Interdisciplinary Team Care: Case 2

Summary

The 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.