vVall

VALL D’HEBRON UNIVERSITY HOSPITAL BARCELONE (SPAIN)

VALL D’HEBRON UNIVERSITY HOSPITAL

BARCELONE - SPAIN

SUFFERED SEVERAL DEVASTATINGINJURIES CONSECUENCE OF ANACCIDENT FIVE YEARS AGO WHICH DIDNOT ALLOW HIM TO BREATH, SWALLOWOR TALK PROPERLY

HE NEEDED A TRACHEOTOMY AND AGASTROSTOMY TO SURVIVE

1 – Vital signs, fluid balance and thorax x-ray

2 - Care and control of tracheotomy

3 - Gastric tube to gravity drainage

4 – Suctioning drainage (every hour)

5 - Echo-doppler vascular anastomosis control

(every hour first 24 h, later every 2 hours)

6 - Serum therapy and pharmacological treatment

(antibiotics and immunosupressors)

7 - Tacrolimus levels in blood daily

1 – Visual examination of the skin

2 – Skin and muscles biopsy within a protocol: days

0, 7 and 14; in a month; every month in a year

3 – Tacrolimus seric levels daily

4 – Lymphocyte population determination

5 – Echo Doppler evaluation every hour

Carotid

Sound

Noise

Hypercaloric & hyperproteic enteral nutrition

First 8 h: 25 ml/h. Next 16 h: 50 ml/h

Increase 25 ml/h every 8 h. until prescribed total

volume

Flush 20 ml of water

and check gastric

retention every 2 h

PIPERACILIN/TAZOBACTAM 4 g/6 h IV (3-5 days)

AMPHOTERICIN B 1 mg/kg/24 h IV

TRIMETHOPRIM/SULFAMETHOXAZOLE 80/400

mg/24h

GANCICLOVIR 5mg/kg/24h

TACROLIMUS 0.15 mg/kg/24 h (continuous IV

perfusion)

THYMOGLOBULIN 2 mg/kg IV to infuse in 12 h (premedication needed: methylprednisolone 2 mg/kg; diphenhydramine 1 mg/kg & acetaminofen 10 mg/kg)

MYCOPHENOLATE MOFETIL 1 gr/12 h (gastrical route)

PREDNISONE 2 mg/kg/24 h

TACROLIMUS TOPICAL OINTMENT 0,1% twice a day during 2 months until the 10th after the surgery

DOMAIN 2. NUTRITION

- 00002 Imbalanced nutrition: less than body

requeriments r/t inability to chew and decreased level of

consciousness

- 00103 Impaired swallowing r/t effects of anatomical

limitations and tracheotomy tube

DOMAIN 4. ACTIVITY/REST

- 00024 Ineffective cerebral tissue perfusion r/t

interruption of arterial and venous flow

- 00032 Ineffective breathing pattern r/t effects of

anesthesia, medication (narcotics, sedatives) and

possible tracheobronchial obstruction

- 00095 Sleep deprivation r/t psychological stress

DOMAIN 5. PERCEPTION/COGNITION

- 00051 Impaired verbal communication r/t oral

deformities and physical barrier for tracheotomy

- 00122 Disturbed sensory perception (gustatory

and olfactory) r/t altered status of sense organs

and perception

DOMAIN 6. SELF PERCEPTION

- 00118 Body image disturbance r/t effects of

loss of body parts and body functions

- 00146 Anxiety r/t change in health status, loss of

control and threat of death

- 00153 Situational low self-esteem r/t role

changes and effects of loss of body parts

DOMAIN 9. COPING/STRESS TOLERANCE

- 00069 Ineffective coping r/t low self-esteem and knowledge deficit regarding therapeutic

regime and surgical process

DOMAIN 11. SAFETY/PROTECTION

- 00004 Risk for infection r/t invasive procedures

and immunosuppresion

- 00039 Risk for aspiration r/t reduced level of

consciousness, presence of tracheotomy tube

and gastric feeding catheter

One year after, he can

see life and the world full

of hope, although he

knows it will be a long

way with lots of

difficulties...but with a

new face