Nursing Case History Project By: Lauren Keller Summer 2009
The Patient • Sunshine is a 12 year old, neutered male, Maine coon cat • He presented at the clinic on 6/16/09 with the chief complaint of anorexia and vomiting • He had been seen a month earlier at the clinic, admitted and diagnosed with hepatic lymphoma • Info on lymphoma can be found here http://www.vin.com/Members/SearchDB/vp/VPA01446.htm • Vitals at time of arrival • Wt. 3.8kg • T – 101°f • P – 180bpm; strong pulses • R – 32 breaths per minute • mm – light pink • CRT ~2 seconds
Nutritional Needs • Since patient is anorexic, a gastrostomy feeding tube is placed • BER = 30(3.8) + 70 = 184kcal/day • MER = 1.2 (cage rest) x 184 = 215kcal/day • The doctor orders a mixture of clinicare and a/d to be made into a “gruel” • Each meal should contain ~25mls of “gruel” • Clinicare = 1kcal/ml; a/d = 1.3kcal/ml • Clinicare = 107.5ml/day; a/d = 83ml/day • The gruel is made at the beginning of the day, refrigerated and heated when necessary
Patient Follow Up Sunshine returned 2 days later for his recheck appointment. His owner was pleased to report he was doing fairly well. He was tolerating the tube feedings pretty well, and even ate a little on his own that morning. He had only vomited once since leaving the hospital and seemed much more energetic to the owner. The owner does understand that this is a terminal illness, and this is the only tube she will place in him. Once it is removed, she wants to keep him comfortable until the time comes to euthanize him. Although his prognosis is grave, Sunshine’s owner is glad we can give her a little more time with her beloved cat.
Reflection I just recently began working at an emergency/specialist clinic where critical care patients are monitored around the clock. Although I have only been there the past three months, I am very impressed with the standard of care. Patients are always number one priority, and if something is not documented correctly or clearly, you can expect a call at home for clarification! Protocol is very strict, but I believe it accounts for the outstanding care expected for each patient. This case, as most others I have seen, was dealt with very well. The patient is checked on at least hourly, but usually more. If a patient is extremely critical, a technician is assigned to that patient for continuous care. Although it is an extremely expensive place for treatment, it is well worth the quality of care that is provided.