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Approximately three weeks ago, I encountered a patient in her late 70s who had an oophorectomy, months prior to her presentation in the ER, due to a previous cystic ovarian cancer. After all the lab tests and the CT of her abdomen and pelvis, it was evident that she was having septic shock secondary to a perforated bowel and new metastasis from her previous cancer. Based on her clinical presentation, the patient did not have a good prognosis. The ER physician explained to the patient and her family that the surgery was more of a palliative method to prolong her life from the ongoing sepsis, and not a cure to her current diagnoses. Based on her H/H levels, the patient was a few points from receiving a packed RBC transfusion, so I requested an order from the …show more content…
physician for a type and screen prior to patient transport to the OR. I then asked the patient’s husband, her medical power of attorney, if the patient has any cultural or spiritual practices that she wishes us to observe. He told me that the patient is a Jehovah’s witness and she does not want to receive any blood products during and after the surgery. I asked the patient the same question and she gave me the same answer.
Upon hearing this, the patient’s daughter and her grand daughter did not agree to her parents’ decisions. She was so upset that she and the rest of the family members caused a commotion, which prompted me to request for the ER physician to explain the risks and reexplain the prognosis of the patient. The ER physician, as well as the colorectal surgeon, explained the risks of hemorrhage and death during the procedure as well as the advanced stage of her cancer and its poor prognosis with the septic shock. I truly understand both sides, and I know that this is a sad situation, but for the patient’s sake we always follow their decision no matter how difficult it can be for the whole family. It took a while for the family to fully understand the situation, again I think they are in a very tough position to respect their mom’s wishes and at the same time spend their last few days with her in an unexpected manner. To make matter’s worse, the patient was unaware that there was new metastasis from her cancer because the last time she was seen by her oncologist, she was informed that she was cancer-free, and the family celebrated the good news
recently. Moreover, I tried my best to provide comfort to the patient and the family. Furthermore, the colorectal surgeon and the ER physician phrased everything so well, and they answered the patient and her family’s questions before having the patient sign the consent and being transported to the OR. Truly, this has been one of my experiences in my career that I’m thankful that I always consider asking a quick question regarding culture and spirituality before a procedure or an OR transfer. Otherwise, it would have been an ethical issue had I not consider my patient’s preference in care.
Amy Widener is a real estate agent, mother of two, and a sepsis survivor. In 2013 Amy was in the best shape of her life. She had just finished a Disney half marathon and was reaping the benefits of her intense training, little did she know that that training was going to save her life. One night she woke up with extreme abdominal pain and was rushed to the emergency room where she learned that she had a kink in her intestines. They performed emergency surgery and released her after a little bit of recovery. Instead of Amy’s pain getting better with recovery after her surgery, it got worse. This resulted in subsequent trips to the E.R. only to be sent home with more and more antibiotics. Two months after her surgery she went into the emergency
HPI: MR is a 70 y.o. male patient who presents to ER with constant, dull and RUQ abdominal pain onset yesterday that irradiate to the back of right shoulder. Client also c/o nauseas, vomiting and black stool x2 this morning. He reports that currently resides in an ALF; they called the ambulance after his second episodes of black stool. Pt reports he drank Pepto-Bismol yesterday evening without relief. Pt states that he never experienced similar symptoms in the past. Denies any CP, emesis, hematochezia or any other associated symptoms at this time. Client was found with past history gallbladder problems years ago.
Mr. Michael Hicks came thru the surgery with no complications during the surgery however, after the surgery there were many complications that occurred. Mr. Hicks suffered some complications after the procedure and sued Dr. Borud, the hospital, five other doctors and two nurses. The case was not settled in court, but was settled for confidential terms. Mr. Hicks deserves compensation for his time lost as well as the wrong doing performed by the hospital and the medical staff on the behalf of his case during his procedure. Mr. Hicks expected to wake up fine and his scare fixed in the time frame of around ninety minutes, not seven hours, plus have complicati...
“Elaine” is a 34-year-old white female patient with an extensive medical history. She has a history of seizures, uncontrolled diabetes since the age of fourteen, neuropathy, fibromyalgia, COPD, Sleep Apnea, and is currently suffering from two venous ulcers on her feet. She came to the ER one week ago with nausea and vomiting and was found to be in Diabetic Ketoacidosis and her wounds had become infected. She spent three days in the ICU and for one day was ventilated. She was then sent out to the Medical/ Surgical for further management 3 days ago.
Conclusion: The whole event made me realise that maintaining once dignity and respect can make a lot of difference in patient life. It gave me great insight into bowel cancer and terminal ill patients and their care. I will research more and learn more to better myself and make difference in patient life by simply maintaining dignity and respect that is key in any health care setting .This incident made me respect the profession more and value the person I was looking after and boost their self –esteem, and learnt that working in the community with the relatives around watching was challenging.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning on urination, and decreased urine output for three days.
On my third day of clinical course I had an African America patient age 72, female, a retired high school teacher who was admitted for an Acute Diverticulitis with Perforation. She is diabetic and had a medical and surgical history of diverticulitis, High Cholesterol, Non-Insulin-Dependent Diabetes Mellitus (NIDDM), Hysterectomy, and Scoliosis. She has been on clear liquid diet since she was admitted then she was Nothing by Mouth NPO for the CT scan for that day. When I got the assignment that I was going to be taking care of a patient with an acute diverticulitis, the first thing on my mind was that she will be in a severe abdominal pain, high fever due to infection because my aunty had same disease. To my surprise, she claimed a 0 /10 on a 0-10 pain scale. Her blood sugar and vital signs were normal except for respiratory that was 22. All her laboratory test results were normal including WBC. Patient concern was that she couldn’t have a bowel movement. She was medicated on Colace- a stool softener, morphine for pain, sulfran for nausea, and azactam an antibiotics.
At the time, I was unable to mentally get past the fact that she was refusing blood products to potentially save her life. This was information that I did not know the answer to. I immediately called the doctor to see if there was we could do to help her. The doctor discussed with the patient if she was willing to receive intravenous iron. Intravenous iron has been shown to be helpful for patients in restoring red blood cell and hemoglobin levels. However, the effects are not immediate (Posluszny & Napolitano, 2014). I continued to do more research and found that by educating this patient on her diet as well as safety precautions to take when ambulating were other ways in which I could help this patient recover.
Cancer has some very painful and serious effects on a person's body. Most of this uncomfort is due to the numerous treatments people go through to destroy the cancer cells. One of the more dangerous treatments is surgically removing the cancer. There is a huge possibility that it may take many surgical procedures to remove the cancer areas, and there are always risks that there will be complications. An example of this is when Peter Teeley went under the knife for a standard removal of a cancerous tumor on his appendix. The surgeon forgot to inform the anesthesiologist that Peter had been throwing up all week, and when it happened in the operation, fluid rushed into his lungs causing aspiration pneumonia (Bashe and Teeley16). Of course this does not happen all the time but is always a huge risk when under the knife.
Ever since I was little I remember playing games where I would fight the bad guy and win the girl in the end. This never seem to affect me or make me wonder what small effect it had on my thought process. In games such as Zelda, call of duty, assassin creed, gears of war, Mario, and even halo you play as a white heterosexual male. The idea of playing this way never seemed to phase me as a young child. As I grew up and became more aware of the difference of people and the need for other as well as myself a need to be able to connect and find one 's self in different place such as games, movies, and TV shows. I became aware of the one sided views that video games seem to have. Then I realized that it was seen as acceptable to only have the one sided displayed due to the lack of speaking out on the need for change.
Transfusions of red blood cells, platelets, and plasma are critical to a patient's return to good health,
Utilising John’s model of structured reflection I will reflect on the care I instigated to a patient with complex needs. The patient in question was admitted to the Emergency Assessment Unit for surgical patients then transferred to the ward where I work as a staff nurse.
Moral support from family members is extremely crucial and benefits the patient in every possible way. The family would want to reveal the truth in order to proceed to treatment before the cancer spreads to other regions of the body. Additionally, if children are present the family would want to begin treatment so that their loved one can be there for their children in the future. However, if the cancer is untreatable, the family members can accommodate so that the patient can live the remainder of their time comfortably and grant his or her wishes. When the circumstances deem the loved one is incompetent and cannot make their own decisions, family members can choose to come to the most appropriate
For so many years I’ve asked myself the question, “what are you going to do with your life?” For a period of time I struggled with this question. Today, I sit staring at my computer, confronting myself, asking my subconscious “what do I want to do for the rest of my life?” Have I finally found the answer I 've been looking for, or am I under the false assumption that this is the right path for me. This semester has been the ultimate opportunity to explore my questions, doubt, issues, and concerns. I feel that by the end of this paper I will have answered all these questions, and will have made the best decision for my future.
I will fund my exhibit through donations and sales. I would reach out to the community, explain my exhibit and ask for donations, but I would primarily generate revenue through selling items related to the exhibit like prints of the works being shown, creative posters, key chains, t-shirts and other mementos. Additionally, I would have bake sales and fairs and other activities of a similar nature.