PN2 Case Study_Small Bowel Obstruction - Rasmussen College | NUR 2571 Case Study_Small Bowel Obstruction - 2020

PN2 2571 Case Study_Small Bowel Obstruction - Rasmussen College Scenario While you are working as a nurse on a gastrointestinal/genitourinary (GI/GU) floor, you receive a call from your affiliate outpatient clinic notifying you of a direct admission, ETA (estimated time of arrival) 60 minutes. She gives you the following information: A.G. is an 87-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 little English. All informa- tion was obtained through her grandson. Past medical history (PMH) includes colectomy for colon cancer 6 years ago and ventral hernia repair 2 years ago. She has no history of coronary artery disease (CAD), diabetes mellitus (DM), or pulmonary disease. She takes only ibuprofen occasionally for mild arthritis. Allergies include sulfa drugs and meperidine. A.G.’s tentative diagnosis is small bowel obstruc- tion (SBO) secondary to adhesions. A.G. is being admitted to your floor for diagnostic work-up. Her vital signs (VS) are stable, she has an IV of D5½NS with 20 mEq KCl at 100 ml/hr, and 3 L oxygen by nasal cannula (O2/NC). 1. Based on the nurse’s report, what signs of bowel obstruction did A.G. manifest? • A.G. is presenting with abdominal pain, bloating, nauseas, and vomiting. 2. Are there other signs and symptoms (S/S) that you should observe for while A.G. is in your care? • While she is in our care we should also monitor A.G. for signs of dehydration, lack of appetite, and severe constipation. Also we should monitor flatulence. 3. A.G. and her grandson arrive on your unit. You admit A.G. to her room and introduce yourself as her nurse. As her grandson interprets for her, she pats your hand. You know that you need to complete a physical examination and take a history. What will you do first? • First, we may want to let the interpreter know that we want to give a brief explanation as to what the physical examination will entitle. We will first want some more information as to how long this has been going on, has she taken anything to help with the pain, is she taking in fluids, what makes it better or worse. Then we will explain the steps of the head to toe procedure and ask if she has any questions before we begin, but also that she can stop and ask anything through the exam. We will also explain what we are doing throughout so she does not become scared. 4. The grandson, an attorney, tells you elderly Italian women are extremely modest and may not answer questions completely. How might you gather information in this case? • Talk to her via the interpreter and comfort her. Let her know that it is essential we gather all the correct information because it could impact her care. If he has any questions to openly ask them. If she is comfortable with her son being in the room while we ask these personal questions. - - - - - - - - - - -- - - - - - - - - - - - - - - - 14. What measures do you anticipate to correct each of the imbalances described in question 13? • The patient may receive IV potassium supplementation. • The patient may be put on TPN to raise her glucose levels. • The patient may need more fluids to decrease BUN and creatinine levels. PART ONE Medical-Surgical Cases CASE STUDY PROGRESS In view of A.G.’s continued slow deterioration, the surgeon met with the patient and her family and they agreed to surgery. The surgeon released an 18-inch section of proximal ileum that had been constricted by adhesions. Several areas looked ischemic, so these were excised, and an end-to-end anastomosis was done. A.G. tolerated the procedure well and recovered rapidly from the anesthesia in the postanesthesia care unit (PACU). Once on the unit, her recovery was slow but steady. A.G. went home in the care of her grandson and his wife on the seventh postoperative day. Discharge plans included home health nurse, home health aide, in-home physical therapy, and dietitian consult. The grandson was included in any plans.