Case Study Andrew is a 58-year-old male who is currently homeless. He was living in a supported livi. Question
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Case Study
Andrew is a 58-year-old male who is currently homeless. He was living in a supported living accommodation but recently was asked to leave due to his drinking issues. He has not worked for 2 years and started drinking heavily when his wife left him 3 years ago. He admits that when he has money, he will drink a cask of wine a night. He has been relying on the soup kitchen that comes around at nights but sometimes they run out of food and if he has no money then he often goes hungry. A few months ago he went to St Vincent’s with chest pain and they diagnosed him with Gastric reflux and put him on some sort of “acid” tablet (Gastro-oesophageal Reflux Disease and prescribed Esomeprazole 40mg mane). After the script ran out Andrew has not had the money to go and get it filled again.
Andrew was brought to ED when a passer-by called an ambulance after he was found vomiting blood in the Bourke Street Mall and had a decreased level of consciousness. Andrew was complaining of severe epigastric pain, vomiting with blood and severe nausea. Andrew is also a smoker and is quite malnourished.
On examination upon admission:
• 58-year-old male – intoxicated with strong odour of urine and alcohol • Dirty clothes and looks quite emaciated.
• BP 148/96 mmHg
• HR 112 beats/min
• RR 22 breaths/min • Temp 36.2
• SpO2 95%
• Pain score 10/10
• Abdominal assessment – tender in the epigastrium with mild rebound tenderness but no guarding
Lab tests on admission: (reference ranges indicated below in brackets) FBC:
– Hb 148 (130-180 g/L)
– WCC, 16,000 (5000-10000)
– PMN 75% (60-70%)
Serum Amylase 750 (60-180 units) Glucose (Random) 7.2 (3.0 – 6.9 mmol/L) Serum ALP 250 (30- 110 U/L)
Serum Sodium 145 (135-145 mmol/L) Serum Potassium 4.0 (3.5- 5.2 mmol/L) Serum Creatinine 62 (60-110 μmol/L Serum Calcium 2.15 (2.10 – 2.60 mmol/L)
Current diagnosis: Acute pancreatitis
Medical Orders:
• Commence IV fluids Sodium Chloride 0.9% at 150ml/hr
• NBM
• Insert Nasogastric tube connected to low intermittent suction
• Morphine 2mg IV bolus PRN for pain
• Ondansetron 4mg IV bolus every 4 hours PRN for nausea
• Ultrasound Abdomen
It has now been 8 hours since Andrew’s last drink and he is starting to enter alcohol withdrawals. The Doctors reviewed Andrew and ordered the following medications:
Thiamine 100mg IV Diazepam 10mg 2hrly prn
SCIENCE
HEALTH SCIENCE
NURSING
HNB 2003
Case Study Andrew is a 58-year-old male who is currently homeless. He was living in a supported livi
