Clerking Notes

Patient One

  • 63 year old Caucasian Female who had a planned admission for IV fluids and a PICC line (a catheter that delivers parenteral nutrition straight into the blood stream).
  • She had had a oesophagectomy which involved removal of part of her oesophagus after a tumour.
  • Her current problem was that she was not able to eat properly and was losing a lot of weight. The reason for this was because her jejunostomy (feeding tube that went into her stomach through abdo wall) had failed. She could not keep oral foods down either and it was unknown why that was the case.
  • Physically the patient was well in herself but had just lost a lot of weight (due to not being able to eat) and was feeling very lethargic. She had also pulled out her last jejunostomy pipe and was in pain around that area.
  • Parenteral – straight into bloodstream
  • Enteral – Into the GI tract

Management

  • The patient needs to be fed so she was prescribed IV fluids and a request for a PICC line was made.
  • A dietician’s review was requested.
  • She needed bloods doing to check for electrolyte disturbances (U&E)- one had to be cautious of re-feeding syndrome. 
  • Perhaps in the long term she might need some sort of exploratory surgery or endoscopy to see why she is not able to eat and why the previous measures had failed.
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