[Institution Title]
Part 1: Case Study on Pulmonary Embolism
A 44-year-old African American male had a partial colectomy to have a cancerous tumor removed. The patient did really well after surgery and was discharged from post-op recovery to the surgical unit at a medical center. Approximately one hour after surgery, the patient complained of gas pains and shortness of breath. The patient continued to complain of gas pains after administration of morphine sulfate. Providers failed to diagnose a pulmonary embolism that resulted in the loss of the patient’s life.
Discussion:
While there were very limited information provided in the case study as far as post-op procedure and evaluation, it seemed that the assessment was insufficient because the members of the medical team assigned to the patient failed to diagnose pulmonary embolism which causes the patient’s untimely death. The nurses simply relied on the superficial manifestations that patient was doing well after the surgery. However, no physical assessment was done and no laboratory exams were requested to verify the physiological effect of the surgery. In addition, the tragic death of the patient implies that the review of system has not been facilitated accordingly.
Pulmonary embolism can usually go undetermined unless the patient will be specifically examined for the condition. Likewise, the reason that health practitioners usually neglect the signs and symptoms of pulmonary embolism because they are either too concentrated on the chief complaint of the patient or they mistake the symptoms for some other medical condition . As with the case of the 44-year old African American patient, the result of the missed diagnose was probably because the doctors were too focus on addressing the removal of the cancer cell and they relied on the physical overt manifestations that signals the patient was recovering well. Since abdominal pain is commonly experienced by patients who have undergone colectomy, this is typically treated with pain killers . Similarly, there seemed to be lacking information whether the patient has any existing heart condition or if there was anyone in the family with such medical history. This could help the medical team to determine whether the patient is high risk for pulmonary embolism.
No further explanation or discussion was presented in reference to the onset of the abdominal pain except that it was experienced even after morphine sulfate has been administered. It was only noted that the patient died after the medical team failed to diagnose pulmonary embolism. Nonetheless, after administration of morphine sulfate the attending nurse failed to evaluate the cause of the abdominal pain and what was compromising the patient’s breathing.
Recommendations:
Pulmonary embolism can easily be detected if the medical team attending to the patient is attentive to the signs and symptoms that are manifested by the patient. However, mere superficial analysis would not be sufficient to determine pulmonary embolism. Initially, like for any medical condition, the primary source of valuable information that can be utilized to understand the patient’s concern is through an extensively and comprehensively conducted physical assessment. During the medical history interview, the nurse could determine the medical conditions that the patient and his immediate family have which might predispose the patient to being at risk of developing pulmonary embolism . Similarly, after the patient complained of shortness of breathing he should have been immediately assesses for any potential risk. Breathing is one of the three most important factors to be monitored aside from airway and circulation. If the patient was also given an extensive but appropriate physical exam, the sign of pulmonary embolism should not have gone undetected.
References
American College of Physicians. (2014). Treatment of anemia in patients with heart disease: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 770-779.
Buttaro, T., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2012). Primary Care: A Collaborative Practice. Amsterdam, Netherlands : Elsevier Health Sciences.
Cassoobhoy, A. (2014, January 31). Understanding Anemia -- The Basics. Retrieved from WebMD: http://www.webmd.com/a-to-z-guides/understanding-anemia-basics
Husney, A., & Simon, J. (2012, October 25). Bowel Resection. Retrieved from WebMD: http://www.webmd.com/digestive-disorders/partial-colectomy-for-diverticular-disease
Kearon, C. (2003). Diagnosis of pulmonary embolism. Canadian Medical Association Journal, 183-194.
Part 2: Case Study of Anemia
An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault
Pathophysilogy:
There are different kinds of anemia caused by various different reasons. Among the most popular causes are genetics and poor nutrition. Anemia is the result of insufficiency of healthy red blood cells that carries oxygen to the different parts of the body . According to the article published online, there are 400 different kinds of anemia and these kinds of anemia can be divided into three distinct groups: (a) one caused by blood loss, (b) one caused by insufficient red blood cells production, and (c) the destruction of red blood cells . In the case of the 82 year old patient, the anemia is potential caused by the destruction of red blood cells brought about by severe hypertension and the possibility of an existing abdominal problem because positive result in epigastria tenderness which could suggest that the spleen can be enlarged which may be causing the red blood cells to be trapped and could potentially destroy it before it can even make into circulating to the body that could compromise the oxygen in the body causing anemia.
Treatment
After evaluating the patient and conducting extensive physical assessment and medical history assessment it was found that the patient may be suffering from a distinct type of anemia that destroys the red blood cells even before it circulates in the body. As a result, circulation is compromised and that also significantly affect the amount of red blood cells that prevents the patient from experiencing anemia. Not to mention that the patient also has a long history of hypertension which the medications could have also significantly affected the red blood cells production .
The positive tenderness of the epigastria region is also indicative of an enlarge spleen which requires special medical attention . In lieu with all these findings, the patient therefore should be advised to seek specialized medical attention that could help address the spleen enlargement which could help address the anemia. This would help the red blood cells from being destroyed because there would be enough room for the red blood cells to circulate and move without being destroyed prior to circulation.
Recommendation:
As recommendation patient should be advised to receive specialized treatment and evaluation should be done to determine if there is any way to reverse the impact of pernicious anemia.
References
American College of Physicians. (2014). Treatment of anemia in patients with heart disease: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 770-779.
Buttaro, T., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2012). Primary Care: A Collaborative Practice. Amsterdam, Netherlands : Elsevier Health Sciences.
Cassoobhoy, A. (2014, January 31). Understanding Anemia -- The Basics. Retrieved from WebMD: http://www.webmd.com/a-to-z-guides/understanding-anemia-basics
