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vVall
VALL D’HEBRON UNIVERSITY HOSPITAL BARCELONE (SPAIN)
VALL D’HEBRON UNIVERSITY HOSPITAL
BARCELONE - SPAIN
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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
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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)
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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
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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
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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
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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)
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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
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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
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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
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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
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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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