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- 5 points Nursing diagnosis- 5 points Objective- 5 points Intervention- 5 points Rationale- 5 points Pathphysiology of disease- 5 points Evaluation- 5 points

Answer 1

1.The reason for the obstruction is the past abdominal surgery .This will lead to adhesion of the intestinal layers and cause the obstruction

Nursing care plan

●Acute pain (in abdomen) related to bowel obstruction as evidenced by verbalisation

Subjective data:

• Verbalisation or description of pain

Objective data

• Changes in facial grimace
• Pain score

Goal:

To relieve pain

Nursing intervention and rationale

• Assess the pain level for intensity, duration ,frequency to plan for care
• Administer analgesics to relive pain
• Keep patient NBM ,as this can prevent peristalsis and pain
• Provide comfort devices to ensure comfort
• Provide diversions therapy to feel relaxed

Evaluation:

The patient should be free of pain

●Impaired nutrition less than body requirement related to bowel obstruction as evidenced by loss of appetite, nausea and vomiting

Subjective data

• Verbalising unable to eat or having no appetite

Objective data

• Nausea
• Vomiting
• Physical appearance

Goal :to relieve nausea and vomiting

Nursing intervention and rationale

• Assess the nutritional status of the patient go gather baseline information
• Administer anti emeticsnas per order
• Keep patient NBM if ordered or else provide clear liquids
• Administer IV fluids

Evaluation :

The patient is able to eat comfortably

●Fluid volume deficit related to disease condition as evidenced by vomiting, dehydration

Goal

To maintain normal fluid balance

Subjective data

• Verbalize

Objective data

• Dry skin, mouth ,lips
• Decreased blood pressure
• Poor skin turgor

Nursing intervention and rationale

• Monitor patients vital signs ,as dehydration can lead to hypotension and plan for care.
• Administer IV fluids as fluid replacement therapy
• Administer anti emetics to stop vomiting
• Monitor serum electrolyte level to assess any loss of electrolyte
• Maintain intake and output chart

Evaluation :Patient shoukd maintain normal fluid balance