Question

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#1 ABDOMINAL SYSTEM

J.P. is a 50-year-old man who presents to the gastroenterologist with cramping and diarrhea.

Subjective Data

Pain level is a 6/10 location = right and left lower abdomen

Works as a union construction worker, has missed 1 day of work

States he has been going to the bathroom about 8 to 10 times a day for past 2 days

Appetite is decreased

PMH: Crohn disease, depression, anxiety

Objective Data

Vital signs: T 37 P 80 R 14 BP 120/68

Bowel sounds hyperactive in all four quadrants

Medications: Infliximab (Remicade) infusions every 6 weeks, fluoxetine (Prozac) 25 mg per day

Weight = 145, last visit weight = 152

Questions

1. What other assessments should be included for this patient?
2. What questions should the nurse ask with regard to the abdominal pain?
3. From the readings, subjective data, and objective data, what is the most probable cause of the abdominal pain?
4. Develop a problems list from the subjective and objective findings.
5. What should be included in the plan of care?
6. What interventions should be included in the plan of care for this patient?

#2 GENITORURINARY SYSTEM

J.D. is a 64-year-old man who presents to the family practice complaining of increased urination at night. The patient has a past medical history of hypertension, hyperlipidemia, and coronary artery disease (CAD). Vital signs are T 97.5, P 85, R 16, and BP 120/60.

1. What subjective information should the nurse obtain?

2. The nurse is performing the physical examination of the patient’s genitals. What are the major structures of the male genitalia?

3. The nurse needs to assess the patient for a hernia. What is the proper procedure for this assessment?

4. What is the most likely cause of this patient’s urinary frequency at night?

Answer 1

ANSWER:-

1) Abdominal system .

a) Other assessments should be included are:-

* Physical examination - for dehydration like poor skin turgor, dryness of oral mucosa and tongue,sunken eyes etc.

- perform abdominal examination for any abdominal distention and tenderness.

- Rectal and anal examination for signs of infection.

- ask for any nausea and vomiting.

- nutritional history like type of food usually eaten.

* Questions related to abdominal pain:-

- does the pain increase or decrease with food intake?

- is the pain reduced or relieved after defecation?

* The most probable cause of abdominal pain is relapse of crohn's disease.( It is a subacute and chronic inflammation of intestinal mucosa ,and it is characterised by remission and relapse).

* Problem list :-

1) Acute pain abdomen( pain score 6/10) related to increased peristalsis and inflammation.

2) Diarrhea (8-10 times/day) related to inflammation.

3) Risk for deficient fluid volume related to diarrhea.

4) Imbalanced nutrition less than body requirements ( evidenced by weight loss of 7kg from last visit) related to loss of appetite, abdominal pain and diarrhea.

* Interventions like reducing anxiety ( anxiety can trigger the problem) , plan for TPN ( Parenteral nutrition) which provides all nutrients to patient and give rest to intestine that promotes healing of inflamed mucosa.

- oral diet planning with high protein and less fat and low residual diet which helps to give rest to intestine by reducing peristalsis .