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- by p123 Mar 10, '09I have an assignment were I am the code blue nurse. I have been called to a med-surg floor to assess a client who has had abd. surgery, a jp drain placed and is holding their stomach complaining of pain. We have to give a 15 to 25 min presentation on just the information given in bold. We can go any route from "Whats the first thing to do, what to expect, any complications, anything is a go. I need at least three scenerios to go with and just need some general information to get started.
Please help me.
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- Mar 10, '09 by Jennyw45013Well what are the first things you would do?
Vital signs, Check JP, asess patient, put page into surgeon
What are your common postop complications with abd surgery?
Is JP working?
Is there a large amount of blood in JP?
There are many possibilities here
I am sure you will do fine! Hope I helped
- Mar 10, '09 by ChayaDirected GI assessment:
bowel sounds, palpation, presence of N/V, distention/ firmness, fecal blood
- May 19, '09 by IheartadviceHa, good one... I've had all three of these problems plus more with JP drains... big thing is the fluid is causing pain... Had to trouble shoot and learned the hard way after my first time with a patient like this...
The JP drain if intact, properly in place, no complications with patient's condition, and the drainage system/bulb properly in use is really a problem I had to trouble shoot through once after walking on shift without knowing much about JP drains besides how to empty it!
1st, assess the drain, ask the patient about their pain while your checking the patency of tubing/drain... That's a common problem with JP drains. The stop lock I think is what it is called, is closed quite frequently by rn's or techs who forget to reopen tubing after the bulb is emptied of fluid. It happens a lot, scary, I know. Simple turn of that knob for me and a patient was still in pain, but it started pouring fluid.
Another one, the tubing might be clogged. Check patency. If you have an md order that its ok to flush, then flush with saline, lower bulb to gravity... see if draining, check output since surgery, if still not draining, might be appropriate to call md, bc I think you have to have an md order to flush. I know I've seen this done, but I'm not sure if its correct, an RN kinked tubing at surgical site with her fingers bc the fluid was thick/pasty, just to loosen up any clots, nothing..
Another problem is the bulb will be inflated all the way, not what its supposed to do, which is suction that fluid out... Its there for suction, if its not sucking, it won't drain. Is it to gravity.
Oh and basics, RRT always asks first for basic background info, vitals, how long has the pain been there, when was the JP drain placed, has it had output... hope that was helpful... wish I would've had a me 7 months ago!! haha. That's what I've seen and learned from my time on the floor.
- Sep 1, '09 by bigredrn57Quote from p123Call the doc with VS. Tell him about the patient's pain and/or lack of BM and bowel sounds, any abdominal distention. I would also ask for permission to place an NG to low intermittent suction before the patient perforates. It sounds like an ileus. While you're at it ask for an abdominal CT with contrast. This happened to a patient of mine not too long ago. I had to fight with the doc to get an NG order. The patient drained 9000 cc of gastric fluid in about 20 minutes. Before hand she had been vomiting all day. When I came on just one whiff was all it took. She was barfing stool. She said I saved her life. Be good to yourself.I have an assignment were I am the code blue nurse. I have been called to a med-surg floor to assess a client who has had abd. surgery, a jp drain placed and is holding their stomach complaining of pain. We have to give a 15 to 25 min presentation on just the information given in bold. We can go any route from "Whats the first thing to do, what to expect, any complications, anything is a go. I need at least three scenerios to go with and just need some general information to get started.
Please help me.
- Sep 11, '09 by TX RNStart with pt history.
3. what specific surgery? Was it open or lap?
Next run through current patient condition
1. Vitals, Objective info, i.e. grimacing, abd guarding, GCS and alertness status
2. Subjective info, i.e. pain level, location, duration, onset, quality, radiating
3. Observe the condition of the wound and abdomen
- is the incision draining, erythema, edges well approximated, heat to site, unproportional pain when touched/palpated around sx site?
And of course you want to check the JP drain condition.
Run through a list of differentials:
#1 on my priority list is PERITONITIS
#2 Bowel Obstruction
#3 ?????? depends on the sx
Make sure you have looked at the latest lab values and analyze the trend of those values over the past several days.
2. Neutrophils (shift to the left, high neutrophil count can be indicative of infxn)
3. H&H (useful if you suspect blood loss)
4. Coag levels
5. Recorded JP output (is it increasing or decreasing, what quality of output? serous, sanguinous, a combination? purulent?)
Call your surgeon when you have all this info. I know it seems like a lot of info but you should be able to gather this in a matter of minutes.
Diagnostic procedures to expect:
CT is your friend.
US? not so likely, CT is better
KUB might help but not the best choice
If infection is suspected:
1. Blood cx's
2. JP drainage cx
4. Lactic acid level
- Sep 11, '09 by TX RNQuote from hypocaffeinemiaThat's exactly what I thought at first. Maybe it's part of the RRT. Staff at our hospital are encouraged to call for ANYTHING they can't put their finger on (problem solving).Patient holding stomach complaining of pain?
Assessment: patient likely not coding.
Plan: move along, move along.