Question

A patient is a 74 years old white female presents to the emergency room with a chief complaint of abdominal pain, nausea, vomiting, and lack of appetite. The patient was mildly dehydrated. She went for CT of the abdomen with contrast and showed a partial small bowel obstruction with no evidence of a mass, inflammation or fecal impaction. Denies fever or chills. The patient had history of abdominal surgery in the past. 1. What is the reason for the obstruction? Based on the patient's presenting signs and symptoms, formulate a nursing care plan for this patient to achieve health care outcomes. Provide a minimum of 2 (two) nursing problems.

Subjective/Objective data-

Nursing diagnosis-

Objective-

Intervention-

Rationale-

Pathphysiology of disease-

Evaluation-

Answer 1

1.The main reason for small bowel obstruction is adhesion of the tissues in the abdomen after any abdominal surgery. The symptoms are usually nausea,vomiting, abdominal pain are some if its symptoms

● Acute pain (abdomen) related to obstruction in bowel as evidenced by verbalisation,facial expression, pain score

Subjective data:

• Vrrbalisation

Objective data

• Facial expression
• Pain score
• Restless
• Withering in pain

Goal:to relieve pain

Nursing intervention and rationale

• Assess the pain level ,intensity,duration,frequency to plan for care
• Administer analgesic as per order to relieve pain and comfort the patient
• Keep patient nil by mouth to prevent gastric stimulation
• Administration of intravenous fluids
• Insertion of nssogastric tube to relieve decompression of the bowel

Evaluation

The patient will be relieved of pain and participating in normal activities

Pathophysiology :An obstruction in the bowel leads to alteration in the digestive process leading to constipation ,nausea and vomiting ,abdominal pain and discomfort

●Deficient fluid volume related to lack of gastrointestinal absorption as evidenced by nausea and vomiting

Subjective data :

• Verbalisation
• Unable to eat

Objective data

• Nauseatingand vomiting
• Dry skin ,sunken eyes
• Decreased capillary reperfusion

Goal :to maintain normal fluid balance

Nursing intervention and rationale

• Administer anti emetic to stop vomiting
• Administer intravenous fluid to replace the lost fluids and electrolyte
• Keeping patient NPO reduces the nausea ad vomiting
• Encourage to have fluids if ordered by provider
• Maintain intake and output chart gives an actual balance of the fluid

Pathophysiology

When there is bowel obstruction ,the food consumed are not digested and absorbed by the intestine to take nutrients and water content. This leads to retention which causes alteration in GI system causing nausea and vomiting along with abdominal pain.This also causes electrolyte imbalances.