Question

A client presents to the Emergency Department reporting a “deep and piercing pain in the mid-epigastric region for the last little over a week, with pain getting progressively worse over the last few days.” The initial assessment include findings of irritability, twitching, and numbness and tingling around the lips. Bowel sounds are absent, with the client reporting pain of 7/10. Per the client, “I start feeling bad after I eat.”

Vital signs are T 100, HR 115, BP 100/57 mm/Hg, RR 26, weight is 131 kilograms. (20 points each)

• Describe the possible clinical reasons for the findings, and include the possible medication that may be ordered and why.
• Discuss the interventions the nurse can implement to help keep the client comfortable, in addition to pain medication, with rationale.
• Identify several possible reasons for absent bowel sounds in this client and the expected orders with rationale.
• “My stomach pain went away. I am ready to eat.” Describe the type of diet the client would receive and why.

Answer 1

The possible clinical findings for the deep and piercing pain in the mid-epigastric region can be due to a number of reasons like Dyspepsia which is normally the indigestion, Gastritis which is nothing but the inflammation of the stomach lining as a result of bacterium infection or any type of Gastroesophageal reflux disease (GERD) which is a condition where the most of the acid in the stomach flow back into the esophagus and create a bruning and painful situation.

Possible medication could be antacids like Alka-Seltzer, proton pump inhibitors like omeprazole or H-2 blockers like Pepcid as these medicines reduce stomach acid and can significantly help in reducing pain and symptoms.

The doctor can also prescribe a combination of anti-biotic like Biaxin and Augmentin if he/she doubts bacterium infection.

Possible nursing interventions could be to first prepare a detailed baseline of the condition. Then according to the assessment the nurse can make the patient try certain pain reliefing positions like the semi-Fowler's position to relieve epigastric tension. Certain analgesic drug can significantly help in eliminating the pain. The nurse should encourage the client to avoid certain food that increases tha activity of acids in the stomach and ask the client to clients to remain set while eating as it helps in preventing the burning sensation in the epigastric region.

There could be several possible reasons for absent bowel sounds in this client. One such condition is Ileus which is a condition of intestinal paralysis or lack of intestinal activity. In this condition the doctor can ask for intravenous fluid hydration along with nasogastric tube with suctioning to restart the intestinal activity which is blocked. Surgery can be the secondary option for this condition. Absense of bowel sound can also indicate a rupture in the intestines, or strangulation of the bowel tissue. The most common reason for Absent bowel sound is a bowel obstruction. The doctor may ask to placing a catheter into the bladder of the patient to drain urine and collect it for further testing. Constipation are also responsible for eliminating bowel sounds. Lubricant laxative, stool softener, a lot of water and high intake of fiber are recommended to prevent constipation.

The client should try to have smaller but more frequent meals. A lot of food in one go can put pressure on the region and the condition can come back. The patient should avoid foods rich in acid and foods which are spicy. The client should also avoid alcohol and caffeine as they do not help in curing from the condition.