Question

An 80-year-old man comes to the emergency department reporting acute upper to mid abdominal, sporadic pain and cramping. Upon assessment, the nurse observes abdominal distention and high-pitched bowel sounds. The physician has ordered flat plate and upright abdominal x-rays that show distention of loops of intestine, with fluid and gas in the small intestine in conjunction with absence of gas in the colon. The physician has diagnosed a bowel obstruction.

1. What could be the problem?
2. What do you assess? Name minimum of five assessments and the reason to do it.
3. What would you implement? Name minimum of five implementations and the reason to do it.
4. What would you teach the patient?
5. What is your primary and secondary nursing diagnosis for this patient? Utilize the PES format (problem, etiology, S&S) NANDA FORMAT
6. What is your goal for this patient? Goal must be S.M.A.R.T (Specific, Measurable, Attainable, Realistic, and Timely)

Answer 1

1-The causes of bowel obstruction may include fibrous bands of tissue in the abdomen that form after surgery,an inflammed intestine like Crohn's disease,infceted pouches in the intestine ,diverticulitis ,hernias and colon cancer.

2- It can be assessed by various methods.

1. assess for swollen or tender abdomen -for detecting lump in the abdomen.
2. Observe for bowel sounds - in bowel obstruction it will be very high pitched.
3. X-ray abdomen -this is important in diagnosing bowel obstruction.When obstruction occurs both fluid and gas collect in the intestine.They produce a characteristic pattern called air fluid levels.
4. Computerised tomography - These images are more detailed than x-ray images
5. Ultrasound- An ultrsound will show a bull's -eye representing the intestine coiled within the intestine.

3-

• Take a careful history to obtain information about current symptoms and previous disese manifestations.
• Abdominal girth should be monitored frequently by using the same tape and in same position.
• Observe for the signs and symptoms carefully to identify the complications.

5-Signs and symptoms of intestinal obstruction.

• Cramping and pain
• Abdominal fullness
• Abdominal bloating
• Constipation
• Diarrhoea
• Vomitting

Nursing diagnosis -

1- Defiecient fluid volume related to nausea ,vomitting or diaphoresis

Goal- Fluid requirements are met

Outcome - Normal vital signs,balanced intake and output.

2- Acute pain related to abdominal distension and rigidity

Goal -The pain is resolved or controlled

Outcome - Patients reveled decreasse discomfort.