Question

In: Nursing

            Hospital Day 1 - Ruth Morrow, 65, hasn’t been receiving routine health care. Over the...

            Hospital Day 1 - Ruth Morrow, 65, hasn’t been receiving routine health care. Over the past several months, she’s noticed that although she’s lost her appetite and is eating less, her pants and skirts have gotten much tighter. Last night she began to vomit large amounts of green liquid. This morning she cane to the ED because she was dizzy, light-headed, and still vomiting. She reports crampy, abdominal pain. She was admitted to your unit with possible bowel obstruction related to intra-abdominal metastatic cancer of unknown primary origin. VS on admission are 99.1°F-96-22 106/60, pulse oximetry 98% on room air.

            Her call light goes on and you enter the room to find the patient projectile vomiting fecal-smelling, brown material.

  1. What is the first thing you will do as the primary nurse?
  2. What medication do you plan to give?
  3. How will you draw up this medication?
  4. How will you administer it?
  5. What do you think may be causing her symptoms?
  6. What assessments will you do now?

Solutions

Expert Solution

a. As a primary nurse offer or hold  a kidney tray to the patient to puke.Make the patient sit on the bed or couch nearby to maintain stability of the patient. Reassure the patient psychologically that the symptoms can be managed. Meanwhile offer water ,like warm water to gargle the mouth.

b. Administer antiemetic drug to the patient to stop vomiting .A proton pump inhibitor can be given to reduce the acid secretion and thus decreasing the vomiting episodes.

Analgesics can be administered as per order to relieve abdominal pain and improve comfort.

c. These medications are available in injection format so it can be withdrawn using a syringe

d. In case of anti emetic and analgesic drugs. If a proton pump inhibitor it has to be diluted and then administered as it is available in powdered form. Administer the drug intravenously for immediate action.

e. The assessment which has to be done are

  • General condition of the patient
  • Vital signs or vital parameters
  • Amy food intake
  • Physical examination of the abdomen by inspection, palpation, percussion, auscultation
  • Assess the quantity ,color of the vomitus
  • Assess for any other signs and symptoms

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