Clinical Presentation

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by Zoe Nicholson0 views·Updated Apr 10, 2022
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  1. Hi my name is Victoria. Um so today I'll be doing my clinical presentation for 4:34.
  2. And we're going to get started with the most important person. This is about and it is
  3. The patient.
  4. So we have a 50 year old male admitted to the hospital due
  5. to SBP um spontaneous bacterial peritonitis and
  6. also had a renal transplant performed.
  7. So we're gonna get into a little bit of path of physiology.
  8. Um Sbp is a bacterial infection of acidic fluid
  9. caused by gram negative bacteria of intestinal origin.
  10. So basically SPP is an acute bacterial infection of
  11. acidic fluid that's collected in the peritoneal cavity.
  12. No source of the infecting agent is easily identifiable.
  13. Which is what makes it spontaneous.
  14. It wasn't quite proven in my patient what may have caused this.
  15. Um Although I know this is not in our scope of practice as nurses.
  16. I didn't ask my precept of what she may have thought maybe in the cause
  17. and she believed that it may have been
  18. a result from him receiving peritoneal dialysis.
  19. So this next slide is just a cute little
  20. mean um basically showing you what SmTP looks like.
  21. Spp.
  22. Are you sure it isn't just too many donuts.
  23. So no we most definitely no it's not too many donuts but basically Spp.
  24. Um when that fluid is built up the stomach is very much floated.
  25. Um That is exactly how my patient looks
  26. um on the bed. It looked very uncomfortable
  27. but that is a representative
  28. what it looks like.
  29. So now we're going to get into a little bit of the patient's history.
  30. So again he um was on peritoneal dialysis hypertension.
  31. The lady ground function of kidney, epic gastric pain,
  32. E. S. R. D. End stage renal disease on dialysis, S. B. O. Small bowel instruction
  33. Trumbo site open Oea.
  34. And if you do not know what that means, that is basically a low blood
  35. platelet count,
  36. hyperglycemia, metabolic acidosis, that section of the abdominal aorta,
  37. hypoglycemia and anemia.
  38. So this here is basically just a chart
  39. showing you what the different cars looked like.
  40. Um The hockey sticks car which is his rental transplant.
  41. That is what that looked like. His peritoneal dialysis scars.
  42. Um when they had those inserted.
  43. Not quite sure if he had a tunneled cuffed cap there.
  44. So I'm not going to hold to that.
  45. Um
  46. But this next picture is what he,
  47. what his dissection of the arterial eight order looked like.
  48. So on top of having a scar on the side. He had this car going down the middle as well
  49. on top of
  50. the
  51. bloated stomach.
  52. Yeah.
  53. Okay
  54. so I'm gonna get into some lab. So um
  55. His labs for his CBC, his red blood cell count was 2.76 which the normal range is 4.5
  56. To 5.5. So that is slow.
  57. Um we do know that red blood cell delivers oxygen throughout the body.
  58. His hemoglobin was a 5.8 normal 13
  59. A 13-17 which again very low.
  60. And we know that hemoglobin is the protein in your body that hosts the oxygen
  61. And his hematocrit 17.8 and the normal is a 40.50 again. Hello.
  62. Um So a low score of hematocrit is a sign of
  63. not having enough iron which is what helps the body make our
  64. Bc.
  65. Um So basically how we ended up trying to get these labs back to a normal level.
  66. We had to give him a blood transfusion.
  67. And as we know,
  68. blood is a main important source of us
  69. being able to survive through the circulation.
  70. Um the next important lab would have to be the tackle alignments levels.
  71. Um tackle Lima's. His level was a 4.5. The normal is a 5-20.
  72. So it's an
  73. immunosuppressant drugs which is important for kidney transplant
  74. plant recipients to take to prevent rejection.
  75. So when the numbers are out of range they are
  76. more than likely to risk um
  77. a risk factor for acute rejection.
  78. So
  79. to get these levels back you just have to do some heavy therapeutic drug monitoring.
  80. Um Different meds can affect these levels so you
  81. have to adjust them according to the patient.
  82. Thank you
  83. Some medications.
  84. Mhm.
  85. His medications consisted of a sentimental 15 Tylenol
  86. which was to treat um matter moderate pain,
  87. carvedilol. Oh um my name is correct. Which is a beta blocker.
  88. We used to treat heart failure and high blood pressure.
  89. I'm sorry if I slaughtered this but
  90. a poet and alpha E. P. B. X. Um Also known as redecorate
  91. um That is a it throw polices stimulating agent.
  92. Um This injection was for treatment of anemia due to chronic kidney disease
  93. that he had um
  94. own or of dialysis
  95. heparin. Um anticoagulants which was used to prevent and treat the blood clots
  96. in the legs and the lungs.
  97. Um
  98. Which is good because he was already um not moving as much as he needed to
  99. and on top of the fluid build up
  100. um might go ventilate. Um Also known as sales Steps
  101. works on the immune system to prevent rejection
  102. after a kidney heart or a liver transplant.
  103. He was on pro
  104. cardia X. L. Also um knife DP.
  105. Um This is an immunosuppressive um It works
  106. on the immune system to prevent rejection.
  107. I'm sorry.
  108. It treats symptoms of angina which is chest pains,
  109. high blood pressure and pulmonary
  110. hyper
  111. attention. And it's actually an antihypertensive drugs.
  112. predniSONE delta zone which is a cortical steroid for his case.
  113. It was used to treat blood disorders and to
  114. um suppress the immune system in order to prevent organ rejection.
  115. Self a method
  116. stocks song try method Brain. Um I sat on his bathroom.
  117. Um This combination is an antibiotic um prevents numerous psychosis.
  118. Carney pneumonia which is a very severe kind of pneumonia and is
  119. more common in patients whose immune systems are not working normally.
  120. Such as those
  121. patients who have transplants.
  122. Um You see this word again which is Tech Olympus which is also known as a program.
  123. It is an immune oppressive is used together with other
  124. medications to prevent body from rejecting the kidney transplant.
  125. The last thing was the valves in
  126. Sis Lover um also known as calcite.
  127. The first choice.
  128. This is the first choice antiviral medication used for
  129. treating infections caused by viruses and preventing C.
  130. M. V.
  131. Um Sidle Medal Medal,
  132. a virus which is an infection in the iron patients who received organ transplants.
  133. So potential problems um Again failure a rejection of the kidney bleeding.
  134. Risk for infection um In the septic shot
  135. shock
  136. um
  137. the risk for infection is very high because of his head.
  138. Open wounds um that needed to be packed and cleaned
  139. to prevent any other infections on top of the kidney
  140. um
  141. whom incision as well.
  142. Um So septic shock is basically a life threatening condition that happens
  143. when the blood pressure drops to a dangerously low level after an infection
  144. um kidney transplant recipients are likely to
  145. infections due to immunosuppressive therapy.
  146. So bacteria remains affected to septic shock in these patients
  147. and that is my presentation and thank you for listening