Question

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’s disease, depression, anxiety

Objective Data
Vital signs: T 98.9, 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 lbs., last visit weight = 152 lbs.

Questions

What other assessments should be included for this patient?

What questions should the nurse ask with regard to the abdominal pain?

From the readings, subjective data, and objective data, what is the most probable cause of the abdominal pain?

Develop a problems list from the subjective and objective findings.

What should be included in the plan of care?

What interventions should be included in the plan of care for this patient?

Answer 1

INTRODUCTION

Gastro -intestinal systems disorders is common and it can be caused by som risk factors such as;

-EXCESSIVE ALCOHOL CONSUMPTION

-EXCESSIVE SMOKING

-EXTREME STRESS

-POOR DIETARY HABITS

-POOR BOWEL HABITS

-DECREASED PHYSICAL ACTIVITIES

-The gastro-intestinal system comprise of the following organs;

-UPPER GASTRO-INTESTINAL TRACT

-LOWER GASTRO-INTESTINAL TRACT

-LIVER

-GALLBLADDER

-PANCREAS

-APPENDIX

QUES-1

Other assessment includes'

   1-HISTORY COLLECTION

-past health history

-past surgical history

-family history

-diet history

-occupational history

-personnal history-it incliudes sleep pattern,elimination pattern,smoking;alcoholism etc

-medication history

-present medical,surgical history

-present health history

2-PHYSICAL EXAMINATION

-It is defined as the head to foot assessment

-It includes four steps,

-INSPECTION

-PALPATION

-PERCUSSION

-AUSCULTATION

1-INSPECTION-For cyanosis,cracking,ulcers,buccal mucosa,lesions,

-Inspect for tonsils,uvula,soft palate,

-Skin changes,dialated veins,rashes,

-Peristalsis,

2-PALPATION

-For nodules,ulcers,and areas of tenderness

-Palpation is the process of assessing the degrees of pain by palpating the regions

-Palpation is used to note the location,size,shape and presence of tenderness

-Palpate the liver ,spleen,appendix etc

3-AUSCULTATION

-It is the process of assessing the bowel sounds by using the stethescope

-Used to assess for increased ,decreased,bowel and vascular sounds

-Assess for high pitched,tinkling,rushing sounds etc

4-PERCUSSION

-It is the assessment used to determine the presence of fluids;distention and abnormal mass

OTHER ASSSSMENTS ARE;

-briefly review the anatomy and physiology of the gastro-intestinal systems

-assess the GI system changes according to age

-perform focussed physical assessment

-assess for chron"s disaeses

-aasess for mental capability

-identify the risk factors

-teach about diadnostic studies

-assess for psychological integrity

QUE-2

The following questions nurse have to ask;

1-How and when did the pain start?

2-Wheather the onset is gradual or not

3-Can u tell me about your current health issues

4-Can you show me where the pain is located

5-Does the pain is radiating pain or not

6-Wheather the pain is constant or not

7-How long the pain duration,short or long

8-Do you have any idea about pain management

9-Does your pain have triggers like food

10-Do you have any idea about the causes or risk factors

11-How can you manage your pain before

QUES-3

According to me the main possible cause is past medical history of chron"s disaese

-Chrons disease is defined as an infection or inflammation of the entire gastro-intestinal tract

-Chrons disaese may damage mucosal layer,causes hypertrophy and fibrosis of abdominal muscles

-I t is a one type of pathologic inflammation,if you are not treating properly,recurrent abdominal pain and diarrhoea may occur

QUES-4

The problem lists

-abdominal cramping

-cramping like pain

-fever

-diarrhoea

-loss of appetite

-early signs of dehydration

-anxiety and less activity

-indigestion

-heart burn

-nausea and vomiting

-changes in bowel habits

-increased perisatsis movement

-weakness or fatigue

-breathing difficulty

-blood instool

-high pitched bowel sounds

-inflammation of the abdominal mucosa

-decreased blood pressure

-breathing difficulty

-severe abdominal pain

-reduced physical activity

QUES-5

-Pain of care included

-assess the severity,intensity,location of the pain

-provide calm and quite enviornment

-pain assessment;

-PRECIPITATING FACTORS

-QUALITY OF PAIN

-RADIATION

-SEVERITY

-TIMING

-assess the objective signs of pain

-provide pharmacological management includes'

-ANTIBIOTICS

-STEROIDS

-ANALGESICS

-ANTI-EMETICS

-Non-pharmacological measures includes

-HEAT OR COLD APPLICATIONS

-RELAXATION TECHNIQUES

-MASSAGE

-AVOID DESTRACTIONS

WATCHING TV OR MUSICAL THERAPY

-assess the pian by using '

-VERBAL RATING SCALE

-NUMERICAL RATING SCALE

-WONG BAKERS FACES RATING SCALES

-maintain ventilation and safe enviornment

-provide pain manageent according to the needs of the patients

QUE-6

OBJECTIVES OF THE CARE;

-to reduce the intensity of pain

-to reduce the further complications

-to prevent dehydrations

-to maintain bowel and bladder pattern

-to provide pain management

-to asess the pulmonary status and cardiac status

-to provide symptomatic care

OTHER INTERVENTIONS INCLUDE;

-Maintain intake and output charts

-assess the patients symptoms

-manage dietry habits

-assess for fluid and electrolyte imbalances

-administer and monitor intra venous therapy

-weight checking

-mainatain nutritional status

-hypovolemic management

-assess for intestinal bleeding

-monitor vital signs

-watch for the signs of shock

-oral or mouth care

-mainatain personal hygeine

-ensure adequate fluid and food intake

-minimizing pain and discomfort

-fever mamagement

-psychological support

-supporting copping measure

-preventing infection

-maintain physical mobility

-promote effective communication

NURSING DIAGNOSIS

-IMPAIRED BOWEL AND BLADDER PATTERN

-IMBALANCED NUTRITIONAL STATUS

-IMAPIRED HYDRATION STATUS

-ACTIVITY INTOLERANCE

-HIGH RISK FOR INFECTION

-HIGH RISK FOR INJURY

SUMMARY

Gastero -enterology is a branch of science which deals with the study of causes,or risk factors,clinical feature,diagnostic evaluations,treatment modalities.follow-up care etc

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