A 55-year-old woman with a prior history of partial colectomy w/colostomy and small bowel obstruction three months ago that resolved with bowel rest and required no surgical intervention. Three days ago Mary developed a sudden onset of sharp generalized abdominal pain with nausea, vomiting and decreased output from her colostomy bag. She has had two small glasses of water today. Mary is admitted to the medical/surgical unit and you will be the nurse caring for her. You receive the following highlights of report from the emergency department (ED) nurse: CT of her abdomen/pelvis revealed high-grade small bowel obstruction. Lactate 2.8, WBC 14.7, Sodium 143, Potassium 3.7, Creatinine 1.35 An NG was placed and she is on low intermittent suction. She had NG output of 225 mL of bile green liquid. Received hydromorphone 0.5 mg IV for pain one hour ago. Abdominal pain decreased from 9/10 to 3/10 and she is resting more comfortably. Abd. is firm, slightly distended, with tympanic bowel sounds. Initial HR/BP was 102 and 92/48. Most recent vital signs: T: 99.8 (oral) P: 78 (regular) R: 18 BP: 108/52 after 1000 mL 0.9% NS bolus 20 g. peripheral IV in left forearm Questions: 1. What signs and symptoms are of concern in this patient's presentation? 2. What could these be telling you is happening to the patient? 3. Of the concerning symptoms, which of these is a priority? Please explain your answer. 4. What can we do to stabilize this patient? Why?
A 55-year-old woman with a prior history of partial colectomy w/colostomy and small bowel obstruction three months ago that resolved with bowel rest and required no surgical intervention. Three days ago Mary developed a sudden onset of sharp generalized abdominal pain with nausea, vomiting and decreased output from her colostomy bag. She has had two small glasses of water today. Mary is admitted to the medical/surgical unit and you will be the nurse caring for her. You receive the following highlights of report from the emergency department (ED) nurse: CT of her abdomen/pelvis revealed high-grade small bowel obstruction. Lactate 2.8, WBC 14.7, Sodium 143, Potassium 3.7, Creatinine 1.35 An NG was placed and she is on low intermittent suction. She had NG output of 225 mL of bile green liquid. Received hydromorphone 0.5 mg IV for pain one hour ago. Abdominal pain decreased from 9/10 to 3/10 and she is resting more comfortably. Abd. is firm, slightly distended, with tympanic bowel sounds. Initial HR/BP was 102 and 92/48. Most recent vital signs: T: 99.8 (oral) P: 78 (regular) R: 18 BP: 108/52 after 1000 mL 0.9% NS bolus 20 g. peripheral IV in left forearm Questions: 1. What signs and symptoms are of concern in this patient's presentation? 2. What could these be telling you is happening to the patient? 3. Of the concerning symptoms, which of these is a priority? Please explain your answer. 4. What can we do to stabilize this patient? Why?
Chapter6: Gut Instincts
Section: Chapter Questions
Problem 1CP
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Question
A 55-year-old woman with a prior history of partial colectomy w/colostomy and small bowel obstruction three months ago that resolved with bowel rest and required no surgical intervention. Three days ago Mary developed a sudden onset of sharp generalized abdominal pain with nausea, vomiting and decreased output from her colostomy bag. She has had two small glasses of water today. Mary is admitted to the medical/surgical unit and you will be the nurse caring for her. You receive the following highlights of report from the emergency department (ED) nurse:
- CT of her abdomen/pelvis revealed high-grade small bowel obstruction.
- Lactate 2.8, WBC 14.7, Sodium 143, Potassium 3.7, Creatinine 1.35
- An NG was placed and she is on low intermittent suction. She had NG output of 225 mL of bile green liquid.
- Received hydromorphone 0.5 mg IV for pain one hour ago. Abdominal pain decreased from 9/10 to 3/10 and she is resting more comfortably.
- Abd. is firm, slightly distended, with tympanic bowel sounds.
- Initial HR/BP was 102 and 92/48.
- Most recent vital signs: T: 99.8 (oral) P: 78 (regular) R: 18 BP: 108/52 after 1000 mL 0.9% NS bolus 20 g. peripheral IV in left forearm
Questions:
1. What signs and symptoms are of concern in this patient's presentation?
2. What could these be telling you is happening to the patient?
3. Of the concerning symptoms, which of these is a priority? Please explain your answer.
4. What can we do to stabilize this patient? Why?
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