- Sudden onset of sharp generalized
abdominal pain with nausea, vomiting, and
decreased output from colostomy bag.
- CT high-grade bowel obstruction
- Slight distention of abdomen
- Change in pulse and BP
- Lactate 2.8, WBC 14.7
6. & 7.
4.
1. & 5.
2. & 3.
- Pain can be caused by inflammation or blockage. If there has been
no change in input but there is a decrease in output that is a concern.
- Primary diagnosis and have to plan care around primary concern
- Distention can be caused by excess gas or digestive contents
- Pulse decreased after pain management
- BP went up after bolus
- Indicates signs of infections and sepsis
1.
2.
3.
4.
5.
6.
7.
- 99.5
- 94
- 118/64
- 5/10 continuous
cramping pain
- Slight fever
- Elevated heart rate
- Slightly low BP
- Patient still reporting pain
- Body tense, grimacing appears
uncomfortable
- Lips, tongue, and oral mucosa
tacky dry
- Abdomen round, firm, and
generalized abdominal tenderness.
BS tympanic in upper quadrants,
hypoactive in lower quadrants
- Showing physical displays of pain
- Patient currently has an NG tube, oral care is important to keeping
oral mucosa moist
- Abdomen is not normally tender and firm. Absent bowel sounds in
the lower quadrants indicating the blockage is affecting those
quadrants
- Patient is experiencing pain and most
likely experiencing anxiety
Small bowel
obstruction
- Provide effective pain management and empathetic care.
Explain every part of the care plan and allow the patient to know
all of the possible options and let them make educated choices
for themselves.
Blockage of intestine from digested food or constricted by the muscles themselves
GI system
- Inspection, auscultation, palpation
- Pain scale
- Input and output
Pain management, possible fluid electrolyte imbalance, sepsis
Decompress small bowel
Pain: Use accurate pain scale and
administer pain medication
Fluids: Administer NS
Sepsis: Continue to monitor Lactic
acid sepsis could be caused by build
up
Find the source of the pain and offer different
types of pain relief and allow the patient to
choose.
If dehydrated NS can help with rehydration
Lactic was elevated
Pain will be
managed and
collaborate with
patient
Patient will be
rehydrated
Patient's lactic acid
will not increase
Perforation causing septic shock or ischemia
- Continuously monitor patient (V/S,
GI) and have thorough discussion
with physician
- Prevent infection (labs, antibiotics)
- Neuro to assess for confusion
- Cardio to monitor HR and BP
- Labs: WBC, neutrophils, lactic acid
- Pain scale
- GI
RAPID team
IV fluids
Antibiotics
Anxiety and fear
- Providing caring/compassion as a nurse allows your
patient to feel comfortable with you and trust you. This
allows better rapport between both parties. The nurses
ability to understand the patient's pain, hesitancies,
and fears allows for better care to be provided.
- Providing physical comfort measure such as pain
medication, oral care, and repositioning allows the
patient to relax as much as they can in their current
state.
- Patient and nurse will
have open
conversation and the
patient will be put at
ease and understand
their care plan
- The patient's pain will
decrease
- It's possible the patient may need surgery so it's important for
them to be NPO in case of an emergent surgery
- Patient dehydrated due to blockage and had lower blood
pressure
- Pain medication for 5/10 pain
- Helps decompress stomach at a slow rate
- While patient has NG tube any medication taken will just be lost
back into the NG
- NPO is maintained
- Patient is rehydrated
- Pain is decreased
- Stomach will
decompress
- Medication will not
be wasted
- Decreased output previously reported, important to see if output
starts to match input as this can show whether blockage gets
better or worse
- Output will be
charted
- Assesses electrolytes
- Electrolytes will be
charted and a trend
will be able to be
identified (same for
CBC and Lactate)
- Can assess WBC, neutrophils, and lactic acid
- Continually monitor lactate to see if there's a trend or it improves
- If blockage continues surgery may have to be next step
- Surgery will be
educated on patient's
case
3.
4.
5.
1.
6.
2.
1.
2.
3.
4.
5.
- Continue fluids to maintain electrolytes and BP
- Address patient's pain
- Now that IV meds have been given insert NG and
put on low intermittent suction
- After NG is in put NPO which includes normal fluids
foods as well as medications
- All orders are accomplished so surgery can view
patient's current status
6.
- WBC
- HGB, PLTs
- % Neuts
- Decreased showing infection may be subsiding
- Decreased showing therapeutic interventions are
working
- Also indicate infection is subsiding
- Improve
- Improve
- Improve
-K
- Gluc.
- Slight depletion still WNL but NG suction can cause
depletion
- Less than yesterday but still elevated (cortisol can
increase gluc.)
- Worsening
- Improve
Lactate
- T: 101.7
- P: 118
- R: 24
- BP: 139/88
- 10/10 pain
- Chills/nausea
- Anxious, discomfort, pale, diaphoretic
- Firm/rigid abdomen
Declined
Improve
Infection has subsided
- All V/S increased out of normal range
All declining
- Pain has become severe, possible perforation
- Warning signs of sepsis
Call rapid, contact physician, get diagnostic tests, plan for
pre-op, get consent
- Patient will receive surgery
correcting perforation improving
patient's overall status
Mary O'reilly is a 55-year-old woman
9/10 pain in abdomen along with decreased output from colostomy
Small bowel obstruction
Partial colectomy with colostomy and small bowel obstruction that was resolved
without surgery
Was improving but had sudden return of severe pain, becoming diaphoretic and clammy.
Abdomen was firm and rigid.
T: 101.7, P: 118, R: 24, BP: 139/88, O2 sat: 98% on room air
GI, abdomen was firm/rigid with generalized pain. NG output of
225mL of bile green liquid. Decreased output from colostomy.
Lactate had decreased to 0.9, K lowered to 3.5, gluc. of 142
Prepare patient for surgery
Perforation can lead to leakage into abdominal cavity which resulted in the sepsis.
This needs surgical correction
Pre-op care
- Prep patient for surgery
- Make sure consent has been collected
- Educate patient
- Chart patient's valuables
- Check for allergies
- Make sure ID band is on patient
- Remove any eyewear, hearing aids, or
dentures
- If pre-op meds are ordered administer
- Patient needs to be educated and give consent for
surgery to happen. Once that is done the patient
needs to be prepped so that when surgeon is ready
the patient can go for surgery immediately. Patient's
items need to be documented and stored safely while
patient is in surgery, patient can't have anything
removeable on them while in surgery and if meds are
ordered they need to be administered so no delays
are experienced
- Everything needed is
collected and surgery is
ready for surgery
- Patient receives
surgery and recovers
well
I recognized the signs of infection and sepsis pretty quickly
with the patient
- Hadn't heard of some of the medications mentioned
I learned more about bowel obstructions and the
complications they can cause
I've learned more about different GI disruptions and how to identify
them within the clinical setting