Question

Mr. Watkins is a 69-year-old male who presented to the Emergency Department 4 days ago with complaints of nausea, vomiting, and severe abdominal pain and was admitted for emergent surgery for bowel perforation. He underwent a hemicolectomy. He has a midline abdominal incision without redness, swelling, or drainage. He is tolerating a soft diet without nausea or vomiting. Bowel sounds are present in all four abdominal quadrants. He had a bowel movement yesterday. Last urinary output was 400 ml at 6 a.m. He is reluctant to use the incentive spirometer, but his wife encourages him to do his deep breathing. Abdominal pain has been controlled with morphine. He has refused to ambulate this morning because of fatigue and a sore leg. He is ringing the call light requesting to see his nurse.

5.   What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.

6.   Discuss why Vernon Watkins may be at risk for right ventricular failure as a complication of his pulmonary embolism (PE).

7.   Discuss how you would communicate with the patient in acute respiratory distress in this emergency situation and what effective communication techniques you would use.

8.   Consider what would have happened if Vernon Watkins’ family members had been present at the bedside, and describe how you would have supported them during this acute episode.

9.   What would you do differently if you were to repeat this scenario? How would your patient care change?

Answer 1

5,In SBAR format considering his report is
S- situation
Mr.Watkins 69years old male admitted 4days bac and underwent a surgery hemicolectomy..After surgery his physical assessment good but in not willing to have incentive spirometry..He can not able to walk by today morning due to his fatigue and sore leg..
B-back ground
Mr.watkins came to hospital 4days ago with complaint of nausea,vomiting and severe abdominal pain..he diagnosed with bowel perforation..He had the surgery hemicolectomy..he is tolerating soft diet,no nausea,vomiting,and bowel sounds and bowel movement are good..urinary output 400ml at 6a.m..His pain controlled with morphine..
A- Assessment:
   Now he is having complaint of fatigue and sore leg..due to that he is not walking today morning..due to his breathing problem he is not using spirometry..
R-recommendation
Inform to the surgeon and primary care physician for further mangement and treatment..check patient vitals and oxygen saturation..Make the patient in comfortable position..elevate patient leg..
6, He refuses spirometry and not willing for walking..he underwent the surgery hemicolectomy..surgery complication include pulmonary embolism,infection and injury to organ near to colon.patient is having sore leg or ulcer leg called deep vein thrombosis,fatigue , and breathing difficulty all this symptoms due to pulmonary embolism and right heart faliure..
   due to pulmonary embolism he developed right heart failure..pulmonary embolism and DVt happens when a piece of blood clot breaks and travel through the blood stream to lungs,it blocks one of the blood vessels..when the blood clot is medium in size there will be a problem like chest pain,breathing difficulty..(as patient refusing spirometry..)a large blood clot can cause lungs collapse and heart failure..
7, first anxiety will be the most significant medical problem..explain the patient condition to his wife and family members with the help of health team.as per doctor advice administer oxygen,make patient in a comfortable position..administer diuretics,anticoagulant medication..shift the patient immediately to ICU..
8, Family feel distress after seeing patient condition..because he was in recovery period after the surgery..They need mental support and occupational support..so explain and educate the family about patient present condition,pathophysiology,symptoms and treatment..according to family understanding level(layperson level) you can include health care team and support group for educating them..
9, from post operative care it changes to intensive care so as a nurse patient in life threatening condition and patient with complication of post surgeryas nurse need more skill in ICU to access the patient problem quickly and must know to handle the high tech equipment..as a nurse advanced skills must care for patient witrh life threatening health problem..asess family members adoption levels and coping skills if they need any intervention..Act as a patient advocate..Provide education and support to family members..