Question

Surgical Case 2: Stan Checketts

Guided Reflection Questions

1.    How did the scenario make you feel?

2.    When reflecting on the care of Stan Checketts, what are signs and symptoms you can assess in the next patient you care for who might be at risk for dehydration?

3.    Discuss signs and symptoms of hypovolemic shock.

4.    Discuss assessment and expected findings in a small bowel obstruction.

5.    What key questions does the nurse ask in an acute abdominal pain assessment?

6.    In evaluating Stan Checketts’ laboratory values, what if any abnormalities did you find?

7.    Stan Checketts had a nasogastric (NG) tube inserted for gastric decompression. What are the preferred methods for confirming placement of the NG tube?

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

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

Answer 1

1. It felt great after seening the scenerio. Felt like real nurse and knowledgeable. I was able to complete the scenerio in first attemt. What i learned in the clinics was able to apply it here too.

2. Headache , nausea, skin turgor

3.hypotension, tachycardia, cool clammy skin, weakness, oliguria, tachypnea.

4. Vomiting, abdominal pain, decrease in appetite, constipation, distended abdomen, flatulence inability.

5. Nurse should ask following questions like-

• Change in appetite
• Any weight loss or gain
• Any episode of vomiting
• Difficulty in swallowing
• Abdominal pain
• Change in any bowel pattern
• smoking or drinking habit
• Medication taken by the patients

6) elevated hematocrit show dehydration and elevated pH and HCO3 value show alkalosis due to vomiting.

7) X- ray shows position of tube and pH less than 5 shows placement is correct when seen in pH aspiration.

8) S(situation)- Mr. Stan Checketts present to the emergency department with abdominal pain ,nausea, vomiting.

B(background)- 52 year old male who has not urinated since yesterday and has abdominal pain and doing vomiting since last few days.

A(assessment)- hyperactive bowel sound with distended and tender abdomen. Skin is cool with decrease skin turgor

R(recommendation)- isotonic IVF, analgesic, antiemetics or surgery for obstruction.

9. Nothing. Can perform the same procedure again and it will definitely work.