Question

You are the nurse caring for Mr. Noah Poupe, a patient on a medical-surgical acute care unit. Mr. Poupe is 3 days post-op from an appendectomy.

You perform an assessment of Mr. Poupe. You find he has decreased PO intake, absent bowel sounds, and no reports of flatus. His last BM was 4 days before surgery. Today, he has been experiencing bouts of N/V without relief, despite receiving anti-emetics.

1.     What is your main concern for Mr. Poupe? (Hint: Pick one related to nutrition or bowel elimination)

What assessment data brought you to this conclusion?

What interventions do you expect to be implementing for Mr. Poupe?

Answer 1

1. What is main concern?

Fluid volume definition related to impaired fluid intake and excessive vomiting.

2. Assessment data:

1. Decreased oral intake

2.Nausea and vomiting

3. Absence of bowel movement

3.Intervention:

1. Monitor vitamins signs closely

2. Early ambulation

3. Encourage breathing exercise, coughing techniques

4. Provide active and passive exercise

5. Administer intra venous fluids.

6. Provide psychological support

7. Maintain strict intake output chart

8. Pain management

9. Comfortable bed and position

19. Provide health education realized to disease conditions