Question

While you are working as a nurse on a gastrointestinal/genitourinary (GI/GU) floor, you receive a call from your affiliate outpatient clinic notifying you of a direct admission, ETA (estimated time of arrival)60 minutes. She gives you the following information: A.G. is an 87-year-old woman with a 3-day history of intermittent abdominal pain, abdominal bloating, and nausea and vomiting (N/V). A.G. moved from Italy to join her grandson and his family only 2 months ago, and she speaks little English. All information was obtained through her grandson. Past medical history (PMH) includes colectomy for colon cancer 6 years ago and ventral hernia repair 2 years ago. She has no history of coronary artery disease (CAD), diabetes mellitus (DM), or pulmonary disease. She takes only ibuprofen occasionally for mild arthritis. Allergies include sulfa drugs and meperidine. A.G.’s tentative diagnosis is small bowel obstruction (SBO) secondary to adhesions. A.G. is being admitted to your floor for diagnostic work-up. Her vital signs (VS) are stable, she has an IV of D5½ NS with 20 mEq KCl at 100 ml/hr, and 3 L oxygen by nasal cannula (O2/NC).

1. Based on the nurse’s report, what signs of bowel obstruction did A.G. manifest?
2. Are there other signs and symptoms (S/S) that you should observe for while A.G. is in your care?

3. With some difficulty, you insert a nasogastric tube (NGT) into A.G. and connect it to intermittent low wall suction (LWS). How will you check for the placement of the NGT?

4. List, in order, the structures through which the NGT must pass as it is inserted.
5. You note that A.G.’s NGT has not drained in the last 3 hours. What can you do to facilitate drainage?

6. The NGT suddenly drains 575 ml; then it slows down to about 250 ml over 2 hours Is this an expected amount?

After 3 days of NGT suction, A.G.’s symptoms are unrelieved. She reports continued nausea, cramps, and sometimes strong abdominal pain; her hand grips are weaker, and she seems to be increasingly lethargic. You look up her latest laboratory values and compare them with the admission data. Her sodium (Na) has changed from 136 to 130 mmol/L, potassium (K) has changed from 3.7 to 2.5 mmol/L, chloride (Cl) from 108 to 97 mmol/L, carbon dioxide (CO2) from 25 to 31 mmol/L, BUN from 19 to 38 mg/dl, creatinine from 1 to 2.2 mg/dl, glucose from 126 to 65 mg/dl, albumin from 3.0 to 2.1 g/dl, and protein from 6.8 to 4.9 g/dl.

7. Which lab values are of concern to you? Why?

Answer 1

1.

Based on the nurse report

A.G. has intermittent abdominal pain, abdominal bloating, nausea, and vomiting. These are the primary symptoms of bowel obstruction.

These symptoms occur due to the deposition of Stool in the intestine.

2.

The nurse should observe

- the bowel frequency and types of the stool to known about the grade of obstruction(Patient is able to pass stool or not).

- Loss of appetite is very common in bowel obstruction so, the nurse should observer patient appetite.

3.

To check for the placement of the NGT, the nurse should

-First, auscultate bubbling sound with a stethoscope on the stomach by pressing air through the NG tube into the stomach.

- After auscultating to confirm the position of NG tube the nurse should obtain an X-ray.

4.

NG Tube must be passed through

1. Nose

2. Pharynx

3. Esophagus

4. Stomach