Ms Rogers is a 68 year old female who presented to the ER 5 days ago with complaints of abdominal pain.?

Tests revealed a bowel obstruction, and she underwent surgery the same day for a bowel obstruction. On assessment, she has NGT to left nare on LIWS with moderate amount of dark green drainage. C/O dyspagia due to tube in the throat. A/R pulses are equal but irregular at 98 BPM. Respirations even but rapid and shallow at 24. Denies SOB. Abd distended at 53cm. with a minute amount of soft brown stool in colostomy bag. Stoma is red and moist, peristoma is without redness, swelling or drainage. States, "that thing makes me gross." Refuses to look at it. 10cm linear abdominal incision abdominal staples present, healing by 1st intention and edges well approximated without redness swelling or drainage. Clear, yellow urine in the bag. Right hand grip strong, left weak. Bil fingernail beds <3 secs. Bil temporal, carotid, brachial, radial DP and PT pulses 3+. Bil footstrenghts strong, toenail beds CRT's < 3 secs. Neg Homans sign. Normal SAline infusing to LAC at 125ml/hr, site intact without redness swelling or drainage. Daily weight 124lbs (admission 130lbs), height 5"6". NPO since admission. VS 140/84, 98, 24, 96, 99.6(T)

AM labs:

WBC 10.6

RBC 3.8

Hgb 9.8

Hct 28

Neut 85.8

Lymph 6.4

Prealbumin 11

Albumin 2

Glucose 70

K+ 3.2

Med/surgical history: HTN, Breast cancer with right mastectomy, CVA, hyperlipidemia, cholecystectomy, CAD, MI, Osteoarthritis. What would be the primary problem and what assessment data supports the problem? What would be the goal and nursing interventions for the problem?

4 Answers

  • 10 years ago
    Favorite Answer

    The primary problem obviously is small bowel obstruction requiring very recent surgical correction.

    The surgical findings at the time of the midline laparotomy must have identified the cause of the obstruction. A 10 cm incision would have allowed careful assessment of the entire peritoneal cavity.

    My guess would be adhesions from the prior cholecystectomy, but there are many other causes of intestinal obstruction. The findings described in the operative report and the pathology report should be on the chart. We are not provided with this crucial information.

    We are told of a remote history of breast carcinoma, but we do not have the stage, the initial treatment, or how long ago that mastectomy was performed. Recurrent breast cancer only very rarely would present as an intestinal obstruction.

    The patient also has anemia, but we are not given the red blood cell indices which would be on the CBC report and would help identify the likely cause. Blood loss is most likely, but the anemia is probably multifactorial. We are not given a platelet count. We do not have the rest of the electrolytes, renal function indicators, or liver function chemistries - all critical basic information since this person also has hypoalbuminemia and hypokalemia.

    The bottom line is that you have been given incomplete information to fully asses this case.

    As far as nursing goals and interventions, you should be able to handle that. They are fairly basic in this case.

    Source(s): MD internal medicine specialist, hematologist and medical oncologist - cancer and leukemia specialist physician for 20 years.
  • 4 years ago

    I think that you answered your own question...get her something she will love! Barbie, Bratz, Disney; yes to all of those. As far as the Nano is concerned, that depends on your you think she is too young for the Ipod?

  • 10 years ago

    You'll get a lot further if you do your homework assignments on your own.

  • 10 years ago

    Let me know if you are ever my nurse so I can request another one.

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