
in his phase. Selection of appropriate professional
assistance.
73. Exploitation phase:
Patient actively seeking and drawing on knowledge
and expertise of those who can help, use of
professional assistance for problem solving
alternatives.
Resolution phase:
Occurs after other phases are successfully
completed and have been met, leads to
termination.
74. Asses health history: note history of smoking or
prior respiratory problems.
Asses respiratory status: note shallow
respirations, persistent cough, or ineffective or
adventious breath sounds
Evaluate Nutritional status is evaluated through
a dietary history and general examination
performed at the time of preadmission testing
Obtain laboratory results to obtain information
about the patient’s nutritional status
75. Ask for pain in the in the operative site
Regarding pain, discussion was made to
assess the severity and the type and duration
of pain.
76. Acute pain and discomfort related to surgical
incision
Impaired skin integrity related to altered biliary
drainage after surgical intervention
Imbalanced nutrition, less than body
requirements, related to inadequate bile
secretion
Deficient knowledge about self-care activities
related to incision care, dietary modifications
(if needed), medications, reportable signs or
symptoms (eg, fever, bleeding, vomiting)
77. The goals for the patient include:
Relief of pain
Adequate ventilation intact skin and
improve biliary drainage
Anxiety related to hospital admission
optimal nutritional intake
absence of complications
understanding of self-care routines.
78. Postoperative:
Place the patient in the low Fowler’s position.
Provide Intravenous fluids.
Provide water and other fluids and soft diet is
started when bowel sounds return.
Relieving pain:
Administer analgesic agents as prescribed to
relieve the pain
Help the patient to turn, cough, breathe deeply,
and ambulate as indicated.
Use of a pillow or binder over the incision during
these maneuvers.
79. Improving respiratory status
Remind patients to take deep breaths and
cough every hour to expand the lungs fully and
prevent atelectasis.
Promote early ambulation. Early ambulation
prevents pulmonary complications as well
Monitor elderly and obese patients must closely
for respiratory problem.
.
80. Promoting skin care and biliary drainage:
observed for indications of infection, leakage
of bile into the peritoneal cavity, and
obstruction of bile drainage, clay colored
stool and vital sign.
note and report right upper quadrant
abdominal, pain, nausea and vomiting,
Observe for jaundice.
changes frequently the outer dressings and
protection of the skin from irritation.
Maintain a careful record of fluid intake and
output
81. Improving nutritional status
Encourage the patient to eat a diet low in fats
and high in carbohydrates and proteins
immediately after surgery.
At the time of hospital discharge, there are
usually no special dietary instructions other
than to maintain a nutritious diet and avoid
excessive fats.
82. Monitoring and managing potential
complications
Closely monitor vital signs and inspects the
surgical incisions and drains, if in place, for
evidence of bleeding.
Periodically assesses the patient for increased
tenderness and rigidity of the abdomen and
report to the surgeon.
Instructs the patient and family to report to the
surgeon any change in the color of stools
because this may indicate complications.
83. Contd…
After laparoscopic cholecystectomy, assesses the
patient for loss of appetite, vomiting, pain,
distention of the abdomen, and temperature
elevation.
These may indicate infection or disruption of the
gastrointestinal tract and should be reported to the
surgeon promptly.
Instruct verbally and in writing about the
importance of reporting these symptoms promptly
after discharge.
84. Teaching Patients Self-Care
Instruct the patient about the medications that
are prescribed (vitamins, anticholinergics, and
antispasmodics) and their actions.
Inform the patient and family about symptoms
that should be reported to the physician,
including jaundice, dark urine, pale-colored
stools, pruritus, or signs of inflammation and
infection, such as pain or fever.
Emphasize importance of keeping follow up
appointments.
85. Asses the knowledge of patient and family of
the therapeutic regimen. (medications, gradual
return to normal activities)
Emphasizes the importance of keeping follow-up
appointments and reminds the patient and
family of the importance of participating in
health promotion activities and recommended
health screening.
Shower can be taken 48 hours after surgery.
No restrictions to physical activities.
Gradually increase activities at a comfortable
and individual pace.
86. Postoperative:
Placed the patient in the low Fowler’s position.
Provided Intravenous fluids.
Provided water and other fluids and soft diet is
started when bowel sounds return.
Relieving pain:
Administerd analgesic agents as prescribed to relieve
the pain
Helped the patient to turn, cough, breathe deeply,
and ambulate as indicated.
Used of a pillow or binder over the incision during
these maneuvers.
87. Improving respiratory status
Remind patients to take deep breaths and
cough every hour to expand the lungs fully
and prevent atelectasis.
Promoted early ambulation. Early ambulation
prevents pulmonary complications as well
Monitored elderly and obese patients must
closely for respiratory problem.
.
88. Promoting skin care and biliary drainage:
observed for indications of infection, leakage
of bile into the peritoneal cavity, and
obstruction of bile drainage, clay colored
stool and vital sign.
noted and report right upper quadrant
abdominal, pain, nausea and vomiting,
Observed for jaundice.
changed frequently the outer dressings and
protection of the skin from irritation.
Maintained a careful record of fluid intake
and output
89. Improving nutritional status
Encouraged the patient to eat a diet low in
fats and high in carbohydrates and proteins
immediately after surgery.
At the time of hospital discharge, therewere
usually no special dietary instructions other
than to maintained a nutritious diet and
avoid excessive fats.
90. Monitoring and managing potential
complications
Closely monitord vital signs and inspects the
surgical incisions and drains, if in place, for
evidence of bleeding.
Periodically assessesd the patient for
increased tenderness and rigidity of the
abdomen and report to the surgeon.
Instructed the patient and family to report to
the surgeon any change in the color of stools
because this may indicate complications
91. After laparoscopic cholecystectomy, assessed
the patient for loss of appetite, vomiting,
pain, distention of the abdomen, and
temperature elevation.
These may indicate infection or disruption of
the gastrointestinal tract and should be
reported to the surgeon promptly.
Instructed verbally and in writing about the
importance of reporting these symptoms
promptly after discharge.
92. Teaching Patients Self-Care
Instructed the patient about the medications
that are prescribed (vitamins, anticholinergics,
and antispasmodics) and their actions.
Informed the patient and family about symptoms
that should be reported to the physician,
including jaundice, dark urine, pale-colored
stools, pruritus, or signs of inflammation and
infection, such as pain or fever.
Emphasized importance of keeping follow up
appointments.
93. Assesed the knowledge of patient and family
of the therapeutic regimen. (medications,
gradual return to normal activities)
Emphasized the importance of keeping
follow-up appointments and reminds the
patient and family of the importance of
participating in health promotion activities
and recommended health screening.
No restrictions to physical activities.
Gradually increase activities at a
comfortable and individual pace
94. Expected patient outcomes
Expected patient outcomes may include:
Reports decrease in pain
Demonstrates appropriate respiratory
function
Exhibits normal skin integrity around biliary
drainage site (if applicable)
Obtains relief of dietary intolerance
Absence of complications
95.
96. Date: - 2068/7/29
Admission day
A patient was admitted in surgical ward from opd for
laproscopic laprotomy.
On admission patient’s vitals sign were:
B.P=100/60 mm of hg, R.R=20/min, Pulse=88/min,
Temp. =98ºf, SPO2 98% according to nursing report.
All investigation report were collected.
Patients general condition was fair.
Patient was kept NPO from 10pm.
97. Date: - 2068/7/ 30
1st day of admission
She slept well but slightly anxious about the surgery.
She is Alert and conscious
History taking and physical examination done
B/P- 110/70 mmof Hg, RR- 20/min, P- 92/min, T- 98 ºf,
SPO2 99%
Preoperative care was done:
Send for bath.
Psychological support given
Consent was taken.
Removed all ornaments.
IV infusion was given.
Gown was given to wear.
Chart was completed.
98. Date: - 2068/8/1
2nd day of admission(1st post op day)
B/P- 110/80 mmof hg, RR- 22/min, P- 80/min, T- 98.2 ºf, SPO2 98%
Intake= 2100ml, output= 1450ml
Patient GCS 15/15.
Patient is self voiding.
No soakage and bleeding from operation site.
Inj NS Ipint and 5%dex IV pint was given.
kept her in fowler position
Slept well at night.
Morning care was given.
Caried out the prescribed medication.
Coplain of pain so inj tramadol and inj phenargan was given and relieved
after one hour.
Patient was ambulated.
99. Date: 2068/8/2
3rd day of admission(2nd post op day)
Slept well at night.
B/P- 120/80 mmof hg, RR- 22/min, P- 78/min, T- 97.2
ºf, SPO2 98%.
Patients GCS -15/15
Intake=1950ml, output=1350ml
Cannula was removed.
Patient transferred to surgical ward.
No soakage and bleeding from wound site.
Patient was ambulated.
patient was given normal diet.
Prescribed medication was given.
100. Date: 2068/8/3
4th day of admission(3rd post op day)
Slept well at night
Patients general condition was fair.
B/P- 130/80 mmof hg, RR- 20/min, P- 88/min, T-
97.2 ºf, SPO2 98%
No any complain.
Normal voiding of urine and stool.
Patient was discharged.
Gave discharge teaching.
101. Adequate fluid intake
Diet
Personal hygiene
Rest and sleep
Exercise.
Prevention of Infection
Medication
Follow up: after 5 days
102. Tab Nise 100mg “0” BD
Cap Broclox 500mg 1cap QID 5days
Follow Up after 5 days for removal of suture.
103. Diversional Therapy “is a client centered practice
and recognizes that leisure and recreational
experiences are the right of all individuals.”
Activities are designed to support, challenge, and
enhance the psychological, emotional and physical
well being of individuals.
These are often quite diverse and can range from:
Games, outings, computers gentle exercise, music,
arts and craft.
104. Gentle exercise.
Deep breathing and coughing exercise
Talking with other patient
Listening music by mobile phone.
Gossiping with her
Allowing her husband to talk with her.
106. Fever, vomiting, indigestion, diarrhea.
Pain on the right side
Utrasonography done in my patient:
Two calculi noted in the GB lumen, largest one
measuring 10mm.
107. I learned many things from the case study
which are as following:
Identified the complete health need,
development Task of Young adult and compared
it with normal one.
Provide comprehensive nursing care by using
Nursing Theories to the Young adult patient.
Assist in different type of diagnostic procedure
for the patient.
Analyze the concept and approach to nursing
practice according to trend and technology.
108. Identified the factors influencing nursing
practice.
Identified the plan, implement and evaluate
the educational need of the patient and
patient family.
Develop therapeutic relationship to the
patient and family and understand their
religion, culture, customs and health care
belief and practices.
Develop competency in handling various
gadgets which were used to patient.
109. Chintamani, Lewis, Heitkemper, Dirksen, O’Brien and
Bucher, (2011). Lewis’s Medical Surgical Nursing:
Assessment and Management of Clinical Problems. 7th
Ed
Black J.M. & Hawks J.M. (2005). Medical –Surgical
Nursing: Clinical management for positive outcomes.
(7th Ed.).
Brunner & Siddhartha's (2004).Medical- Surgical
Nursing. (12th Ed.) .
Mosby’s Nursing Drug Reference. (2010). 23rd Ed.
Davidson’s principle and practice of medicine 20th
edition
Retrieved on 2068/10/20 from
http://emedicine.medscape.com/article/175667-
overview#showall.
Retrieved on 2068/10/20 from
http://www.nlm.nih.gov/medlineplus/ency/article/00
0273.ht