Past Medical history includes : Essential Hypertension, Cardiac pacemaker, Coronary Artery Disease, Dyspnea, Sensiosenural hearing loss, Restless legs, headache, acute hypothyroidism due to radiation, Mandible Cancer, Pseudophakia of both eyes, Posterior vitreous detachment, malnutrition, Generalized weakness, Smoker of 2 packs of cigarettes per day for 30 years. J.H. s is a 78 y.o. male with a history of moderately differentiated SCC of the left mandible. This was diagnosed in October 2013. There was some delay on the patient’s behalf on scheduling the surgery. He then had a sync opal episode and was found to have severe bradycardia and junctional bradycardia. He underwent a CABG X4 for 3 vessel disease and pacemaker placement on 11/10/2013.
He underwent a left marginal mandibulectomy and left neck dissections of level 1-4 on 01/23/2014. Pathology reported grade 2 moderately differentiated SCC nodes were positive. Patient declined adjuvant therapy. Patient did well until June when he developed an infection in the hardware. He was taken back to surgery 02/10/2014 for removal of hardware and biopsy of the left cheek and mass, which was found to be invasive cancer. He then agreed to radiation and chemotherapy, which has since started. Since he develop issues with dysphagia during therapy, and a peg tube placement was recommended. He underwent a successful placement of a peg tube on 4/05/14. Physical Examination
The Term Paper on Patient Monitoring Systems And Ultrasound Machines
Philips Electronics India Limited is the leading Healthcare Company today. It strives to improve the quality of people’s lives by focussing on their health and well-being. As a company it is essentially divided into Patient Care and Clinical Informatics (PCCI), Imaging and Ultrasound. PCCI as a modality includes patient monitors, diagnostic ECG which features HOLTER, stress test etc, anaesthesia ...
BP 166/73 | Pulse 69 | Temp 96.9 °F (oral) | Resp 14 | SpO2 99% on room air
General appearance: alert and oriented x 3, cooperative, no distress Head: Normal
Eyes: Cataract surgery 5 years ago; slightly red
Nose: Normal
Ears: Hearing is abnormal, currently having to repeat questions Throat/Oropharynx: recent mandibular surgery. Limited ability to open mouth. Upper plate. Neck: Abnormal recent surgery and radiation to area. Area reddened. Lungs: clear to auscultation bilaterally and normal respiratory effort Heart: regular rate and rhythm, no murmurs
Abdomen: bowel sounds hypo x 4, no rebound, no guarding, no distention and soft and abnormal findings: tenderness moderate in the LUQ at peg site, surrounding skin of peg site excoriated Rectal: deferred
Extremities: normal ROM and extremities normal, no cyanosis or edema Pulses: 2+ and symmetric
Skin: Normal
Neurologic: Normal
Functional Health Pattern (FHP) Assessment
Cognitive-Perceptual Pattern: Able to express himself but takes extra time to answer questions and at times forgetful Nutritional-Metabolic Pattern: Currently malnourished only able to take in 3 cans of recommended feeding due to nausea should be taken 6 cans. Patient receives feedings four times a day. Sexuality-Reproductive Pattern: Patient has children that are adults but happen he has grandchildren. Pattern of Elimination: Frequent urination causes episodes of incontinence; recently bowels have been loose and fluctuate to constipation Pattern of Activity and Exercise: Currently sedentary
Pattern of Sleep and Rest: Requires the use of sleep medication due to anxiety Pattern of Self-Perception and Self-Concept: Unable with facial; currently has left side facial drop from previous stroke Summary of Findings
Situation
Patient being seen today for increase complaints of abdomen pain, nausea and vomiting of blood, spouse reports last bowel movement was four days ago. Background
Patient refused to take feedings today, he stated, “that’s what is making me sick”, Rates pain in abdomen due to vomiting. PEG tube recently placed and has been tolerated tube feeding until yesterday. Increased urination with pain, “burning sensation when I urinate” Assessment
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Alzheimer's 2 Alzheimer's DiseaseAlzheimer's 2 Essay, Research Paper Alzheimer's Disease does not kill instantly; it destroys the individual bit by bit, tearing away at their person-hood and self-identity. Most victims suffer for 9 to 15 years after onset of the illness. It is the most common type of dementia in the United States and Canada and after age 40, the risk of developing it doubles with ...
PEG tube site with excoriation around the site; green dried crust on abdomen and tube. Bowel sounds hypo. Imbalanced nutrition, less than body requirements, related to feeding problems. Risk for impaired skin integrity at tube site. Ineffective coping related to inability to eat normally. PEG tube site care should be performed twice daily. Recommendations
CT scan of abdomen to rule out bowel obstruction. Culture discharge around tube site for antibiotic treatment. Teach patient and caregiver strategies to prevent infection. Teach caregiver and patient signs and symptoms of infection. Encourage adequate nutritional intake. Wash hands before contact with site. (Gulanick)
References
Gulanick, M., Myers, J.,; Nursing Care Plans: Nursing Diagnosis and Intervention, (2012) Jarvis, C., Physical Examination and health assessment, (2012) www.cancer.org
www.mcw.edu – Center for Health Communities (414) 456-8291 A Cancer support group meets the first Tuesday of every month at Froedtert and Medical College. 9000 w. Wisconsin
