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• Intestinal obstruction is a significant mechanical impairment or complete arrest of the passage of contents through the intestine. Intestinal obstructions account for 20% of all acute surgical admissions. Mortality and morbidity are dependent on the early recognition and correct diagnosis of obstruction. If untreated, strangulated obstructions cause death in 100% of patients. However, the mortality rate decreases to 8% with prompt surgical intervention (Vicky P. Kent, RN, PhD, CNE, 2009).
• Nanay Ganda, 84 years old, was admitted last December 8, 2010 at General Santos Doctors’ Hospital under the care of Dr. Albano, had complaints of inability to defecate by about 4 days. A background of one year history of intermittent abdominal pain with bloating was claimed by the patient.
• The impression to the result of the ultrasound of her whole abdomen is to consider ileus; partial obstruction and fecal stasis. Dr. Albano believed that the symptoms being manifested were results of a disorder she has in a long time. Since they weren’t able to have that checked and it wasn’t figured out earlier, the signs become more evident now. It’s also because these manifestations develop and progresses relatively slowly. It was then that the physician decided to let the patient undergo exploratory lap to detect what really had cause the obstruction.
• It was December 13, 2010 when the surgeon discovered a tumor at the site of the obstruction particularly at the descending colon and immediately removed it. The found tumor was then subjected for biopsy.
Intestinal obstruction is a significant mechanicalimpairment or complete arrest of the passage ofcontents through the intestine. Overall, the mostcommon causes of mechanical obstruction areadhesions, hernias, and tumors. Other generalcauses are diverticulitis, foreign bodies (includinggallstones), intussusceptions (bowel folding intoitself), and volvulus (twisting of the colon).
The symptoms usually includecrampingpain, vomiting, constipation, andlack of flatus. Diagnosis is clinicalwhich is confirmed by abdominalx-rays. Treatment is fluidresuscitation, nasogastricsuction, and, in mostcases, surgery.
Intestinal obstructions account for 20% of allacute surgical admissions. Mortality andmorbidity are dependent on the earlyrecognition and correct diagnosis ofobstruction. If untreated, strangulatedobstructions cause death in 100% ofpatients. However, the mortality ratedecreases to 8% with prompt surgicalintervention (Vicky P.Kent, RN, PhD, CNE, 2009).
In the course of this study, 84 year-old, NanayGanda, admitted last December 8, 2010 atGeneral Santos Doctors’ Hospital under the careof Dr. Albano, had complaints of inability todefecate by about 4 days. A background of oneyear history of intermittent abdominal pain withbloating was claimed by the patient
Because of this, Dr. Albano believed that thedisorder had a gradual onset and itssymptoms were experienced timely yet laterwith age. The patient recently claimed thatpain usually starts at the right upper quadrantand radiates all throughout the abdomen.Abdominal distention was also observed withrounded asymmetric contour of the abdomen.The bowel sounds were normal at first andbecomes quiet later on. She also hadepisodes of vomiting.
Last December 13, 2010, the patient hadundergone exploratory laparotomy and thesurgeon found out that there was apresence of tumor and immediately removedit. However, the result of the biopsy has notbeen seen. She also had a colostomy toeliminate waste products until such time thecolon heals.
The study focuses on the nature andpossible causes which may lead people toexperience this obstruction. The patient is inher older age and same with other elderswho have the same case as NanayGanda, it is difficult in their part to deal withthe disorder. Since they are older, theyneed more attention and care from themedical team, and particularly, from theirsignificant others.
It is for this reason why the studentnurses decided to have the case. Togive awareness and knowledge ofwhat is the disorder all about and howcan somebody be of help to managepatients with this case especially theolder ones.
This will be a big implication in the medicaland nursing care since it is a challenge todiagnose a bowel obstruction. The keys tosuccessful management are to identifysigns and symptoms that may present verysubtly at first, followed by a commitment tohelp the patient before the conditionbecomes aggravated. Whatever thetreatment, participation in management andpostoperative care is vital. Staying currentwith new findings and methods is the bestcourse.
General Objectives: Comprehend and recognize salientpoints that are important to remember whendealing with patients who manifestedintestinal obstruction; itsnature, causes, clinicalmanifestations, management, and prognosisThis is to enhance the students’ and otherhealth care providers’awareness, knowledge, and understanding ofit in order to promote health, prevent thedisease and help manage patients with this
Specific Objectives: Present the introduction of the studied disease; State the purpose of the study; Present the obtained initial database of the patient; Present the nursing history including the past and present illness of the patient, as well as his activities of daily living;
Present the patient’s cephalocaudal assessment; Identify the anatomy and physiology of the system involved (Gastrointestinal System); Trace the pathophysiology of the disorder process through an illustration and explanation; Compare the clinical manifestations of the disorder based on the theories and actual observations; Explain the assessment and diagnostic findings;
Interpret the laboratory results and the nursing responsibilities; Discuss the medical and nursing management for the said condition. Outline the drug study from the patient’s medication; State the discharge planning of the patient; List the health teachings given to the patient;
State the prognosis of the disease; Enumerate the problem list; Present the Gordon’s Functional Pattern of the patient; and Present the nursing care plan made for the patient.
Name: Nanay GandaAge: 84 years oldSex: FemaleAddress: Block 17 Lot 14 GensanvilleSubd., Bula, GSCReligion: Roman Catholic
Civil Status: MarriedBirthdate: September 12, 1926Birthplace: Bajada, Davao CityRoom: 242 A and 242 BDate of Admission: December 8, 2010Attending Physician: Dr. Albano
Chief Complaints: Generalized Abdominal Pain; Inability to defecate; Abdominal distentionAdmitting Diagnosis: T/C Ileus Partial Obstruction; Fecal StasisOccupation/Source of Income : Housewife
A. History of Present Illness 4 days before the admission, NanayGanda experienced inability of defecating.She also recalled and claimed that it’sapproximately a year that she has beensuffering from intermittent pain in theabdominal area. She cited that pain starts atthe right upper quadrant and radiates allthroughout the abdomen.
Nanay Ganda and her children thendecided to let her be seen by a physician.They scheduled the check-up lastDecember 8, 2010. According tothem, the physician advised NanayGanda to be admitted on that sameday, after doing assessment and series oflaboratory tests such as complete bloodcount and fluid serum. After 5 days beingat the hospital, she had episodes ofvomiting.
The impression to the result of the ultrasoundof her whole abdomen is to consider ileus;partial obstruction and fecal stasis. Dr. Albanobelieved that the symptoms being manifestedwere results of a disorder she has in a longtime. Since they weren’t able to have thatchecked and it wasn’t figured out earlier, thesigns become more evident now. It’s alsobecause these manifestations develop andprogresses relatively slowly.
It was then that the physician decided to letthe patient undergo exploratory lap to detectwhat really had cause the obstruction. It wasDecember 13, 2010 when the surgeondiscovered a tumor at the site of theobstruction particularly at the descendingcolon and immediately removed it. The foundtumor was then subjected for biopsy.
B. Past Medical History• Immunization and Childhood Illness The patient can only recall beingimmunized with BCG and OPV. She had ahistory of having chicken pox infection whenshe was on her 1st year high school. She alsoexperienced cough andcolds, fever, diarrhea, constipation, sorethroat, rashes, and nausea and vomiting.
• Compliance to Health Management Nanay Ganda rarely visits a doctor tohave a check-up. However, she is usingherbal medicines since her childhood daysdepending on what condition she has suchas oregano, guava, bitter gourd, and ginger. She also takes over the counter drugsand what she mentioned wereSolmux, Neozep, Biogesic, Mefenamicacid, Bentyl, and Loperamide. She said thatwhen she was still on her 30’s to 40’s, she istaking multivitamins which is Enervon andlater on, she stopped taking it.
• Menarche Her menarche started when shewas in her 6th grade. She was 11 yearsold back then on the year 1938.C. Family History There is no known inheritedcondition present in her both paternal andmaternal family. She’s the first in theirfamily to be experience intestinalobstruction.
D. Activities of Daily Living• Personal Hygiene The patient is able to bathe herself.She takes a bath everyday. According toher, before and after eating her meals, sheonly washes her hands with the use ofwater though sometimes, she can be ableto use soap.
• Nutrition Since she believes that eating fruitsand vegetables is good for her and will beable to maintain her health, she doesn’tseek for medical assistance that much. She eats her meals three times aday with snacks in between. She admittedthat she only drinks 4-5 glasses of water aday which approximately is equal to 1.5L.She drinks coffee in the morning andafternoon. She claimed that she hasallergies on food particularly shrimps.
• Elimination She voids 4-5 times a day. Herurine color is yellow which is dark mostof the times. There is no burningsensation/ pain felt during urination.She usually moves her bowel everymorning with brown and formed stools.But recently, she is having difficulty indefecating.
• Rest and Sleep She can sleep for 7-9 hours pernight. Her earliest time in going tosleep is at 9:30 PM while the latesttime in waking up is at 6:30 AM. Shesometimes takes a nap at noon forabout 1-3 hours. She said that shedoesn’t experience any difficulties ingoing to sleep and doesn’t take anysedatives.
• Exercise The patient ambulates within thehouse and does household chores. Shealso takes a walk at their subdivision invisiting their neighbors or buying at thestore. She does simple exercises on theupper and lower extremities by means ofshaking and stretching.
• Religion She is a Roman Catholic who has astrong faith in God. She goes to thechurch with her youngest child and hergrandchildren to attend the mass everySunday. She always brings with her therosary and always prays at night.
• Sexuality The patient is married and has 4children. She has no history of SexuallyTransmitted Disease or any diseaseaffecting her sexual organ. Her menarchewas on the year 1938 when she was still11 years old and she is now on hermenopausal stage.
E. Hospitalization This was her first hospitalization.She never experienced beinghospitalized before because herparents would just bring her tomanghihilot in their place.
Date Conducted: December 13 – 14, 2010a. General AppearancePre-operative PhaseIVF of D5NM 1L x 160 hooked at her left cephalicvein
Thin Clean and well-groomed Conscious and coherent Tries to be calm and relaxed Facial grimacing at times Oriented to people, time, and place Frequent sighing
Post-operative PhaseIVF of PLR 1L x 8 hours as main linehooked at her left cephalic vein with aside drip of PNSS 500mL + 2 ampulesVoltaren at 20cc/hr and an IVF of PNSS1L x KVO hooked at her right cephalicvein with a side drip of 2units PRBC
Uses oxygen via face mask at 3 LPM She has a nasogastric tube attached to a drainage bottle Calm but shows evidence of weakness A colostomy is being attached to colostomy bag at the left upper quadrant of her abdomen A vertical surgical incision is present on the abdomen with clean and intact dressing Foley catheter is attached to uro bag draining well with dark yellow urine
Skin, Hair, Nails Light brown in color same all throughout the body Senile skin turgor Wrinkles present on the face and neck Dry and flaky prominent over the extremities Brown-colored macules on the face and upper extremities No edema
Unblemished skin No masses noted No lesions found Warm to touch Evenly distributed short, thin, white hair Short and thick fingernails and toenails
Head Normocephalic Oblong-shaped Symmetric facial features Symmetric facial movements Without lesions, lumps, or masses noted
Eyes Eyebrows are unevenly distributed and aligned Eyelashes are short and curl outwards Sunken eyeballs White sclera Pale conjunctiva Pupils appear smaller in size and both react to light and accommodation Bilateral blinking
Ears Color is same as facial skin Symmetrical Mobile and firm pinna that recoils after it is fold Pinna aligned with the outer canthus of the eye No unnecessary foul discharges Can hear sounds in both ears
Nose Color is same as facial skin Symmetric Greenish discharges present after operation No lesions
Mouth Symmetric Dark colored dry lips Able to purse lips No lesions noted Dark colored gums No swelling Uses dentures Tongue is moist and pink in color which is in central position Tongue moves freely
Neck Color is same with the head Wrinkles present Not enlarged Head centered Coordinated movement
Spine and Back Spinal curvature is accentuated Before operation, patient can turn to sides with slight discomfort After operation, patient is flat on bed
Thorax and Lungs Decrease in depth of respiration during inspiration Use of accessory organs during expiration Before operation, respiration rate is 24 cpm After operation, respiration rate is 18 cpm Vibrations present and can be felt on the chest Clear breath sounds
Breast Color is same all throughout the abdomen Slightly unequal in size Generally symmetric Appears flaccid Lacks firmness No masses and lesions found Areola and nipples are darker in pigmentation No discharges noted
Heart Present and audible heartbeats Beats with regular rhythm Before operation, cardiac rate is 90 bpm After operation, cardiac rate is 73 bpm
AbdomenPre-operative Phase Uniform color Unblemished skin Round with asymmetric contour Rises with inspiration and falls with expirations Umbilicus centrally positioned Hypoactive bowel sounds auscultated
Abdominal distention Claimed that pain starts at the right upper quadrant and radiates all throughout the abdomen The impression to the result of the ultrasound of her whole abdomen is to consider ileus; partial obstruction and fecal stasis
Post-operative Phase Symmetric contour A colostomy is being attached to colostomy bag at the left upper quadrant of her abdomen A vertical surgical incision is present on the abdomen with clean and intact dressing No tenderness
Upper Extremities Both arms are in the same size and length Movement is limited No lesions noted No masses noted No rashes found Dry and flaky skin Brown-colored macules noted Senile skin turgor
Lower Extremities Both legs are in the same size and length No lesions and masses noted Dry and flaky skin Fissures noted With lesser hair distributed in the legs
Musculoskeletal Muscles are equal in size on both sides of the body Flaccid muscles No tremors found and no presence of tenderness or swelling Limited range of motion; decreased strength; becomes weak in prolonged activities
Neurologic Has poor posture but is able to walk and maintain balance; but aided during ambulation Reaction to stimuli are slower Has reduced speed of movement
Genitourinary On menopausal stage No history of disease affecting genitals After operation, a foley catheter is attached to uro bag draining well with dark yellow urine; no pain during urination
Abdominal CT scan - combines special x-ray equipment with sophisticated computersto produce multiple images or pictures ofthe inside of the body. These cross-sectional images of the area being studiedcan then be examined on a computermonitor, printed or transferred to a CD.
Abdominal X-Ray - An abdominal X-ray isa picture of structures and organs in thebelly (abdomen). This includes thestomach, liver, spleen, large and smallintestines, and the diaphragm, which is themuscle that separates the chest and bellyareas. Often two X-rays will be taken fromdifferent positions. An abdominal X-raymay be one of the first tests done to find acause of belly pain, swelling, nausea, orvomiting.
Abdominal Ultrasonography - An idealclinical tool for determining the sourceof abdominal pain. It can simplify thedifferential diagnosis of abdominalpain, especially when pain andtenderness are present over the site ofdisease.
Barium Enema - X-ray examination ofthe large intestine (colon and rectum).The test is used to help diagnosediseases and other problems thataffect the large intestine. To make theintestine visible on an X-raypicture, the colon is filled witha contrast material containing barium.This is done by pouring the contrastmaterial through a tube inserted intothe anus.
Laboratory studies(e.g., electrolyte studies and acomplete blood cell count)reveal a picture ofdehydration, loss of plasmavolume, and possible infection.
Decompression of the bowel through anasogastric or small bowel tube issuccessful in most cases. When thebowel is completely obstructed, thepossibility of strangulation warrantssurgical intervention.Before surgery, intravenous therapy isnecessary to replace the depletedwater, sodium, chloride, and potassium.
The surgical treatment of intestinalobstruction depends largely on the causeof the obstruction. In the most commoncauses of obstruction, such as hernia andadhesions, the surgical procedureinvolves repairing the hernia or dividingthe adhesion to which the intestine isattached. In some instances, the portionof affected bowel may be removed and ananastomosis performed. The complexityof the surgical procedure for intestinalobstruction depends on the duration ofthe obstruction and the condition of theintestine.
A colonoscopy may be performed tountwist and decompress the bowel. Acecostomy, in which a surgicalopening is made into the cecum, maybe performed for patients who arepoor surgical risks and urgently needrelief from the obstruction. Theprocedure provides an outlet forreleasing gas and a small amount ofdrainage.
A rectal tube may be used todecompress an area that is lower inthe bowel. The usualtreatment, however, is surgicalresection to remove the obstructinglesion.A temporary or permanent colostomymay be necessary. An ileoanalanastomosis may be performed if it isnecessary to remove the entire largecolon.
Nursing management of the nonsurgicalpatient with a small bowel obstructionincludes maintaining the function of thenasogastric tube, assessing and measuringthe nasogastric output, assessing for fluidand electrolyte imbalance, monitoringnutritional status, and assessingimprovement (eg, return of normal bowelsounds, decreased abdominaldistention, subjective improvement inabdominal pain and tenderness, passage offlatus or stool).
The nurse reports discrepancies inintake and output, worsening of pain orabdominal distention, and increasednasogastric output. If the patient’scondition does not improve, the nurseprepares him or her for surgery. Theexact nature of the surgery depends onthe cause of the obstruction. Nursingcare of the patient after surgical repairof a small bowel obstruction is similar tothat for other abdominal surgeries
Fluid Serum December 8, 2010Electrolytes exist in the blood as acids, bases, and salts (suchas sodium, calcium, potassium, chloride, magnesium, andbicarbonate). They control such things as cardiac functionand muscle contraction and are routinely measured bylaboratory studies of the serum.Fluid Serum is the cell-free fluid of the bloodstream. Itappears in a test tube after the blood clots and is often usedin expressions relating to the levels of certain compounds inthe blood stream.A Blood chemistry test is a procedure to examine the generalhealth of a patient especially to assess the functioning ofcertain organs.
Test Result Reference Interpretation value Creatinine 0.8 mg/dl 0.7-1.2 Normal Sodium 137 mmol/L 137-145 NormalPotassium 3.4 mmol/L 3.5-5.0 Low Amylase 37 u/L 30-110 NormalInterpretation:The table shows that Potassium is slightlydecreased. This decrease in potassium maybe due to patient’s vomiting, deficientpotassium intake, or dehydration.
Nursing Responsibilities:•define and explain the test•state the specific purpose of the test•explain the procedure•discuss testpreparation, procedure, and posttestcare•some blood chemistry tests will havespecific requirements such as dietaryrestrictions or medication restrictions.
Complete Blood Count December 8, 2010The complete blood count (CBC) is one of themost commonly ordered blood tests. The completeblood count is the calculation of the cellular(formed elements) of blood. These calculations aregenerally determined by special machines thatanalyze the different components of blood in lessthan a minute.This test may be a part of a routine check-up orscreening, or as a follow-up test to monitor certaintreatments. It can also be done as a part of anevaluation based on a patients symptoms.
Test Results Reference Interpretation Value WBC 12.1 5-10 x 10^9/L High Segmenters 0.76 0.55-0.65 High Lymphocyte 0.15 0.25-0.35 Low Monocyte 0.08 0.03-0.06 High Eosinophil 0.01 0.02-0.04 Low Hemoglobin 96 140-170 9/L Low Hematocrit 0.29 0.40-0.50 Low volume Platelet 291 150-350x10^9/L NormalInterpretation:CBC is a combination report of a series of test of theperipheral blood. White blood cells (leukocytes) arebody’s defense against infective organisms and foreignsubstances. The table shows that there is elevatednumber of WBC which indicates that there is possibleinfection or immunosuppression happening inside.
Segmenters are above the normal rangewhich indicates infection.Low Lymphocyte, Eosinophil andMonocyte count indicates that the bodysresistance to fight infection has beensubstantially lost and one may become moresusceptible to certain types of infection,namely cancer and tumor. As lymphocytecells make up fifteen to forty percent of thetotal white blood cells that circulate in thebloodstream, a low count can cause damageto organs.
Hemoglobin is the oxygen carrying protein withinthe RBC’s. The table shows that there isdecreased hemoglobin concentration in theblood, which indicates that there is less oxygenbeing transported throughout the body, becauseof the less oxygen being transported. Withthis, the patient is likely experiencing difficulty ofbreathing that leads patient to have impaired gasexchange.Hematocrit is the percentage of RBC mass tooriginal blood volume. The table shows thathematocrit volume is decreased which indicatesthat there is over expansion of extra cellular fluidvolume, since the patient has a decreased RBCshe also have a decreased hematocrit level..
Nursing Responsibilities:•Explain that the tests are done to detect anyhematologic disorders as well as infection andinflammation.•Tell the patient that a blood sample will be takenand that she may feel slight discomfort from thetourniquet and needle puncture.•Use gloves when collecting and handling allspecimens.•Transport the specimen to the laboratory as soonas possible after the collection.•Do not allow the blood sample to clot, of theresults will be invalid. Place the specimen in abiohazard bag.
Abdomen Supine and Upright December 8, 2010Abdominal x-rays may be performed todiagnose causes of abdominal pain, such asmasses, perforations, or obstruction.Abdominal x-rays may be performed prior toother procedures that evaluate thegastrointestinal (GI) tract or urinarytract, such as an abdominal CT scan andrenal procedures.
Result:Lung bases are clear. Free subphrenic air is noted.There are gas containing loops of small and largebowel in all quadrants with no definite pattern. Anovoid soft tissue density is seen in the right lowerquadrant area overlying pattern of the right superioriliac crest. This is seen in the supine view only andmay be in the soft tissues. Reacted gas is present.There are advance degenerative changes in lumbarspine characterized by osteophytes/ spursformation. Asymmetrical narrowing of L4-L5intervertebral joint space, left is seen with linearlucencies within. Mild levoseoliosis is noted.Impression:Essentially (-) study of the abdomen save fordegenerative changed of the lumbar spine.
Abdomen Supine and Upright December 8, 2010Abdominal x-rays may be performed todiagnose causes of abdominal pain, such asmasses, perforations, or obstruction.Abdominal x-rays may be performed prior toother procedures that evaluate thegastrointestinal (GI) tract or urinarytract, such as an abdominal CT scan andrenal procedures.
Abdomen Supine and upright December 9, 2010Re-examination no longer shows theovoid soft tissue density in the right lowerquadrant area or seen in the abdominalsupine view. Gas containing loops ofpredominantly small bowel segments arestill seen in all quadrants with no definitepattern. Rectal gas is present. Pro-peritoneal flank stripes areintact, abdomen are not displacedlaterally.
Nursing Responsibilities:•Remove any clothing, jewelry, or other objects thatmight interfere with the procedure.•Given a gown to wear.•Position in a manner that carefully places the partof the abdomen that is to be observed. The patientmay be asked to stand erect, to lie flat on atable, or to lie on the side on a table, depending onthe x-ray view the physician has requested.•Body parts not being imaged may be covered witha lead apron (shield) to avoid exposure to the x-rays.
Nursing Responsibilities:•Once positioned, ask the patient to hold still for afew moments while the x-ray exposure ismade. Also, ask the patient to hold his/her breathat various times during the procedure.•It is extremely important to remain completely stillwhile the exposure is made, as any movement maydistort the image and even require another x-ray tobe done to obtain a clear image of the body part inquestion.•The x-ray beam is then focused on the area to bephotographed.
Urinalysis December 9, 2010Routine urinalysis is performed forgeneral health screening to detectrenal and metabolic diseases; todiagnose diseases or disorders of thekidneys or urinary tract. In addition, itis performed to help diagnose specificdisorders such as endocrine diseases.
Color Reaction Transparency Specific gravity Light yellow 6.0 Clear 1.003 Sugar Albumin Negative Negative Pus cell RBC 0.1/ HPF 0.1/ HPFInterpretation: The physical and chemical properties of thepatient’s urine show normal results. Normally, blood mustbe absent in the urine. Presence of blood may indicateacute kidney infections, chronic infections, and stoneformation in the kidneys.
Nursing Responsibilities:•Explain how to collect a clean catchspecimen of at least 15 mL.•Explain that there is no food or fluidsrestriction.•Obtain a first voided morning specimen ifpossible.•Medications may be restricted for it mayaffect laboratory results.
Fecalysis December 9, 2010It refers to a series of laboratory testsdone on fecal samples to analyze thecondition of a persons digestive tractin general. Among other things, afecalysis is performed to check for thepresence of any reducing substancessuch as white blood cells (WBCs),sugars, or bile and signs of poorabsorption as well as screen for coloncancer.
Color Chemical and Result occult blood Black Positive No intestinal parasite seenInterpretation: Black stool may be a result of possibleinternal bleeding, particularly somewhere in thedigestive tract.
Nursing Responsibilities:•Discourage patient from taking aspirin, alcohol,vitamin C, ibuprofen, and certain types of food iffecal sample will be checked for any sign of blood.•The patient must urinate first to prevent any urinefrom mixing with feces.•The patient must wear gloves when its time tohandle stool and transfer it to a safer container.This will prevent any possibilities of beingcontaminated or infected by bacteria found withinthe stool.•Solid and liquid fecal samples are both acceptableas long as they do not have urine or other foreignsubstances like soap, water, and toilet paper mixedin them.
Nursing Responsibilities:•If the patient is suffering from diarrhea, placinga plastic wrap and securing it under the toiletseat could facilitate the collection process.•Collected samples must be brought to thedoctors office or laboratory as soon aspossible. Delays could compromise the qualityof the sample.• Volume or amount is also important so thepatient must be sure he has collected anadequate amount of stool.
Potassium Test December 10, 2010This test measures the amount of potassium in the blood.Potassium (K+) helps nerves and muscles communicate. Italso helps move nutrients into cells and waste productsout of cells. Test Result Reference Interpretation value Potassium 4.1 3.6-5.0 mmol/L Normal Interpretation: The potassium level of the patient is normal.
Ultrasound in the Whole Abdomen December 10, 2010It is an ideal clinical tool fordetermining the source of abdominalpain. It can simplify the differentialdiagnosis of abdominalpain, especially when pain andtenderness are present over the site ofdisease.
Result:Liver is normal in size and contour. Itshows normal homogenous echopattern. No mass lesion is noted.Intrahepatic bile ducts and CBD arenot dilated. Hepatic vessels areunremarkable. Gallbladder isphysiologically distended. It showsnormal wall thickness. No internalechoes are noted. No pevicholecysticfluid collection is seen.
Pancreas and spleen are normal. Rightkidney measures 9.6 x 4.2 cm withcortical thickness of 1.2 cm. Left kidneymeasures 9.5 x 4.0 cm with corticalthickness of 1.5 cm. Both are normal insize showing homogenouscorticomedullary parenchymalechogenecity. No echogenic focus ormass lesion is noted. There is noseparation of the central echo complexes.Proximal uterus is not dilated. Uterus isatrophic and is compatible with the age ofthe patient. No abnormal masses areseen in both advexac.
Moderately dilated, fecal-filled segment oflarge bowel are noted in both paracolicgutters, iliac regions and pelvis. Noevident mass lesion is appreciated.Impression:Considers ileus; Partial obstructionFecal stasis
Nursing Responsibilities:•Before procedure, instruct patient to beon NPO 8-12 hrs since air or gas carreduce quality of image•Assess abdominal distention because itmay affect quality of image•During procedure, keep the patient in asupine position
An exploratory laparotomy is doneespecially when a personcomplains of abdominal pain. Theoperation allowed the surgeon toexamine the internal organs.Disease or damage can beuncovered. In some cases, theproblem can be corrected duringthe surgery.
A colostomy is when the colon is cut in half andthe end leading to the stomach is broughtthrough the wall of the abdomen and attachedto the skin. The end of the colon that leads tothe rectum is closed off and becomes dormant.Usually a colostomy is performed for infection,blockage, or in rare instances, severe trauma ofthe colon. This is not an operation to be takenlightly. It is truly quite serious and demands theclose attention of both patient and doctor. Acolostomy is often performed so that aninfection can be stopped and/or the affectedcolon tissues can heal.
•Assess and measure the nasogastric output•Assess fluid and electrolyte balance andadminister IV as prescribed•Monitor nutritional status•Assess improvement such as return of normalbowel sounds, decreased abdominaldistention, abdominal pain andtenderness, passage of flatus or stool•Prepare patient for surgery which includespreoperative teaching
•After surgery, provide wound care andpost-operative nursing care•Place ice chips on the same day ofsurgery to ease the patient’s thirst. By thenext day, the patient may be allowed todrink clear liquids.•Slowly add thicker fluids and then softfoods as the bowels begin to work again.•Patient may eat normally within 2 daysafter the surgery.
•The colostomy drains stool(feces) from the colon into thecolostomy bag. Most colostomystool is softer and more liquid thanstool that is passed normally. Thetexture of stool depends on thelocation of the segment ofintestine used to form thecolostomy.
When client is to be discharged fromthe hospital, nursing care is stillcontinued. With sufficient support athome, most client recover gradually.During home visits, the client’s physicalstatus and progress towards recovery isassessed. The client’s understanding oftherapeutic regimen is alsoassessed, and previous teaching isreinforced.
Method•Instruct the significant others to take the following homemedication as ordered by the physician.•Explain to the significant others the drug names as well asthe right route and dosage.•Inform the significant others about the side effects thatmay occur brought by the medication.•Encourage the significant others to comply and followreligiously the right timing in taking the medication.•Confer with the patient’s family the need take precautionsregarding medication therapy, activity, and dietaryrestriction.•Discuss with the patient’s family ways to cope withstressful situations in positive manner.
Method•Instruct patient’s family to report for immediate occurrenceof signs and symptoms to a health care professional.•Reinforce and supplement patient’s family knowledgeabout diagnosis, prognosis, and expected level of function.•Provide patient’s family with specific directions about whento call the physician and what complications require promptattention.•Peer support and psychological counseling may be helpfulfor some families.
Exercise/ Environment•Once at home, patient may resume much of thenormal activity short of aggressive physicalexercise.•Walk short distances everyday and graduallyincrease activity.•No lifting of a weight greater than 20 lbs (9kg) for6 weeks. Exercise should be started cautiously.•Encourage to practice deep breathing exerciseand range of motion exercises up to the level ofcapability.
Exercise/ Environment•Explain the need for rest periods both before andafter certain activities.•Teach client the importance of stressmanagement through relaxation technique,•Help improve patient’s self-concept by providingpositive feedback, emphasizing strengths andencouraging social interaction and pursuit ofinterests.
Treatment•Explain to the significant others theneed to continue drug therapy•Provide patient’s family with a list ofmedications, with information onaction, purpose and possible sideeffects.•Advise significant others to alwayscomply with the medications. Call thephysician if there is a problem takingthem.
Hygiene•Keep proper hygiene. Teach client’sfamily the importance of hygiene likedaily oral care, bathing and changingclothes.•Proper Wound care must beobserved.
Outpatient•Advise to visit or have her follow upcheck-up with her attending physician.•Advise to call and notify the attendingphysician for any unusualities that mayoccur•Routinely, follow up check – up withpatients within two weeks. If there arestaples that requireremoval, postoperative problems, orwound issues, a follow-up appointmentwill be scheduled sooner.
Diet•Emphasize to the client’s family the importance of propernutrition, its need for early recovery. This can aid inrestoring body functioning.•Provide dietary instructions to help patient’s familyidentify and eliminate foods that is needed by the patient.•Soft or low residue diet upon discharge; this should becontinued at home for approximately 2 weeks (thisincludes breads, cereals, chicken, fish, and soup).•Avoid large quantities of raw fruits and vegetables.•After 2 weeks, gradually reintroduce your regular diet.•Encourage to drink plenty of fluids.•Take nutrition supplements