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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
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