Question

You are a student nurse assigned to a 57 year old male patient has come to medical ward to have treatment due to mild to severe cramping in his abdomen and bloody stool. Your initial findings include a mildly obese man who demonstrate guarding of his abdomen especially the left lower quadrant. His vital signs are 168/98, 119,24, 38 degree Celsius and is slightly diaphoretic. He reported periodic constipation. He has had previous episodes of abdominal cramping, but this time the pain is getting worse. He denies having regular exercise and his diet consist of white bread, meat, potatoes and ice cream with fruit and nuts over it. Further assessment he complaints of being thirsty, tired and his urine output is 20 ml for the past hour and stated that his urine is usually dark in color.

I. Identify health problem of the patient. (list all of them)

II. Based on your list of problem choose 1 problem of each category and write 4 independent nursing management and 1 dependent nursing management

A.Nutrition

Problem: ______________________________

Independent Nursing Management :

1.

2.

3.

4.

Dependent Nursing Management:

1.

B.Bowel/ Elimination

Problem: ______________________________

Independent Nursing Management :

1.

2.

3.

4.

Dependent Nursing Management:

1.

B.Urinary

Problem: ______________________________

Independent Nursing Management :

1.

2.

3.

4.

Dependent Nursing Management:

1.

Answer 1

Health problem of the patient:-

1. mild to severe cramping in his abdomen and bloody stool.

Independent Nursing Management :

1.Assess pain:- We must have a detailed baseline so we not only know how to treat appropriately, but also to know if it has changed.

2.Control pain: repositioning, heat/cold, Patients who are in pain have trouble participating in care, relaxing, sleeping, and healing.

3.Monitor Hemoglobin (HGB).

4.Monitor heart rate and blood pressure.

Dependent Nursing Management:

1. Administer pantoprazole (Protonix) Potential surgical intervention to stop the bleeding ; medications (muscle relaxants, analgesics)

2. Nutritional problem:- obesity.

Independent Nursing Management :

1.Assist patient to take at least 20 g of dietary fiber (e.g., raw fruits, fresh vegetable, whole grains) per day.Carry out and review daily food diary (caloric intake, types and amounts of food, eating habits).

2.Encourage the patient to take in fluid 2000 to 3000 mL/day, if not contraindicated medically.

3.Formulate an eating plan with the patient, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, energy, and nutrient requirements. Determine which diets and strategies have been used, results, individual frustrations and factors interfering with success.

4.Develop an appetite reeducation plan with patient.

Dependent Nursing Management:

1.Appetite-suppressant drugs like diethylpropion (Tenuate), mazindol (Sanorex), Sibutramine (Meridia); Hormonal therapy like thyroid (Euthyroid), levothyroxine (Synthroid).

3. bowel and elimination problem:- constipation

Independent Nursing Management :

1.Check on the usual pattern of elimination, including frequency and consistency of stool.

2.Check out usual dietary habits, eating habits, eating schedule, and liquid intake.

3.Evaluate for fear of pain with defecation.

4.Consider the degree to which the patient responds to the urge to defecate.

Dependent Nursing Management:

1.Bulk fiber (Metamucil and similar fiber products); Stool softeners (e.g., Colace); Suppositories; Oil retention enema

4.urinary problem:- less urine output

Independent Nursing Management :

1.Monitor ABG levels as necessary to evaluate acid-base balance.Monitor BUN, creatinine, and electrolyte.

2.Measure blood pressure at various times during the day with patients in supine, sitting, and standing positions.

3. Adjust fluid intake to avoid volume overload and dehydration.

4.Offer high-carbohydrate feedings because carbohydrates have a greater protein-sparing power and provide additional calories.

Dependent Nursing Management:

1.oliguria with volume overload requires fluid restriction and IV furosemide.