Clinical Case Conference Report: Analysis of Patient's Medical Condition and Nursing Management

This report discusses the case of a 74-year-old female suffering from Ascites and stage-4 endometrial cancer. It provides analysis of patient’s medical conditions, medical management of patients and sound rationale for the healthcare delivery to patient. It includes discussion on interdisciplinary team involvement, clinical inferences based on the available data, critique of care provided and suggestions for alternative management and nursing care.

Clinical Case Conference
Report

Table of Contents
INTRODUCTION...........................................................................................................................3
DISCUSSION AND EVALUATION.............................................................................................3
Analysis of patient’s medical condition......................................................................................3
Discussion and evaluation of nursing and medical management................................................4
Consideration of interdisciplinary team involvement..................................................................4
Clinical inferences based on the available data...........................................................................5
Discussion and Evaluation...........................................................................................................6
Critique of care provided and Suggestions for alternative management and nursing care..........7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................1

INTRODUCTION
The clinical case conference is prepared to improve the healthcare provider’s
performance and competency so that health status of the patients could be improved and research
could be translated into providing effective healthcare delivery as well (Danto‐Nocton & et.al.,
2018).
In the given case study, Mrs. XYZ is 74 years old female suffering from Ascites. She
lives in her own house and have past medical history of endometrial ca+Mets, Total hip
replacement, Knee replacement and Irritable Bowel Syndrome as well. Various assessments for
health care of Mrs. XYZ were taken. In this case, the progressive increase in Ascites is noted
which can potentially develop Acute small bowel obstruction. The patient is diagnosed with
stage-4 endometrial cancer. He patient was prescribed HEHP diet and protein but the patient
was having nausea. So the food by consumed by patient through tubes. The patient was advised
to insert a Nasogastric Tube but she refused. The multidisciplinary team for the current case
involves a nurse, doctors, radiologist, Pharmacist, social worker and Oncologist. After chemo
symptoms were well managed however the patient was declined to return home.
The report aims to provide analysis of patients medical conditions, medical management
of patients and sound rationale for the healthcare delivery to patient.
DISCUSSION AND EVALUATION
Analysis of patient’s medical condition
Pathophysiology
The patient suffered from Ascites and has a past medical history of endometrial cancer.
When fluids accumulate in the abdomen, the condition is known as Ascites. This can be caused
due to many diseases (Angeli and et.al., 2019). Therefore, in order to determine the cause of
Ascites in the patient, it is important to analyze the sample of fluids. Considering the
pathophysiology of Ascites, it can be analyzed that it is a symptom of cancers of various types.
However, other conditions such as Cirrhosis of liver and hear diseases may also cause it. When
the lining of the abdomen is irritated by the cancer cells, it generates excess of fluid. In the
present case, the ascites may exist in the patient at any time and may have spread to the
abdominal lining. However, this is more commonly seen in the cases where cancer has
metastasized (Piano, Tonon and Angeli, 2018). This indicates that the condition of Ascites will
occur when cancer has spread to liver or veins carrying blood to the liver. This leads to increase

in blood pressure thus limiting the circulation of fluid leading to its build – up. Moreover, if the
lymphatic system is blocked by the cancer, proper drainage of excess fluid is restricted leading to
its build- up in the abdomen. This leads to the symptoms such as nausea, vomiting, abdominal
distension and tightening of belly.
Anatomy and physiology
Considering the anatomy of Ascites, more than 25 ml of fluid builds up in the peritoneal
cavity. However, there may also be volumes greater than 1 litre. Normally the peritoneal cavity
has a pressure of 5 – 10 mmHg and contains approximately 25- 50 ml of serous fluid. This fluid
is required for enabling the bowel to move past each other and hydration of the serosal surfaces.
When alterations occur in the properties of the lymphatic system, the process of optimal
reabsorption is also altered (Fortune and Cardenas, 2017). When the dysregulation of these
parameters occurs on a continuous basis, there takes place retention of ascetic fluid.
Discussion and evaluation of nursing and medical management
In the present case, various assessments were undertaken so that best care could be
provided to the patient. Nervous observations were made along with the baseline observations.
The patient was observed half hourly for 1 hour and hourly for 4 hours. The observation of the
drains site was also done for 2 hours. Skin integrity was checked for any signs of bruising,
redness or infection. Further various haematology tests were performed. As the patient was
diagnosed with endometrial cancer, various medications were provided. Anticoagulant
Enoxaparin was administered. It can be evaluated that early initiation of anticoagulant leads to re
– permeation. Moreover, it improves microcirculation within the intestines which decreases the
chances of bacterial infection. The use of Buscopan for treatment of abdominal cramping is
justified as it would relax cramping in the muscles of the bowel thus providing relief to the
patient.
Dexamethasone which is a glucocorticoid was also prescribed to the patient. It can be
evaluated that glucocorticoids perform the work of inducing apoptosis in lymphoid tissue and
controlling its growth (Garcia-Tsao, 2017). These are also widely accepted as adjuvants with
chemotherapy as these help in reduction of side effects of the therapy. Furthermore, their use is
justified in the present case with Mrs xyz as they assist in increasing appetite and preventing
vomiting by ureteric obstruction. Prescription of Pantaprazole for reflux is justified as it will

assist in inhibiting the final step in the production of gastric acid (Rudler and et.al., 2020). It will
be beneficial in the symptoms such as headache and constipation.
Consideration of interdisciplinary team involvement
In the management of the present patient, interdisciplinary team involvement has been made.
Doctors
The doctors performed the work of diagnosing the clinical aspect of the patient. They
further provided referral to the patient for diagnostic tests.
Nurse
Nurse also performed variety of assessments on the patient. She monitored the patient’s
condition and attends to the administration of medication. The nurse also developed care plans
for the patient.
Oncologist
Oncologist has an important role as he recommends the tests for determining if the
patient suffers from cancer (Fortune and Cardenas, 2017). Further, he also played a role in
explaining the diagnosis of cancer to the patient and family members. This would include
providing explanation of the various stages of cancer. The oncologist also coordinated with the
undergoing chemotherapy. In addition to this, he has undertaken blood tests and monitors and
manages the side effects of the treatment.
Radiologist
The radiologist performed the tests like CT scan and X- ray.
Pharmacist
He performed the role of delivering medications to the patient.
Social worker
The work of the social worker is to help in coordination and communication between the
various team members, patient and the family. Furthermore, staying at hospital is a stressful
experience, especially for elderly patients (Mustapha, 2020). It is here that the role of social
worker is important as he provided the supportive counselling to the patient as well as the family.
Clinical inferences based on the available data
On the basis of the available data, it can be inferred that due to endometrial cancer, the
lymphatic system of the patient was blocked. This caused the build – up of the fluid in the
abdomen. The cancer cells irritated the lining of the abdomen making it generate excess fluid.

The patient has stage IV endometrial cancer which indicates that cancer cells have spread across
the body. Presence of Ascites further indicates that the cancer has metastasized to other parts
(Piano, Tonon and Angeli, 2018). As the patient was suffering from nausea and nutrition from
mouth is nil, it is important take care of her nutrition needs. Further, there is need to educate the
patient and the family about the condition. Patient education is also required regarding diet and
fluids. In addition to it, the patient has been instructed to revisit for follow up.
Discussion and Evaluation
Psycho-social aspects
These aspects involves the needs to provide holistic care and support to patients and
family members (Riva, 2020). In the current case, the patient lived in her own house where she
had a very supportive family. The patient's family is supportive which helps her in stress
management. The patient is also actively participating in the healthcare to receive information
for managing illness effective access to healthcare services.
Environmental Aspects
The environmental aspects in health care focus on interrelationships between people and
environment which promotes health and well being of patients. In the current case the patient
was provided with an environment which supported the medical care and also promoted
relationships.
Economic aspects
The patient had enough financial support in order to cope up with the diagnosis and
manage illness (Chambers, 2020). The patient was provided good medical services as well as a
good quality of care. The patient can afford the expenses of her medical care.
Ethical and legal aspects
Since the patient safety is the most significant aspect in ethical and legal imperatives, it is
important for the care care providers to ensure the same. As per the medical ethics ensuring
patient safety is major priority (Gerke, Minssen and Cohen, 2020). In the given case, the patient
was discharged after ensuring the safety of the patient and proper care.
Education needs of patient
According to the views of Salmasi & et.al., (2019), patient education is important as it
can help in effective healthcare and self management by patients and avoid any unnecessary
further readmissions. In the current case, the patient was provided the education regarding

medications. Medication education involves providing the knowledge regarding when and how
to take the medicines as well as what are their side effects and how to manage those side effects.
The patient and her family were also educated regarding the diagnosis and after discharge care.
Education regarding High Energy, High Protein and fluid intake was also provided. The patient
was also educated regarding follow up care and calling the general practitioner regarding any
concerns.
Family addressed
Addressing and connecting with the family can help in ensuring the safety and
management of patients regarding their diet and other needs such as exercise and appropriate
medication. In the current case, The patient's family was very supportive. The family was
educated regarding the diagnosis and after discharge care and follow up.
Discharge planning
Discharge planning involves the process to identify and prepare a patient for the
anticipated health care needs after they leave the medical care units (Mabire & et.al., 2018). The
patient was discharged after the completion of chemo and management of N/V symptoms. The
patient was educated regarding the after discharge care.
Critique of care provided and Suggestions for alternative management and nursing care
As per the views of Solà‐Miravete & et.al. (2018), the nursing assessment includes the
collection of information regarding the patient's sociological, psychological, spiritual and
individual needs. In the current case, the Nursing assessments such as CNS, CVS, GIT, Mobility
and skin integrations as well as nutrition were assessed. Nursing assessment is necessary to
provide the patient wit identification and fulfilling the present and future needs of the patients. It
allows the health care providers to immediate recognition of apposite changes. It allows nurses
to recognize and prioritize the appropriate interventions in patient care.
According to Giger & Haddad (2020), Percutaneous endoscopic Gastrostomy can be
more beneficial as it can be more effective and have lower chance of intervention failure. It can
help the patient to receive nutrition through stomach directly. However, in the current case, the
patient was having nausea she was unable to consume food from mouth. The Master of
Obstetrics advised to insert NGT was the patient declined. In this case the alternative suggestion
for nursing can be PEG (Percutaneous endoscopic Gastrostomy).

As per Alamri & Almazan (2018), Peritoneal Fluid Analysis can help in diagnose the
fluid build-up causes in Ascites and inflammation. However, in the current case several nursing
assessments were undertaken to provide the patient with best care. However, the PFA (Peritoneal
Fluid Analysis) and abdominal ultrasounds were not undertaken. As the patient was feeling
nausea, the healthcare provider should have suspect Ascites and get tested. It is suggested that
the healthcare providers should use PFA and Abdominal ultrasound for Ascites. The abdominal
ultrasound can help in confirming he presence as well as quantity of Ascites in the patients. It
can also provide the important information regarding the causes of Ascites as well as can detect
any signs of portal hypertension (evaluated pressures in portal venous systems). It offers
guidance during paracentesis. This is the alternative management for nursing assessment of
Ascites to the patient. In the current case, the nursing assessment also involved CVS during
admission. The patient was feeling nausea. Basoline obs were taken when patient returned to the
ward from post drainage insertion.
According to Lucoveis & et.al. (2018), assessment of past medical history is very
important. It can help in providing better understanding of health status of the patient. It allows
the service care providers to recognise patterns and make effective decisions that are based on
the specific individual health needs of a patient. It provides sufficient information of patients
and is also used while making the diagnosis prior to examination of patient and other additional
tests. However in the current case, the past medical issues of Mrs. XYZ were not given much
priority. Additional tests were undertaken but the past interventions were not considered
appropriately. It is suggested that the nursing assessments should involve the past medical record
of Mrs. XYZ before diagnosis.
CONCLUSION
From the above discussion it can be concluded that Clinical care conference reports assist
in improving healthcare competencies and performances of healthcare delivery. In the case of
Mrs. XYZ, she is suffering from Ascites. She had a long history of past medical interventions.
Th patients medical condition is analysed which describes that there was no growth of Ascited in
the microbiology. Various nursing assessments were undertaken to provide care for Mrs. XYZ
such as CNS, CVS, GIT and Skin Integrity etc. From the ECHO tests various chemo precaution
were recommended. The psycho-social, environmental, economic and ethical aspects describes
the aspects considered while providing care. The short term outcomes comprised of relief to the

patient from nausea and abdominal cramping. The long term outcomes were treatment and
control of further spread of endometrial cancer.

REFERENCES
Books and journals
Alamri, M. S., & Almazan, J. U. (2018). Barriers of physical assessment skills among nursing
students in Arab Peninsula. International journal of health sciences. 12(3). 58.
Angeli, P., Garcia-Tsao, G., Nadim, M. K., & Parikh, C. R. (2019). News in pathophysiology,
definition and classification of hepatorenal syndrome: a step beyond the International
Club of Ascites (ICA) consensus document. Journal of hepatology, 71(4), 811-822.
Chambers, S. (2020). Why the Economic Aspects of Healthcare are not Unique. Sultan Qaboos
University Medical Journal. 20(2). e165.
Danto‐Nocton, E. S. & et.al., (2018). Strength in numbers: a national monthly case conference
series for fellows. Journal of the American Geriatrics Society. 66(7). 1404-1408.
Fortune, B., & Cardenas, A. (2017). Ascites, refractory ascites and hyponatremia in
cirrhosis. Gastroenterology Report, 5(2), 104-112.
Garcia-Tsao, G. (2017). Ascites. In Liver Pathophysiology (pp. 475-484). Academic Press.
Gerke, S., Minssen, T. and Cohen, G., 2020. Ethical and legal challenges of artificial
intelligence-driven healthcare. In Artificial intelligence in healthcare (pp. 295-336).
Academic Press.
Giger, J. N., & Haddad, L. (2020). Transcultural nursing-e-book: Assessment and intervention.
Elsevier Health Sciences.
Lucoveis, M. D. L. S. & et.al., (2018). Degree of risk for foot ulcer due to diabetes: nursing
assessment. Revista brasileira de enfermagem. 71. 3041-3047.
Mabire, C. & et.al. (2018). Meta‐analysis of the effectiveness of nursing discharge planning
interventions for older inpatients discharged home. Journal of advanced nursing. 74(4).
788-799.
Mustapha, S. K. (2020). Cirrhotic ascites: A review of pathophysiology and
management. Nigerian Journal of Gastroenterology and Hepatology, 12(1), 3.
Piano, S., Tonon, M., & Angeli, P. (2018). Management of ascites and hepatorenal
syndrome. Hepatology international, 12(1), 122-134.
Riva, N. (2020). Laboratory and psycho-social aspects of anticoagulation and venous
thromboembolism.
Rudler, M., Mallet, M., Sultanik, P., Bouzbib, C., & Thabut, D. (2020). Optimal management of
ascites. Liver International, 40, 128-135.
Salmasi, S. & et.al., (2019). Assessment of atrial fibrillation patients' education needs from
patient and clinician perspectives: a qualitative descriptive study. Thrombosis research.
173. 109-116.
Solà‐Miravete, E. & et.al., (2018). Nursing assessment as an effective tool for the identification
of delirium risk in older in‐patients: A case–control study. Journal of Clinical Nursing.
27(1-2). 345-354.
1

2