Case Study 6-Erika Hopper
Scenario
While as a nurse on a gastrointestinal (GI) unit, you receive a call from an affiliate
outpatient clinic notifying you of a direct admission with an estimated time of
arrival of 60 minutes. The clinic nurse gives you the following information: A.G. is
an 82-year-old woman with a 3-day history of intermittent abdominal pain,
abdominal bloating, and nausea and vomiting (N/V). A.G. moved from Italy to join
her grandson and his family only 2 months ago, and she speaks very little English.
All information was obtained through her grandson. Past medical history includes
colectomy for colon cancer 6 years ago and ventral hernia repair 2 years ago. She
has no history of coronary artery disease, diabetes mellitus, or pulmonary disease.
She takes only ibuprofen (Motrin) occasionally for mild arthritis. Allergies include
sulfa drugs and meperidine. A.G.'s tentative diagnosis is small bowel obstruction
(SBO) secondary to adhesions. A.G. is being admitted to your floor for diagnostic
workup. Her vital signs (VS) are stable, she is receiving an intravenous (IV) infusion
of D5 ½ NS with 20 mEq KCl at 100 mL/hr, and 2 L oxygen by nasal cannula.
1. Based on the nurse's report, what signs of bowel obstruction does A.G.
manifest? Abdominal bloating, intermittent abdominal pain, N/V, history of
colectomy surgery.
2. Are there other signs and symptoms that you should observe for while A.G.
is in your care? Pay attention to guarding, grimacing, facial expression of
pain and discomfort, oxygen saturation, electrolyte levels, IV site patency,
flow rate of IV meds,
3. While A.G. is on the way, you secure the hospital's interpreter service on
the telephone. A.G. arrives on your unit with her grandson. You admit A.G.
to her room and introduce yourself as her nurse. As her grandson
introduces her, she pats your hand. You know that you need to complete a
physical examination and take a history. What will you do first? Give a brief
overview of the situation to the interpreter letting them know you’d like to
ask the patient some questions about their condition. After you introduce
yourself, you would want to speak directly to the patient rather than to the
interpretation device. This allows the patient to feel connected and listened
to in the process despite the language barrier. Explain that you will be doing
a complete exam, and go through each step with the patient.
This study source was downloaded by 100000817935606 from CourseHero.com on 02-01-2022 07:37:23 GMT -06:00
https://www.coursehero.com/file/30829403/Case-Study-6-Project-Script-Small-Bowel-Obstruction-SBOdocx/
, 4. Before you begin your examination, the grandson, an attorney, tells you that
elderly Italian women are extremely modest and might not answer
questions completely. He indicates that he'd like to stay in the room during
the examination. How will you proceed? Ask the patient what they prefer
and if they want the grandson to be in the room while going through the
exam. Using the interpreter allows for a more accurate level of
communication when getting specific information about the patients
health. Family members are not the most reliable for interpretation because
they may not accurately impart all the information the patient needs to
hear and understand.
5. What key questions must you ask this patient while you have the use of an
interpreter? Where is your pain? Quality, type? Past medical history? Last
bowel movement? Ask clarifying questions to ensure that the patient
understands what is being communicated.
6. For each characteristic listed, specify whether it is a characteristic of small-
bowel obstruction (SBO), large bowel obstruction (LBO), or both (B).
__B_____ a. Intermittent lower abdominal cramping
__SBO_____ b. Abdominal discomfort or pain accompanied by visible
peristaltic waves in the upper and middle abdomen
_____SBO__ c. Upper or epigastric abdominal distention
_LBO______ d. Distention in the lower abdomen
_B______ e. Obstipation
____PARTIAL LBO___ f. Ribbon-like stools
_LBO______ g. Nausea and early, profuse vomiting, which may contain fecal
material
___SBO____ h. Minimal or no vomiting
___LBO____ i. Severe fluid and electrolyte imbalances
7. What is obstipation? Complete or severe constipation. Blockage that
doesn’t allow fecal matter or gas to pass.
8. During your examination, you note that she does not have muscle guarding
and rebound tenderness on palpation. Is this important? Explain your
This study source was downloaded by 100000817935606 from CourseHero.com on 02-01-2022 07:37:23 GMT -06:00
https://www.coursehero.com/file/30829403/Case-Study-6-Project-Script-Small-Bowel-Obstruction-SBOdocx/
Scenario
While as a nurse on a gastrointestinal (GI) unit, you receive a call from an affiliate
outpatient clinic notifying you of a direct admission with an estimated time of
arrival of 60 minutes. The clinic nurse gives you the following information: A.G. is
an 82-year-old woman with a 3-day history of intermittent abdominal pain,
abdominal bloating, and nausea and vomiting (N/V). A.G. moved from Italy to join
her grandson and his family only 2 months ago, and she speaks very little English.
All information was obtained through her grandson. Past medical history includes
colectomy for colon cancer 6 years ago and ventral hernia repair 2 years ago. She
has no history of coronary artery disease, diabetes mellitus, or pulmonary disease.
She takes only ibuprofen (Motrin) occasionally for mild arthritis. Allergies include
sulfa drugs and meperidine. A.G.'s tentative diagnosis is small bowel obstruction
(SBO) secondary to adhesions. A.G. is being admitted to your floor for diagnostic
workup. Her vital signs (VS) are stable, she is receiving an intravenous (IV) infusion
of D5 ½ NS with 20 mEq KCl at 100 mL/hr, and 2 L oxygen by nasal cannula.
1. Based on the nurse's report, what signs of bowel obstruction does A.G.
manifest? Abdominal bloating, intermittent abdominal pain, N/V, history of
colectomy surgery.
2. Are there other signs and symptoms that you should observe for while A.G.
is in your care? Pay attention to guarding, grimacing, facial expression of
pain and discomfort, oxygen saturation, electrolyte levels, IV site patency,
flow rate of IV meds,
3. While A.G. is on the way, you secure the hospital's interpreter service on
the telephone. A.G. arrives on your unit with her grandson. You admit A.G.
to her room and introduce yourself as her nurse. As her grandson
introduces her, she pats your hand. You know that you need to complete a
physical examination and take a history. What will you do first? Give a brief
overview of the situation to the interpreter letting them know you’d like to
ask the patient some questions about their condition. After you introduce
yourself, you would want to speak directly to the patient rather than to the
interpretation device. This allows the patient to feel connected and listened
to in the process despite the language barrier. Explain that you will be doing
a complete exam, and go through each step with the patient.
This study source was downloaded by 100000817935606 from CourseHero.com on 02-01-2022 07:37:23 GMT -06:00
https://www.coursehero.com/file/30829403/Case-Study-6-Project-Script-Small-Bowel-Obstruction-SBOdocx/
, 4. Before you begin your examination, the grandson, an attorney, tells you that
elderly Italian women are extremely modest and might not answer
questions completely. He indicates that he'd like to stay in the room during
the examination. How will you proceed? Ask the patient what they prefer
and if they want the grandson to be in the room while going through the
exam. Using the interpreter allows for a more accurate level of
communication when getting specific information about the patients
health. Family members are not the most reliable for interpretation because
they may not accurately impart all the information the patient needs to
hear and understand.
5. What key questions must you ask this patient while you have the use of an
interpreter? Where is your pain? Quality, type? Past medical history? Last
bowel movement? Ask clarifying questions to ensure that the patient
understands what is being communicated.
6. For each characteristic listed, specify whether it is a characteristic of small-
bowel obstruction (SBO), large bowel obstruction (LBO), or both (B).
__B_____ a. Intermittent lower abdominal cramping
__SBO_____ b. Abdominal discomfort or pain accompanied by visible
peristaltic waves in the upper and middle abdomen
_____SBO__ c. Upper or epigastric abdominal distention
_LBO______ d. Distention in the lower abdomen
_B______ e. Obstipation
____PARTIAL LBO___ f. Ribbon-like stools
_LBO______ g. Nausea and early, profuse vomiting, which may contain fecal
material
___SBO____ h. Minimal or no vomiting
___LBO____ i. Severe fluid and electrolyte imbalances
7. What is obstipation? Complete or severe constipation. Blockage that
doesn’t allow fecal matter or gas to pass.
8. During your examination, you note that she does not have muscle guarding
and rebound tenderness on palpation. Is this important? Explain your
This study source was downloaded by 100000817935606 from CourseHero.com on 02-01-2022 07:37:23 GMT -06:00
https://www.coursehero.com/file/30829403/Case-Study-6-Project-Script-Small-Bowel-Obstruction-SBOdocx/
