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J.L 51 y/o Female Primary Diagnosis: Colovaginal Fistula and…
J.L
51 y/o
Female
Primary Diagnosis:
Colovaginal Fistula and colostomy
Treatment
Had a Low anterior bowel resection and colostomy takedown to remove colostomy from a previous loop sigmoid colostomy (9/9/2019) that was placed to help heal colovaginal fistula
Severe "8/10" pain treated with multiple medications- Gabapentin, Acetaminophen, Robaxin, Percocet, Norco and Dilaudid
Dressing changed 3/3/2020
Risk for infection
Monitor signs of infections; swelling, redness, pain, fever
Monitor WBC levels
Risk for Refeeding Syndrome
Slowly progress diet as tolerated
Monitor electrolyte levels
Risk for thrombus formation r/t impaired mobility
Prophylaxis heparin administration
Promote mobility daily
Risk for an ileus
Promote mobility
Provide adequate fluids and advance diet as tolerated
Moderate Risk for Falls
Medications
Docusate sodium 100 mg PO 2 times daily
Gabapentin 200 mg PO 3 times daily
Heparin 5,000 units subcutaneous injection q 12 hrs
Ketorolac 30 mg IV q 6 hrs
Metoclopramide 10 mg PO 4 times daily (before meals)
Balanced Electrolytes in Water 75 mL/hr continuous IV
PRN Medications
Acetaminophen 650 mg PO PRN q 4 hrs for pain/fever
Norco 5-325 mg PO PRN q 4 hrs for moderate to severe pain
Hydromorphone 0.4-0.8 mg IV PRN q 1 hr for severe pain
Ondansetron 4 mg PO or IV PRN q 6 hrs for nausea/vomiting
Percocet 5-325 mg PO PRN q 4 hrs for moderate to severe pain
Methocarbamol 1,500 mg PO PRN q 6 hrs for muscle spasms
Abnormal Labs
Elevated blood glucose level (215) related to Type 2 Diabetes Mellitus diagnosis
Elevated AST (52) and ALT (48) related to muscular trauma from abdominal surgery
Diagnostic Tests
XR Abdomen (1/4/2020); for abdominal pain. No evidence of a bowel obstruction or pneumoperitoneum
Psych/Social
Lives in Tri-Cities, WA
lives with her husband
Has 2 kids
Works at a restaurant
Pathophysiology
A colovaginal fistula is an abnormal connection between the vagina and the colon. A common cause of this is diverticulitis, which is an inflammatory disease causing pouches in the intestine to become inflamed/infected. The most common risk factor for a fistula from an inflammatory condition is prior hysterectomy. When the uterus is gone, inflammatory conditions in the pelvis can find a weak point at the vaginal cuff, and a fistula can form. A fistula caused by diverticular disease may require a sigmoid colectomy with an approach from the abdomen, with takedown and repair of the fistula interposed with normal tissue.
Medical History
Colovaginal Fistula
Acute Kidney Injury (2008)
Asthma
Anxiety
Claustrophobia
Diabetes Mellitus Type 2
Hyperlipidemia
Hypertension
R ovarian Mass
Diverticulitis
Surgical History
Cholecystectomy
Colonoscopy
Colostomy (9/9/2019); creation of loop sigmoid colostomy
Left Ovary Cyst removal
Endoscopic Retrograde Cholangiopancreatography (1/21/2019)
Total Hysterectomy (8/26/2019)
Tubal ligation
Family History
Maternal; Type 2 diabetes, kidney failure
Brother; type 2 Diabetes, seizures