Interdisciplinary Team Care: Case 2

Donald W. Reynolds

23 Jan 201403:47

Summary

TLDRThe transcript details a medical case involving a 72-year-old patient, Mr. James, who recently underwent a stent procedure for gastric carcinoma at the University Hospital. The patient is unaware of his diagnosis, which was kept from him until after the procedure. He experienced a fever post-transfusion, which is being investigated with pending cultures. His diet is being cautiously managed to avoid complications with the stent, and his medications, including pain management, are being adjusted. The patient's family is involved in his care, and a home safety evaluation is suggested once the diagnosis is disclosed.

Takeaways

👨‍⚕️ Mr. James, a 72-year-old male, is a new patient under Dr. Carter's care, who has taken over from Dr. Punch.
🏥 Mr. James was transferred to the University Hospital for a stent procedure due to a new diagnosis of gastric carcinoma.
🙅‍♂️ Mr. James is unaware of his diagnosis, which was kept from him until his family could inform him together.
🩸 He was scheduled for a blood transfusion to address low hemoglobin, but developed a fever after the first unit, possibly indicating a transfusion reaction.
🤒 Mr. James is currently febrile and requires monitoring to determine the source of the fever, with cultures pending.
📈 His hemoglobin and hematocrit levels have improved after the partial transfusion, responding to a count of 8.9 to 10.7.
🍲 Mr. James is on a clear liquid diet, which will be slowly advanced by the GI team, with caution to avoid fresh vegetables or fruits that could clog the stent.
🥣 He consumed probiotic yogurt for breakfast, which is considered acceptable despite being on a low-residue diet.
💊 His medication, including pain management, needs to be transitioned from IV to oral forms, starting with allopurinol for pain.
🛏️ A home safety evaluation and home health services are suggested if the family wishes for Mr. James to return home.
💔 The family should be informed about the diagnosis, which may be a sensitive and emotional conversation.
💓 Mr. James' heart rate and blood pressure have been monitored, with tachycardia possibly due to medication withdrawal during his time in Mexico.

Q & A

Who is the patient mentioned in the script?
-The patient is Mr. James, a 72-year-old male.
What is the diagnosis that Mr. James has recently received?
-Mr. James has been diagnosed with gastric carcinoma.
Why was Mr. James transferred to the University Hospital?
-Mr. James was transferred to receive a stent for his new diagnosis of gastric carcinoma.
Is Mr. James aware of his diagnosis?
-No, Mr. James is not aware of his diagnosis, as his family was waiting for another son to arrive before informing him.
What happened after Mr. James received the first unit of transfusion?
-After the first unit of transfusion, Mr. James' temperature spiked to 101.6, possibly indicating a transfusion reaction.
What is the current status of Mr. James' hemoglobin?
-Mr. James has low hemoglobin, and he was scheduled to receive two units of transfusion.
What is the plan regarding Mr. James' diet after his procedure?
-GI has advised that Mr. James' diet can be slowly advanced, and he is currently on a clear liquid diet.
What is the concern with Mr. James' diet in relation to his stent?
-There is a concern about giving Mr. James fresh vegetables or fruits as they could clog the stent.
What kind of yogurt did Mr. James have for breakfast, and is it suitable for his condition?
-Mr. James had a probiotic yogurt, which is considered okay for his condition despite being on a low-residue diet.
What is the plan for Mr. James' pain management?
-Mr. James was initially on IV morphine for pain management, and the plan is to transition his pain meds to oral as he responds to treatment.
What is the current status of Mr. James' heart rate and blood pressure?
-Mr. James' heart rate is tachycardic, and his blood pressure has been in the low hundreds to 120 after the transfusion.
What additional measures are being taken to monitor Mr. James' condition?
-Mr. James is being monitored for his heart rate, and cultures are pending to determine the source of his fever.

Outlines

00:00

🏥 Patient Update on Mr. James' Hospital Stay

The script begins with a discussion about a 72-year-old male patient, Mr. James, who has been under the care of Dr. Carter but is now managed by another doctor. Mr. James was diagnosed with gastric carcinoma and underwent a stent procedure at the University Hospital. The patient is unaware of his diagnosis, which was kept from him until his family could discuss it together. He experienced a fever after a blood transfusion, which may have been a reaction, and his condition requires further investigation with pending cultures and chest x-rays. The patient's diet is being managed carefully to avoid clogging his stent, and his medications, including pain medication, are being adjusted from IV to oral as he recovers. His heart rate and blood pressure are being monitored, and concerns about his medication adherence due to a recent stay in Mexico are noted.

Mindmap

Keywords

💡Mr. James

Mr. James is a 72-year-old male patient who is central to the narrative of the video. He has been diagnosed with gastric carcinoma and has undergone a procedure for a stent at the University Hospital. His condition and treatment are the primary focus of the video's dialogue, illustrating the medical care and communication surrounding his case.

💡Dr. Carter

Dr. Carter is mentioned as a physician who has been replaced, indicating a change in the medical team caring for Mr. James. This change is significant as it shows the dynamic nature of healthcare teams and the importance of continuity in patient care.

💡Gastric Carcinoma

Gastric Carcinoma, also known as stomach cancer, is the medical condition diagnosed in Mr. James. It is a serious condition that requires specialized treatment and is a key element of the video's theme, highlighting the challenges faced by both patients and healthcare providers in managing such diagnoses.

💡Stent

A stent is a medical device used to treat narrowed or weakened arteries in various parts of the body. In the context of the video, Mr. James has a stent placed, which is part of his treatment for gastric carcinoma, showing the multifaceted approach to managing his condition.

💡Transfusion

Transfusion refers to the process of transferring blood or blood components into the circulatory system. In the video, Mr. James is scheduled for a transfusion due to low hemoglobin, but experiences a fever after the first unit, suggesting a possible transfusion reaction.

💡Fever

Fever is a common medical symptom indicating a potential infection or other underlying issue. In the script, Mr. James' fever is a concern that requires further investigation, as it could be related to his recent procedure or another medical issue.

💡Cultures

Cultures in a medical context refer to the laboratory process of growing microorganisms to identify the cause of an infection. The video mentions pending cultures, indicating that the healthcare team is actively seeking the source of Mr. James' fever.

💡Hemoglobin

Hemoglobin is a protein in red blood cells that carries oxygen. The script mentions Mr. James' low hemoglobin levels, which is why he was scheduled for a transfusion, highlighting the importance of hemoglobin in maintaining overall health.

💡Diet

Diet is a critical aspect of patient care, especially after surgery or during recovery. The video discusses advancing Mr. James' diet slowly, starting with clear liquids and progressing to pureed foods, which is a standard approach to ensure the patient's digestive system can handle food intake after a procedure.

💡Probiotic Yogurt

Probiotic Yogurt contains live bacteria that are beneficial to the digestive system. In the script, Mr. James consumes probiotic yogurt, which is part of his diet plan, illustrating the consideration of nutritional needs in his recovery.

💡Medication Transition

Medication Transition refers to the process of changing from one form of medication to another, such as from IV to oral. The video mentions transitioning Mr. James' pain medications, indicating an important step in his recovery process as he moves from acute care to a more stable condition.

💡Tachycardia

Tachycardia is a medical term for a heart rate that is faster than normal. In the script, Mr. James experiences tachycardia, which could be related to his recent medical procedures or other health issues, and is a concern that the healthcare team is monitoring.

💡Beta Blocker

A beta blocker is a class of medications that are used to treat various conditions, including high blood pressure and heart rhythm disorders. The script mentions that Mr. James was not on a beta blocker, which could be related to his tachycardia, and the healthcare team is considering this in his treatment plan.

Highlights

72-year-old male patient Mr. James diagnosed with gastric carcinoma.

Patient unaware of diagnosis, family waiting for another son to inform him.

Patient had stent procedure at University Hospital.

Patient spiked a fever after first unit of blood transfusion, possible transfusion reaction.

Patient very tachycardic, heart rate in the 120s.

Cultures pending to determine source of fever.

Chest x-rays appear normal, no obvious issues.

Hemoglobin and hematocrit levels improved after transfusion.

Speech therapy recommended to benefit patient's condition.

Home safety evaluation and home health services discussed.

Diet advancement discussed with GI, currently on puree diet.

Concern about low-residue diet and potential for clogging the stent.

Patient had yogurt for breakfast, discussion about probiotics.

Medication transition to oral form, especially pain medication.

Patient on IV morphine, pain levels and response to be monitored.

Consideration of patient's heart rate and potential need for a beta blocker.

Blood pressure improved after transfusion, discussion about monitoring.

Patient's current condition and next steps in care summarized.