Highlights
Clinical Scenario (for Group B nursing students)
Identification Mal Valance, 52, Farmer from Roma
Situation Mal presented with low abdominal pain, irregular bowel habits, blood in his stools, nausea & vomiting. Mal is admitted under the surgeons for a bowel resection to treat newly diagnosed colorectal cancer.
Background Allergies: nil
Medication: ACE inhibitors
Past illnesses: hypertension, MVA in his 20s
Last meal: Yesterday, minimal appetite.
Events leading up to presentation:
Recent weight loss and lethargy, ongoing nausea with some
vomiting, intermittent bowel obstructions, rectal bleeding. The
patient appears pale.
Assessment RR: 19
SpO2: 94% RA (room air)
HR: 110
BP: 115/70 (laying), 80/50 (standing)
T: 36.0
GCS: 15
Pain: 6/10
Cap. Refill Time: 4 seconds
Blood test results:
BGL: 7.5mmol/L
Haemoglobin: 90
Na: 125 mmol/L
Cl: 85 mmol/L
K: 3.0 mmol/L
pH: 7.50
Lactate: 3
CEA: 20 ng/mL is raised (carcinoembryonic antigen)
Urinalysis:
osmolality: 1.040
Colour: dark
Output: 400ml/24hrs
Imaging
Xray found multiple fluid levels in the abdomen
CT has confirmed stage 3 CRC with a bowel obstruction
Other information:
Mal’s Father and Mother are both dead, his father died from an AMI at 47 and his mother died of a CVA at 65. Mal has a standard western diet high in salt, sugar and fats, low in fibre. He smokes and drinks moderately and has done so since his teenage years. Mal does not exercise but he has a very active job. Mal is single, he has some close friends in his Roma, Mal left school at the end of grade 9, his reading skills are appropriate for his schooling but he has difficulty understanding patient handouts. Mal
has a mortgage over his farm, but he has modest savings and he does have private health insurance.
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