Question

Scenario

A.H. is a 70-year-old retired construction worker who has experienced lumbosacral pain, nausea, and upset stomach for the past 6 months. He has a history of heart failure, high cholesterol, hypertension (HTN), sleep apnea, and depression. His chronic medical problems have been managed over the years with benazepril (Lotensin) 5 mg/day, fluoxetine (Prozac) 40 mg/day, furosemide (Lasix) 20 mg/day, potassium chloride (KCl) 20 mEq (20 mmol) bid, and atorvastatin 40 mg each evening.

A.H. has just been admitted to the hospital for surgical repair of a 6.2-cm abdominal aortic aneurysm (AAA) that is now causing him constant pain. On arrival to your floor, his vital signs (VS) are 109/81, 61, 16, and 98.3 ° F (36.8 ° C). When you perform your assessment, you find that his apical heart rhythm is regular, and his peripheral pulses are all 2+. His lungs are clear, and he is awake, alert, and oriented. There are no abnormal physical findings; however, he has not had a bowel movement for 3 days. His electrolytes, blood chemistries, and clotting studies are within normal range, except his hematocrit is 30.1%, and hemoglobin is 9 g/dL (90 g/L).

1. When you perform A.H.’s abdominal assessment, you do not hear any bowel sounds when auscultating his abdomen. What should you do?

CASE STUDY PROGRESS

A.H.’s recovery is uneventful. While preparing him for discharge, you talk to him about health promotion and lifestyle change issues that are pertinent to his health problems.

2. Name 4 health-related issues you might discuss with him and what you would teach in each area.

3.  A.H. will be receiving follow-up visits from the home health care nurse to change his dressing and evaluate his incision. What can you discuss with A.H. before discharge that will help him understand what the nurse will be doing?

Answer 1

1.Using the diaphragm of the stethoscope will allow you to hear high-pitched sounds. Normal bowel sounds are not constant, and so it is important to listen for about a minute over each quadrant. In order to conclude that bowel sounds are absent, one must listen for three to five minutes. Decreased or absent bowel sounds often indicate constipation.

2.

• The first health issue is that he would be anemic. Food rich in green vegetables and protein would be recommended.
• He may probably also have a urinary tract infection which would explain the back pain and vomiting.
• High cholesterol can lead to more heart complications. So managing his diet is recommended.
• Sleep apnea: Home remedies and lifestyle modifications can go a long way in reducing sleep apnea symptoms.

3. I would tell him the following:

If you think that there is something wrong with your wound once you get home, you should call a vascular nurse, the numbers are listed on page six of this leaflet. The things to keep a lookout for to tell the vascular team are

• pain in your legs when walking

• swelling, or excess pain in the wound

• continued poor appetite, upset bowel movements.

If you develop sudden pain or numbness in your legs that does not get better within an hour, then return to the hospital immediately. Likewise, if you experience severe pain in your back or stomach, pain or swelling in your calves, shortness of breath, or pains in your chest, you must seek medical attention as soon as possible.