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Sorry if this is in wrong spot, but anyone interested in commenting on the following?
CASE STUDY 5
A 37 year-old man is involved in a collision with tree while riding his motorcycle. He is found by a passing motorist some time later, although it is not clear how long ago the accident occurred. There is much blood at the scene of the accident, some broken bones and his blood pressure is 70 mm Hg systolic. He is given normal saline intravenously (IV) in the ambulance and on arrival at hospital is rushed to theatre and ?patched up? as well as possible. There are no torn abdominal viscera and his head seems relatively intact. He has further saline, haemaccel, and ultimately 5 units of packed red blood cells. On leaving theatre his haemoglobin is 11 g/dl (normal range 13-19 g/dl) and his blood pressure 120/75 mm Hg. He passes no urine since admission to hospital and a catheter only yields 120 ml of urine, which shows blood + and protein trace with dipstix.
In the operating theatre his plasma biochemistry and urine output showed the following values:
PARAMETER PATIENT VALUES NORMAL VALUES
Potassium 3.9 mmol/l 3.4-4.7
Urea 5.7 mmol/l 3-6
Creatinine 90 mol/l 60-120
Urine output 120 ml 1.2-1.9 l/day
His plasma biochemistry and urine output was followed up over the next three days with the following results:
PARAMETER DAY 2 DAY 3 DAY 4
Potassium 3.8 mmol/l 4.4 mmol/l 4.9 mmol/l
Urea 11 mmol/l 18 mmol/l 27 mmol/l
Creatinine 170 mol/l 290 mol/l 410 mol/l
Urine output 50 ml 60 ml 40ml
1. Why was this patient?s plasma biochemistry normal on admission to theatre?
(4 marks, 80 words)
2. A patient arriving in casualty following an accident of this kind may be expected to have a high plasma level of potassium. What would be the most likely reason for an elevated plasma potassium level in such a case?
(2 marks, 70 words)
3. Why was the patient?s blood pressure so low? How would the body attempt to compensate for this problem? Describe the mechanisms involved.
(4 marks, 120 words)
4. What relevance would broken bones have to the patient?s condition and would it be significantly influenced by which bones were broken?
(4 marks, 100 words)
5. What other signs and symptoms may have been evident in this patient when the ambulance arrived at the scene of the accident? How do these observations relate to the body?s compensatory mechanisms?
(4 marks, 120 words)
6. What is haemaccel and how does it work?
(2 marks, 50 words)
7. Which vital organ is not functioning in this patient? Explain how you arrive at your conclusion.
(2 marks, 40 words)
8. What is the main reason why this organ has failed? What is this condition called?
(2 marks, 35 words)
9. What is the principal pathological change seen in the cellular structure of this organ? How does this relate to the abnormal plasma biochemistry seen in days 2, 3 and 4?
(4 marks, 110 words)
10. In the nursing management of this patient what are the principal physiological parameters that require careful monitoring?
(3 marks, 65 words)
11. Briefly describe what pathological conditions may arise as a result of failure to adequately monitor the relevant parameters.
(4 marks, 125 words)
12. Patients recovering from this type of accident may be reluctant to eat solids in the early stages of convalescence. Would this be of relevance in the management of this patient and if so explain why?
(2 marks, 20 words)
13. Assuming the patient is monitored appropriately what procedure would be used to resolve any abnormalities observed? Would this procedure be required more than once?
(2 marks, 30 words)
14. Will the damaged organ regain function? If so explain the physiological mechanisms that occur in the repair process. In particular make reference to the time-frame of recovery.
(3 marks, 110 words)
15. What is the long-term prognosis for this patient? Will the damaged organ always recover fully? Justify your answer.
(3 marks, 70 words)
CASE STUDY 5
A 37 year-old man is involved in a collision with tree while riding his motorcycle. He is found by a passing motorist some time later, although it is not clear how long ago the accident occurred. There is much blood at the scene of the accident, some broken bones and his blood pressure is 70 mm Hg systolic. He is given normal saline intravenously (IV) in the ambulance and on arrival at hospital is rushed to theatre and ?patched up? as well as possible. There are no torn abdominal viscera and his head seems relatively intact. He has further saline, haemaccel, and ultimately 5 units of packed red blood cells. On leaving theatre his haemoglobin is 11 g/dl (normal range 13-19 g/dl) and his blood pressure 120/75 mm Hg. He passes no urine since admission to hospital and a catheter only yields 120 ml of urine, which shows blood + and protein trace with dipstix.
In the operating theatre his plasma biochemistry and urine output showed the following values:
PARAMETER PATIENT VALUES NORMAL VALUES
Potassium 3.9 mmol/l 3.4-4.7
Urea 5.7 mmol/l 3-6
Creatinine 90 mol/l 60-120
Urine output 120 ml 1.2-1.9 l/day
His plasma biochemistry and urine output was followed up over the next three days with the following results:
PARAMETER DAY 2 DAY 3 DAY 4
Potassium 3.8 mmol/l 4.4 mmol/l 4.9 mmol/l
Urea 11 mmol/l 18 mmol/l 27 mmol/l
Creatinine 170 mol/l 290 mol/l 410 mol/l
Urine output 50 ml 60 ml 40ml
1. Why was this patient?s plasma biochemistry normal on admission to theatre?
(4 marks, 80 words)
2. A patient arriving in casualty following an accident of this kind may be expected to have a high plasma level of potassium. What would be the most likely reason for an elevated plasma potassium level in such a case?
(2 marks, 70 words)
3. Why was the patient?s blood pressure so low? How would the body attempt to compensate for this problem? Describe the mechanisms involved.
(4 marks, 120 words)
4. What relevance would broken bones have to the patient?s condition and would it be significantly influenced by which bones were broken?
(4 marks, 100 words)
5. What other signs and symptoms may have been evident in this patient when the ambulance arrived at the scene of the accident? How do these observations relate to the body?s compensatory mechanisms?
(4 marks, 120 words)
6. What is haemaccel and how does it work?
(2 marks, 50 words)
7. Which vital organ is not functioning in this patient? Explain how you arrive at your conclusion.
(2 marks, 40 words)
8. What is the main reason why this organ has failed? What is this condition called?
(2 marks, 35 words)
9. What is the principal pathological change seen in the cellular structure of this organ? How does this relate to the abnormal plasma biochemistry seen in days 2, 3 and 4?
(4 marks, 110 words)
10. In the nursing management of this patient what are the principal physiological parameters that require careful monitoring?
(3 marks, 65 words)
11. Briefly describe what pathological conditions may arise as a result of failure to adequately monitor the relevant parameters.
(4 marks, 125 words)
12. Patients recovering from this type of accident may be reluctant to eat solids in the early stages of convalescence. Would this be of relevance in the management of this patient and if so explain why?
(2 marks, 20 words)
13. Assuming the patient is monitored appropriately what procedure would be used to resolve any abnormalities observed? Would this procedure be required more than once?
(2 marks, 30 words)
14. Will the damaged organ regain function? If so explain the physiological mechanisms that occur in the repair process. In particular make reference to the time-frame of recovery.
(3 marks, 110 words)
15. What is the long-term prognosis for this patient? Will the damaged organ always recover fully? Justify your answer.
(3 marks, 70 words)
