Clinical Case Conference


Clinical Case Conference
Case Management (40 points)
Exceptional discussion expressed with insightful and original
thought using exemplary written communication. demonstrating depth of understanding of the case.Succinct, correct clinical rationales provided.
Establishing the evidence supporting
the discussion (30 points).
Research selected is highly relevant to the argument, is presented
accurately and completely. The link between the literature findings and the presented case is consistently and persuasively made. The management and nursing care of the patient is compared and
critiqued in detail with the best and most recent available evidence.
Feasible / thoughtful suggestions of alternative management and nursing care are made, based on the best available evidence.
Conclusion
(5 points)
A succinct yet complete summary of the crucial aspects of the case is presented. The short and long term outcomes are described in depth.Insightful comments are made about whether the case and its
management was representative.Excellent alignment between introduction and conclusion
Referencing
(10 points)
Multiple sources utilised and all correctly referenced as per
Harvard Referencing Guidelines. Reference list is correctly presented and is complete.
Adheres to academic writing & presentation guidelines
Adheres to all guidelines. Excellent:*Correct spelling,punctuation,
*Sentence structure and paragraph*Use of inclusive language.
NURS3005 Assignment 2- CCC Report Guidelines
Weighting: 40% (2500 words)
Details: This academic paper requires students to write – up the patient presented at their Clinical Case Conference (CCC) to their Nurs3005 PEP facilitator and present it as a detailed report. There
must be analysis of the patient’s medical condition(s) demonstrating the ability to apply theoretical concepts including (but not limited too) pharmacology; pathophysiology; anatomy and physiology.
There must be presentation and evaluation of nursing and medical management of the patient. Sound clinical rationales must be provided that support the care afforded the patient. Appropriate
evidence sources must be used and Harvard referencing used throughout. Students are encouraged to write up this report prior to undertaking their CCC presentations. For specific details
please refer to the marking rubric. The CCC Report must be submitted via FLO.
Please use the format below.
Introduction: (150 words)
Introduction of an assignment requires mapping out the essay, outlining your reader the main argument points in the essay. The following should be included:
? Introduction of the assignment content.
? Introduction of the case including biographical data, current and past medical history of the patient.
? Patient confidentiality needs to be maintained all times.
Case Management: (1250 words)
This section should address the current nursing management and the interdisciplinary management that is provided for the patient. This includes;
? patient’s medical condition(s), including relevant pathophysiology
? clinical assessment using (IS)BAR, or a system – based approach, explanation of how nursing management relates to medical management with clear clinical rationales provided, role of interdisciplinary team involvement explained and primary health care
strategies described.
? Medical management and treatments described including all relevant pharmacological,non-pharmacological treatments, pain management explained and clear clinical rationales
provided.
? Relevant Laboratory results /Diagnostic tests included and discussed.
? Psychosocial / Environmental / Economic aspects discussed
? Ethical and legal aspects included
? Education needs of patient /family addressed
? Discharge Planning addressed
Establishing the evidence supporting the current practice (1000 words)
? Description of how research findings/recent evidence selected is relevant to the case management.
? Comparison and critique of the management / nursing care of the case against best practice literature included.
? Suggestions of alternative management / nursing care
? All the articles selected needs to be primary or secondary research articles (peer reviewed).
Summary and Conclusion (100 words)
This section should provide a summary of the of the crucial aspects of the case that is presented and overall conclusion. No new information or references are required in this section.
Referencing
Academic writing involves using sound evidence to support and strengthen your own arguments.
This assignment needs researching broadly, and skilfully from correctly (Harvard) cited credible
sources which were mainly published between 2006-2016.
Peer reviewed research articles, scholarly articles, reference textbooks can be used.
Articles from these publications are usually NOT academic:
•newspapers
•magazines and trade journals
•newsletters
•articles without a bibliography
This are some information about the patient. My placement was in theatre room. The theatre too was urology
Name: Brook John, Sex: Male, Birth: 20-3-1954, Age 62 years old, MRN;01188380 Married has 4 children lives at Parafield Gardens. Came from England 35 years ago. Mobility; Independent, NKAD Allergies.
Over 2 years PT has hematuria associated with dysuria, nocturia and frequency of urination during the day. Since it was 11 years old PT had a injury riding the bike. GP recommended a CT scan and was found 2 simple renal cysts bilaterally urinalysis. And the cystoscopy showed irregular mucosa with papillary lesions suspicions cell carcinoma.
PT is admitted for; referred fro GP
Bladder lesions cystoscopy Biopsy Bilateral Retrograde Pyelogram, and trans-urethral resection
Before the Retrograde Pyelography
Be sure to tell your doctor if you have a known shellfish or iodine allergy or have ever had an adverse reaction to x-ray contrast dyes.
Notify your physician if you are sensitive to or are allergic to any medications, latex, and tape.
Notify your physician of all medications and supplements that you are taking. In particular, be sure to mention if you are taking blood thinners, including aspirin, or any other drugs that affect blood clotting. You may have to stop them for a short period before the test.
Tell your doctor if you have/have ever had a bleeding disorder.
If you are receiving a local anesthetic, you should have a liquid breakfast on the morning of the test.
If general anesthesia is required, do not eat or drink after midnight on the day before the test.
An intravenous (IV) catheter may be inserted into a vein in your arm to provide fluids and/or to administer a general anesthetic during the procedure.
What You Experience
You will lie on your back on an examination table with your knees bent and feet resting in stirrups.
After local or general anesthesia has been administered, the doctor carefully inserts the cystoscope through your urethra and into the bladder, and performs a visual examination.
Next, a thin tube, or catheter, is threaded through the cystoscope into the ureter. (Sometimes both ureters are catheterized.)
The contrast dye is injected through the catheter. If you are conscious, you may feel some discomfort during catheter insertion and when the dye is instilled.
X-ray films are obtained. You must remain still to avoid blurring the pictures.
As the catheter is slowly withdrawn, more contrast dye is instilled and additional x-rays are taken to visualize the complete length of the ureter.
A delayed x-ray film is usually taken about 5 minutes after the last injection to check for retention of contrast dye, which indicates a ureteral obstruction.
If an obstruction is present, a catheter may be left in place in the ureter so that it can drain.
The procedure usually takes about 1 hour.
Past medical history;
Acute Pancreatitis
Cysts in pancreas
Diabetes; Type 2
Smoker
Meds;
Metformin is antihyperglycemic agents
Panadol
Oxycodone
This are drugs in theatre
Fentanyl
Propofol .
Cefazolin
Gentamicin.
Hartmann’s solution
Bladder irrigation
The risk of surgery;
UTI, risk of blood in the urine, unable to pass urine, burning sensation on passing urine, reaction to the anesthetic.
Risks and Complications
Possible complications include urinary tract infection, temporary blockage of the ureter due to swelling, and, rarely, inadvertent perforation of the bladder or ureter.
Rarely, some people may experience an allergic reaction to the iodine-based contrast dye, which can cause symptoms such as nausea, sneezing, vomiting, hives, and occasionally a life-threatening response called anaphylactic shock. Emergency medications and equipment are kept readily available.
After the Retrograde Pyelography
If no complications develop, you are usually free to leave the testing facility. Your doctor will instruct you to keep track of your urine output and report any urinary retention.
Your urine may contain blood at first, causing a slight pink tinge; this should resolve after you have voided 3 times. If blood persists or you see bright red blood or blood clots, notify your physician.
Urination is often painful or difficult for the first few times after the test. You may be instructed to take tub baths to help ease any discomfort, and painkillers will be prescribed, as needed.
You are encouraged to increase your intake of fluids to help prevent urinary retention and accumulation of bacteria in your bladder.
Inform your doctor immediately if you experience pain in the area of the kidneys, chills, fever, redness, swelling, bleeding or increase in the amount of blood in your urine and difficulty urinating.
Results
The doctor will examine the x-ray films for evidence of any abnormalities, such as a ureteral obstruction.
If a definitive diagnosis can be made, your doctor will recommend an appropriate course of treatment.
In some cases, additional diagnostic tests, such as a renal CT scan, renal nuclear scan, or ureteroscopy, may be needed to further evaluate abnormal results.
These are some extra information about the procedure
What is a Cystoscopy + Retrograde Pyelogram?
A cystoscopy may be suggested for a number of reasons including;
Blood in the urine
Assessment of urinary tract infections
Difficulties passing urine
Pain or bothersome urinary symptoms.
A cystoscopy is a procedure where a telescope is used to inspect the urethra (water-pipe), the prostate (in men), and the bladder. A very clear and magnified view can be achieved.
It is possible to assess the drainage system of each kidney with an x-ray called a retrograde pyelogram. Contrast (radiological dye) is injected via a small catheter into the ureter. As it fills, x-rays are taken in the operating theatre to look for any abnormality. Your urologist will advise you whether this is indicated.
Preparing for your procedure:
We will provide you with instructions regarding all aspects of preparing for your operation.
Pre-operative blood and urine tests.
Details of admission to hospital.
Information regarding fasting and medications.
What to expect afterwards:
You are usually able to eat and drink what you feel like after the surgery. You will be encouraged to maintain a good fluid intake. Pain relief is always available, however, it is not usual to have significant pain after this procedure. You will most likely experience irritation and have a frequent need to urinate afterwards. There will most likely be some blood in the urine which should settle within a few days.
You will be given pain relief if required and antibiotics if necessary to take home with you.
Complications:
This is generally a very safe procedure with a low risk of complications.
The chance of infection is <5%.
Significant bleeding requiring readmission to hospital or blood transfusion is <5%.
The chance of an injury or perforation of the bladder is <1%.
After discharge from hospital:
You should drink extra fluid over the first week or two after surgery. Drinking 1500-2000mL per day is usually satisfactory. Do not drink excessively. Aim to keep your urine a pale yellow or straw colour. If you find your urinary symptoms are not improving or become worse, then you could have an infection. Either contact our office or see your GP to organise a urine test.
If you do notice an increased amount of blood in the urine, then drink extra water to dilute the urine. Occasionally there is more excessive bleeding, and maybe clots in the urine that make it difficult to pass. If this occurs then please contact our office, contact your GP or present to a hospital emergency department for assessment.
You should be able to recommence most of your usual activities shortly after surgery. Please avoid heavy lifting or straining until bleeding settles. Sexual activity can be recommenced once the bleeding settles.
Driving:
You should not drive for at least 24 hours after having sedation/anaesthetic (or as instructed by your Urologist).
Patients who are travelling outside the metropolitan area are required to check when they are able to travel, and will be required to stay in the metropolitan area for 24 hours (or as instructed by your Urologist).
Emergency Contacts:
In the event of an emergency, call our office within business hours and speak to our Practice Nurse. If out of hours, please call our office to contact our On-Call Urologist, or present to your nearest Emergency Department.
Retrograde pyelography combines the use of a long, flexible viewing tube called a cystoscope with contrast x-rays to visualize the kidneys and ureters. The cystoscope is inserted through the urethra into the bladder; fiberoptic cables permit direct visual inspection of these structures. A catheter is then threaded through the scope so that a contrast dye can be infused directly into the ureters to delineate them on x-ray films.
Retrograde pyelography is most often performed when intravenous pyelography produces inconclusive results, or when it cannot be performed because of impaired kidney function or another reason.
Purpose of the Retrograde Pyelography
• To evaluate the structure and integrity of the kidneys and ureters
• To identify the cause of obstructions in the kidneys or ureters, such as tumors, narrowing, scarring, blood clots, or stones
• To determine if a catheter or ureteral stent is positioned properly
Who Performs It
• A urologist or a radiology technician.
Special Concerns
• Pregnant women should not undergo this test because exposure to ionizing radiation may harm the fetus.
• Retrograde pyelography is the preferred test to examine the urinary tract in people who are allergic to iodine or shellfish, and therefore may be hypersensitive to iodine-based contrast dyes. Allergic reactions rarely occur with this test, because none of the dye is absorbed into the bloodstream.
• This test must be performed carefully to prevent further damage to the ureter in individuals who have a slowing or stoppage of normal urine flow (urinary stasis) caused by ureteral obstruction.
• The presence of feces, gas, or residual barium from recent contrast x-rays of the gastrointestinal system can obscure visualization of the urinary tract.
Before the Retrograde Pyelography
• Be sure to tell your doctor if you have a known shellfish or iodine allergy or have ever had an adverse reaction to x-ray contrast dyes.
• Tell your doctor if you are or could be pregnant.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, and tape.
• Notify your physician of all medications and supplements that you are taking. In particular, be sure to mention if you are taking blood thinners, including aspirin, or any other drugs that affect blood clotting. You may have to stop them for a short period before the test.
• Tell your doctor if you have/have ever had a bleeding disorder.
• If you are receiving a local anesthetic, you should have a liquid breakfast on the morning of the test.
• If general anesthesia is required, do not eat or drink after midnight on the day before the test.
• An intravenous (IV) catheter may be inserted into a vein in your arm to provide fluids and/or to administer a general anesthetic during the procedure.
What You Experience
• You will lie on your back on an examination table with your knees bent and feet resting in stirrups.
• After local or general anesthesia has been administered, the doctor carefully inserts the cystoscope through your urethra and into the bladder, and performs a visual examination.
• Next, a thin tube, or catheter, is threaded through the cystoscope into the ureter. (Sometimes both ureters are catheterized.)
• The contrast dye is injected through the catheter. If you are conscious, you may feel some discomfort during catheter insertion and when the dye is instilled.
• X-ray films are obtained. You must remain still to avoid blurring the pictures.
• As the catheter is slowly withdrawn, more contrast dye is instilled and additional x-rays are taken to visualize the complete length of the ureter.
• A delayed x-ray film is usually taken about 5 minutes after the last injection to check for retention of contrast dye, which indicates a ureteral obstruction.
• If an obstruction is present, a catheter may be left in place in the ureter so that it can drain.
• The procedure usually takes about 1 hour.
Risks and Complications
• Possible complications include urinary tract infection, temporary blockage of the ureter due to swelling, and, rarely, inadvertent perforation of the bladder or ureter.
• Rarely, some people may experience an allergic reaction to the iodine-based contrast dye, which can cause symptoms such as nausea, sneezing, vomiting, hives, and occasionally a life-threatening response called anaphylactic shock. Emergency medications and equipment are kept readily available.
After the Retrograde Pyelography
• If no complications develop, you are usually free to leave the testing facility. Your doctor will instruct you to keep track of your urine output and report any urinary retention.
• Your urine may contain blood at first, causing a slight pink tinge; this should resolve after you have voided 3 times. If blood persists or you see bright red blood or blood clots, notify your physician.
• Urination is often painful or difficult for the first few times after the test. You may be instructed to take tub baths to help ease any discomfort, and painkillers will be prescribed, as needed.
• You are encouraged to increase your intake of fluids to help prevent urinary retention and accumulation of bacteria in your bladder.
• Inform your doctor immediately if you experience pain in the area of the kidneys, chills, fever, redness, swelling, bleeding or increase in the amount of blood in your urine and difficulty urinating.
Results
• The doctor will examine the x-ray films for evidence of any abnormalities, such as a ureteral obstruction.
• If a definitive diagnosis can be made, your doctor will recommend an appropriate course of treatment.
• In some cases, additional diagnostic tests, such as a renal CT scan, renal nuclear scan, or ureteroscopy, may be needed to further evaluate abnormal results.
Name: Brook John, Sex: Male, Birth: 20-3-1954, Age 62 years old, MRN;01188380 Married has 4 children lives at Parafield Gardens. Came from England 35 years ago. Mobility; Independent, NKAD Allergies.
Over 2 years PT has hematuria associated with dysuria, nocturia and frequency of urination during the day. Since it was 11 years old PT had a injury riding the bike. GP recommended a CT scan and was found 2 simple renal cysts bilaterally urinalysis. And the cystoscopy showed irregular mucosa with papillary lesions suspicions cell carcinoma.
PT is admitted for; referred fro GP
Bladder lesions cystoscopy Biopsy Bilateral Retrograde Pyelogram, and trans-urethral resection
Before the Retrograde Pyelography
Be sure to tell your doctor if you have a known shellfish or iodine allergy or have ever had an adverse reaction to x-ray contrast dyes.
Notify your physician if you are sensitive to or are allergic to any medications, latex, and tape.
Notify your physician of all medications and supplements that you are taking. In particular, be sure to mention if you are taking blood thinners, including aspirin, or any other drugs that affect blood clotting. You may have to stop them for a short period before the test.
Tell your doctor if you have/have ever had a bleeding disorder.
If you are receiving a local anesthetic, you should have a liquid breakfast on the morning of the test.
If general anesthesia is required, do not eat or drink after midnight on the day before the test.
An intravenous (IV) catheter may be inserted into a vein in your arm to provide fluids and/or to administer a general anesthetic during the procedure.
What You Experience
You will lie on your back on an examination table with your knees bent and feet resting in stirrups.
After local or general anesthesia has been administered, the doctor carefully inserts the cystoscope through your urethra and into the bladder, and performs a visual examination.
Next, a thin tube, or catheter, is threaded through the cystoscope into the ureter. (Sometimes both ureters are catheterized.)
The contrast dye is injected through the catheter. If you are conscious, you may feel some discomfort during catheter insertion and when the dye is instilled.
X-ray films are obtained. You must remain still to avoid blurring the pictures.
As the catheter is slowly withdrawn, more contrast dye is instilled and additional x-rays are taken to visualize the complete length of the ureter.
A delayed x-ray film is usually taken about 5 minutes after the last injection to check for retention of contrast dye, which indicates a ureteral obstruction.
If an obstruction is present, a catheter may be left in place in the ureter so that it can drain.
The procedure usually takes about 1 hour.
Past medical history;
Acute Pancreatitis (Acute pancreatitis is an acute inflammatory process of the pancreas, Acute pancreatitis should be suspected in patients with severe acute upper abdominal pain)
Cysts in pancreas (Pancreatic cysts are collections (pools) of fluid that can form within the head, body, and tail of the pancreas. Some pancreatic cysts are true cysts (non-inflammatory cysts), that is, they are lined by a special layer of cells that are responsible for secreting fluid into the cysts)
Diabetes; Type 2 diabetes is a progressive condition in which the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce.
Meds;
Metformin is antihyperglycemic agents; Mechanism of action decreases blood glucose levels by decreasing hepatic glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity by increasing peripheral glucose uptake and utilization. the initial activation by metformin of AMP-activated protein kinase (AMPK), a liver enzyme that plays an important role in insulin signaling, whole body energy balance, and the metabolism of glucose and fats. Activation of AMPK is required for metformin’s inhibitory effect on the production of glucose by liver cells
Panadol also known as paracetamol, is commonly used for its analgesic and antipyretic effects. Its therapeutic effects are similar to salicylates, but it lacks anti-inflammatory, antiplatelet, and gastric ulcerative effects. . Mechanism of action interferes with prostaglanding
Oxycodone is a semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. Mechanism of action Oxycodone acts as a weak agonist at mu, kappa, and delta opioid receptors within the central nervous system (CNS). Oxycodone primarily affects mu-type opioid receptors, which are coupled with G-protein receptors and function as modulators, both positive and negative, of synaptic transmission via G-proteins that activate effector proteins.
Fentanyl is an opioid analgesic. Fentanyl interacts predominately with the opioid mu-receptor but also binds to kappa and delta-type opioid receptors.
Propofol is an intravenous anaesthetic agent used for induction and maintenance of general anaesthesia.The action of propofol involves a positive modulation of the inhibitory function of the neurotransmitter gama-aminobutyric acid (GABA) through GABA-A receptors.
Cefazolin (also known as cefazoline or cephazolin) is a semi-synthetic first generation cephalosporin for parenteral administration. Cefazolin has broad-spectrum antibiotic action due to inhibition of bacterial cell wall synthesis. It attains high serum levels and is excreted quickly via the urine.
Gentamicin is a bactericidal antibiotic that works by irreversibly binding the 30S subunit of the bacterial ribosome, interrupting protein synthesis.
Hartmann’s solution or compound sodium lactate (CSL) is a crystalloid solution that is closely isotonic with blood and intended for intravenous administration. Hartmann’s solution is used to replace body fluid and mineral salts that may be lost for a variety of medical reasons.
The risk of surgery;
UTI, risk of blood in the urine, unable to pass urine, burning sensation on passing urine, reaction to the anesthetic.
Risks and Complications
Possible complications include urinary tract infection, temporary blockage of the ureter due to swelling, and, rarely, inadvertent perforation of the bladder or ureter.
Rarely, some people may experience an allergic reaction to the iodine-based contrast dye, which can cause symptoms such as nausea, sneezing, vomiting, hives, and occasionally a life-threatening response called anaphylactic shock. Emergency medications and equipment are kept readily available.
After the Retrograde Pyelography
If no complications develop, you are usually free to leave the testing facility. Your doctor will instruct you to keep track of your urine output and report any urinary retention.
Your urine may contain blood at first, causing a slight pink tinge; this should resolve after you have voided 3 times. If blood persists or you see bright red blood or blood clots, notify your physician.
Urination is often painful or difficult for the first few times after the test. You may be instructed to take tub baths to help ease any discomfort, and painkillers will be prescribed, as needed.
You are encouraged to increase your intake of fluids to help prevent urinary retention and accumulation of bacteria in your bladder.
Inform your doctor immediately if you experience pain in the area of the kidneys, chills, fever, redness, swelling, bleeding or increase in the amount of blood in your urine and difficulty urinating.
Results
The doctor will examine the x-ray films for evidence of any abnormalities, such as a ureteral obstruction.
If a definitive diagnosis can be made, your doctor will recommend an appropriate course of treatment.
In some cases, additional diagnostic tests, such as a renal CT scan, renal nuclear scan, or ureteroscopy, may be needed to further evaluate abnormal results.
 
 
 
 
 
 
 

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