Question

Gastrointestinal Disorders 20 Case Study 4 Name Class/Group Date Group Members INSTRUCTIONS: All questions apply to this case study. Your responses should be brief and to the point. Adequate space has been provided for answers. When asked to provide several answers, they should be listed in order of priority or significance. Do not asume Information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it. Scenario T.B., a 60-year-old retiree, is admitted to your unit from the ED (emergency department). Upon arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. Indicates that he has severe RUQ (right upper quadrant) pain that radiates to his back, and he is more comfortable walking bent forward than lying in bed. He admits to having had several similar bouts of abdominal pain in the last month but "none as bad as this." He feels only slightly nauseated but has expenenced N/V (nausea and vomiting) during previous episodes. T.B. experienced an acute onset after eating fish and chips at a fast-food restaurant. His daughter insisted on taking him to the hospital. Assessment findings are AAO (awake, alert, oriented) x 3 and MAEW (moves all extremities well). Moves restlessly and continually, C/O of notable fatigue. Breath sounds clear throughout, anterior and posterior. Heart sounds clear without adventitious sounds, heart rate regular, all pulses 3+ bilaterally. Bowel sounds audible, abdominal guarding noted with exquisite tenderness to light palpation over R side, especially RUQ (right upper quadrant). Has sharp inspiratory arrest with palpation of the RUQ. Reports light-colored stools x 1 week. Voids medium amber urine per urinal without difficulty. Skin and sclera slightly jaundiced. Admit VS are 164/100, 132, 26, 36° C.

Answer 1

Qusetion no 5) Patient stabilization includes administrating analgesics,iv fluids, when appropriate antibiotics.Once the patient has been stabilized and a diagnosis made appropriate definitive therapy can be initiated.Definitive treatment can be medical or surgical ,depending on the primary cause acute abdomen.Physical therapies like heat or cold packs,psychological therapies like relaxation techniques.

Question no 6) The character of pain is trimbling and nearly doubled over with severe abdominal pain,and the pain indicates severe in Right upper quqrdent and radiates to his back,Nausea and womiting ,abdominal guarding noted with exquisite tendeeness to light palpation over right side especially RUQ and also he has sharp inspiratory arrest with palpation of the RUQ,other findings are stool and urine colour, the colour changes of skin sclera.

Question no-7)The antibiotic dosing recommendations are based on creatine clearance calculated using the Cockcroft -Gault equation ,the elevated creatinine level may cause seizure thats why before dose adjustment needs to chck renal function.Patient with creatinine clearances of less than 15/ml /min should not receive imipenem .

Question no-8)T Tube is a draining TUBE placed in the common bile duct after common bile duct exploration.It provides external drainage of bile into a controlled route while the healing process of cholecystectomy.This tube is inserted with the intention of preventing the build-up of bile in the common bile duct due to temporary swelling,which is common after any cut in any part of the body.

Question no -9) The benefits of hydrocolloidal dressing in  blister is ,it starts to absorb moisture from the wound (medically it is called "exudate")to form a gel and rapidly turns in to a soft and spongy mass to premote faster healing.

Question no 10) Take care not to lie on the same side as the tube during sleep because this may compress it.Always try to secure the tube and bag inside his dress and also the caregivers can give him suggestions to prevent the tube from being pulledout.Keep the bandage and tube site dry . While discharging if T-tube connected to drainage bag,follow the instuctions while empty the bag atleast twice a day,empty it more often if need ,before emptying bag he must wash his hands,remove the closure at the bottom of the bag,drain the fluid in to measuring cup,record the amount of fluid each time empty the bag shere the information to healthcre provider on his next visit,replace the clouure on the bottom of the bag and again he needs to follow hand hygiene.

Question no -11) Wash the skin around the incision daily with mild soap and water ,eat regular diet,avoid physical job with heavy lifting for a while,do not drive untill the first post operative visit,practice 10 deep breaths every hour and 2 coughs every hour,follow medications as per doctor instructions,and also instuct him if he has any symptoms like fever ,diarrhea,elevated heart rate,sudden shortness of breath or chest pain,leg swelling and painwound drainage, drainage has foul odour ,sudden new stomach pain contact the phusician.