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Patient Initials: RH Room number: 447 Sex: M Age: 62 Allergies: NKDA …

- - - - Chest X-Ray, 02/03/17:
        Results: Chart states, “Trach tube is in place and adequately positioned. Dobbhoff tube is not clearly identified. No acute infiltrate or pleural effusion. Dobbhoff tube not ID’d - may be coiled within the mouth or neck.”
        
        These findings successful tracheostomy surgery and proper trach-collar fit and placement. The Dobbhoff tube not being identified is as the chart states.
        
        It is standard practice to have a chest X-Ray done after placement of a tracheostomy and also for NG tube placement. This is done in order to view the placement of the tracheostomy tube, rule out pneumothorax and surgical emphysema, as well as check the NG tube for correct placement (Paw & Bodenham, 2004).
      - Abdominal X-Ray, 02/03/17:
        Results: Chart states, “Dobbhoff tube not identified with in ab”.
        
        These findings indicated that the Dobbhoff Nasogastric feeding tube is not in the abdomen, which means it needs to be removed. This is to further confirm that the tube is not the desired location, but has not perforated the abdomen.
        
        “An abdominal radiograph is considered the “gold standard” for determining the position of a nasogastric tube, especially in a critically ill, elderly, dysphagic or unconscious patient” (Lemyze, 2010).
        Due to the lack of identification of the NG tube, it was stated in the chart that it, “May be coiled within the mouth or neck”, and thus, the NG tube was removed, and a PEG tube was placed.
    - - CBC on 02/07/17:
        Results:
        White Blood Cell count: 9.4
        [ 4.5 - 11.0]
        Hemoglobin: 15.4
        [13.5 - 17.5]
        Hematocrit: 44.5%
        [42% - 54%]
        Platelet: 275
        [150 - 350]
        These findings indicate that the patient has no sign of postoperative infection, and has maintained adequate hemoglobin and platelets since surgery. Additionally, these findings show that the patient’s hematocrit is still low, which is consistent with a postoperative patient.
      - BMP on 02/07/17:
        Results:
        Na: 135
        [135 - 145]
        K: 4.4
        [3.5 - 5]
        Cl: 100
        [98 - 106]
        Ca: 8.3
        [8.6 - 10.6]
        Glucose: 151
        [60 - 140]
        These findings indicate that the patient is nutritionally stable after receiving adequate hydration and nutrition via PEG tube feedings and IV fluids, with only a few results indicating need for intervention. The patient’s calcium levels are below normal, which is most likely due to the formula’s make up. Also, the patient’s glucose level is elevated as a result of his continuous PEG tube feedings, and because he is actively healing from surgery. Due to the patient’s post-op status, there is an increase in blood glucose, “as a result of stress-mediated cortisol and catecholamine release” (Lewis, 2014, p.464).