Question

87 year old male admitted from a long term care facility with a bowel obstruction. History of beginning stages of Alzheimer’s disease, hypertension, and DM which is controlled by diet. He is alert and cooperative. He is able to answer questions appropriately, but unable to self medicate. His bowel blockage is in the sigmoid colon which was removed surgically 2 days ago.

Need a focused assessment on him.

Answer 1

Post Operative Assessment on Sigmoid Colectomy

Assessment Include:-

• Surgical site- dressing dry & intact.
• Proper draining of drainage tubes.
• Rate and patency of IV fluids.
• Patient safety.
• Gently digitate the stoma to assess for any stenosis and check patency.
• Assess for any pain.
• Assess the location of the stoma and the type of colostomy performed.
• Assess stoma appearance and surrounding skin condition frequently.

Assessment of patient at the begining stage of Alzheimer's disease

• Assess for the memory impairment such as difficulty remembering events.
• Assess the concentration and problem solving ability of the patient.
• Ask for whether he is facing any problem in finishing daily tasks at home or at work.
• Assess whether the patient is oriented to time,place and person.
• Assess for any visual or space difficulties.
• Assess for any language problem,such as word-finding problems or reduced vocabulary in speech or writing.
• Assess the knowledge level of patient regarding the medication administration.

Assessment on Hypertension

• Assess the medical history of the patient.
• Assess the blood pressure of the patient.
• Assess the routine tests such as a urine test(Urinalysis),blood tests, a cholestrol test and an electrocardiogram.
• Assess for headache,dizziness,chest pain.
• Assess for any visual impairment such as blurred vision.
• If the patient is on antihypertensive medication,blood pressure is assessed to determine the effectiveness and detect changes in the blood pressure.
• Pay attention to the rate,rhythm and character of the apical and peripheral pulses.

Assessment on Diabetes mellitus

• Assess the vital signs.
• Collect the medical history of the patient.
• Assess the blood sugar level of the patient.
• Fundoscopic examination should be done.
• Foot assessment should be done.
• Vascular and neurologic examination should be assessed.
• Changes to the skin can give an early indication of patient's circulatory and neurological status as well as ulceration risk,so skin assessment is important for a diabetic patient.
• Assess the knowledge level of patient regarding the diabetic diet administration of medication frequent blood check up and routine follow up.