Interdisciplinary Team Care: Case 2
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
- π¨ββοΈ Mr. James, a 72-year-old male, is a new patient under Dr. Carter's care, who has taken over from Dr. Punch.
- π₯ Mr. James was transferred to the University Hospital for a stent procedure due to a new diagnosis of gastric carcinoma.
- π ββοΈ Mr. James is unaware of his diagnosis, which was kept from him until his family could inform him together.
- π©Έ He was scheduled for a blood transfusion to address low hemoglobin, but developed a fever after the first unit, possibly indicating a transfusion reaction.
- π€ Mr. James is currently febrile and requires monitoring to determine the source of the fever, with cultures pending.
- π His hemoglobin and hematocrit levels have improved after the partial transfusion, responding to a count of 8.9 to 10.7.
- π² 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.
- π₯£ He consumed probiotic yogurt for breakfast, which is considered acceptable despite being on a low-residue diet.
- π His medication, including pain management, needs to be transitioned from IV to oral forms, starting with allopurinol for pain.
- ποΈ A home safety evaluation and home health services are suggested if the family wishes for Mr. James to return home.
- π The family should be informed about the diagnosis, which may be a sensitive and emotional conversation.
- π 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
π₯ 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
π‘Mr. James
π‘Dr. Carter
π‘Gastric Carcinoma
π‘Stent
π‘Transfusion
π‘Fever
π‘Cultures
π‘Hemoglobin
π‘Diet
π‘Probiotic Yogurt
π‘Medication Transition
π‘Tachycardia
π‘Beta Blocker
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.
Transcripts
all right I have 5216 mr. James
he's a 72 year old male patient of dr. I
have dr. Carter but is it dr. punch ah
yeah I took over for him
okay but the human yesterday over to the
University Hospital for a stent for his
new diagnosis of gastric carcinoma you
Crowley doesn't know he's not aware of
the diagnosis which I wasn't informed of
initially so I guess his family was
waiting for another son to arrive before
they told him today it was going to be
there with them for this conversation we
will end yeah
so the intolerant of the procedure fine
he was gonna get transfuse two units
last night for his low hemoglobin but
after the first unit is temp spiked to
101 six it's not clear this would have
been a transfusion reaction he's also
very tacky he seemed Jackie today you
know he's gonna have to be here in a
couple days till we figure out the
source of the fever we have cultures
pending we can get the are you a in the
urine culture and the chest x-rays so
far looks okay and he's H and H looks
good yeah looks like he responded eight
nine to ten seven a couple of days you
say I think so
this be TC no me either we saw him
before his heart rate went up he would
really benefit from sniff rehab but if
the family wants him home then what to
get a home safety evaluation we can send
home health out there and oh that should
probably wait Congrats to the top of the
family about the diagnosis the other
thing is his diet so I spoke with GI
this morning and they said that they can
advance his diet slowly right now I
think he's on a clear liquid diet no he
got pure it okay yeah then so if you
tell her he's that flying today and
tonight we do a little
we just got to make sure we don't give
it more fresh vegetables or fruits they
can clog the stem and he wasn't really
interested in breakfast this morning but
he had the probiotic yogurt do you want
him to get that then if he's on the low
residue is is it okay with the bacteria
in it with the rest of it I think it
should be okay he had the yogurt and
then he wasn't really interested in much
more breakfast he just order an oatmeal
or something
is that okay no cancel that please okay
his med should start being transitioned
to pee oh especially his pain meds
yes he was on IV morphine I don't know
how much was needed he just told me he
was having some pain like cramping
around the area like the lower abdomen
he's having a hard time so I'll give him
some all payments and see how he
responds to that yeah I will give him
the morphine the IV then right Buford if
he starts taking world nights okay and
then the night nurse put him on the
monitor do you still want that yeah I
would like for him to be monitor it's -
its tacky was in the low teens 120 okay
yeah so we just need a monitor for that
you could shut that down okay is he on a
beta blocker has he started knows that
on a beta blocker right now City v no
but he was in Mexico so he stopped
taking his medication for two weeks the
tachycardia could be reflux his blood
pressures have been better since you got
the transfusion it looks like low
hundreds to 120 when we round upstairs
we'll talk about that okay yeah
you
Browse More Related Video
How to undertake a suicide risk assessment in an inpatient setting
Interdisciplinary Team Care: Case 1
KangSu FirstTrailer4K
Communication Skills: A Patient-Centered Approach
Intravenous (IV) cannulation | OSCE Guide | UKMLA | CPSA
I'm 50 years old Japanese man and am really worried about my future. What should I do?
5.0 / 5 (0 votes)