Question

1. Peter, age 30, ate at a Japanese restaurant and the chicken tasted weird. A few hours later, he started having nausea, vomiting, and diarrhea. In the ER, he vomited 4 times and was sent to an isolation room. You have the following orders. Prioritize your interventions. (place a number next to each intervention)

- 1L Normal saline over 1h

- Insert PIV

- Obtain CBC, CMP

- Zofran 4mg IV every 4 hours PRN nausea/vomiting

- Zofran 12.5mg po every 4 hours PRN nausea/vomiting

- obtain V/S (vital signs)

- obtain stool sample for culture, O &P, C-diff

- Protonix 40mg IVP x 1 dose now

2. Is a post-op patient at risk for constipation? Why?

3. You're taking care of a patient that requires the use of laxatives for bowel cleansing before a surgical procedure.

- what concerns you when you give a patient a laxative?

- how do you monitor what you're concerned about?

- what are you going to do if your concern occur?

- what is the most important question to ask when patient arrives at the OR for a bowel procedure having been ordered to complete a bowel cleansing regimen?

Answer 1

Answer for the first question

1. obtain V/S (vital signs)

2.Insert PIV

3.Obtain CBC, CMP

4.Protonix 40mg IVP x 1 dose now

5.1L Normal saline over 1h

6.Zofran 4mg IV every 4 hours PRN nausea/vomiting

7.obtain stool sample for culture, O &P, C

8. Zofran 12.5mg po every 4 hours PRN nausea/vomiting

Answer for the Second question:

Post op patients are at risk of constipation due to :

1. prolonged immobility due to bed rest and activity restriction
2. decreased consumption of solid foods and fluids
3. Dehydration due to excessive loss of fluids
4. Effect of certain medications which reduces bowel movements
5. Lack of privacy and improper timing for bowel elimination

question No:3

a. the major concern while administering laxatives is dehydration due to profuse watery diarrhea which in-turn leads to potentially fatal acid-base and electrolyte imbalance. Consequently, hypokalemia and metabolic alkalosis can result as a result of distal renal tubular acidosis.

b. Monitoring of patients receiving laxatives: Strict intake output chart should be maintained. Frequency and consistency of bowels should be documented. Serum electrolytes and Renal function test values should be monitored closely. Closely monitor for signs of dehydration

c. With hold medication and contact the health care provider immediately. NPO status should be maintained . Start an IV normal saline immediately. Vital signs should be monitired and patient should be on continous cardiac monitor othervise, a 12 lead ECG should be obtained, because hypokalemia can cause life threatening arrhythmias. Samples should be sent to the lab for serum electrolytes and renal function test

d. OR nurse should check whether the bowel cleansing has been done two times . First one should be done 2 hours after dinner the night before surgery and one enema the morning of the procedure. She should confirm with the nurse whether cleansing has done accordingly . So the important question she should ask is when was the last enema given?.