Care plans for small bowel obstructionRegister Today!
- by chasdc May 22, '09I am a student and care plans are bad for me. I need help with the small bowel obstruction no surgery.
- May 22, '09 by JenRN2011How are they bad for you? Care plans are not fun for most people. Give an example of what you think a nursing care plan for small bowel obstruction is then someone might be able to give you pointers on how to tweak it or to improve upon what you have.
- May 22, '09 by tconlgirlhere are a few to start with acute pain, risk for fluid and electrolyte imbalance, risk for impaired tissue perfusion
- May 22, '09 by chasdcI have problem coming up with the interventions. I have Pain, Acute , Fluid deficit, Nausea but this pt did not have surgery had a ng tube in which was takin out, AAAAAAAAAAAhhhhhhhhhhhhh this is frustrating, I am a part time PN student 1 more year to go and I also feel like I will never get the meds in my brain,
- May 22, '09 by WhisperaYour books surely have lists of interventions for pain, fluid deficit, and nausea. You can do this!
- May 22, '09 by chasdcThey do but i always think they will not due pertaining to this problem or is that what is messing me up. As long as it is about pain? Or does it not matter about the bowel obstruction or does it.
- May 22, '09 by WhisperaIt matters about the bowel obstruction, of course, but you don't always have to address the cause for the symptoms in a care plan. Care planning for symptoms is always appropriate, and what should be done. Remember to think of safety and comfort too, as you consider what's most important. What can a nurse do to help the patient get better? That's what your care plan needs to focus on. You can't fix the bowel obstruction--that's the doc's job. You can help ease symptoms and be a helper to get the medical diagnosis under control though.
What is most important for you to do, to help your patient--what will help the most? That can lead to the nursing diagnoses you should use.
- May 23, '09 by Not_A_Hat_PersonIf they have an NG tube, they probably have Impaired Comfort, (Risk For) Disturbed Body Image, and a Knowledge Deficit.Last edit by Not_A_Hat_Person on May 23, '09 : Reason: spelling
- May 23, '09 by Daytonitei see that you are new to allnurses. there are several sticky threads in the student forums on how to put together a nursing care plan. the nursing process needs to be followed. you can see how this is done on this thread (http://allnurses.com/general-nursing...ns-286986.html - help with care plans) in the general nursing student discussion forum. you cannot begin diagnosing the patient's nursing problems until you have completed an assessment of the patient which is the first step of the nursing process. the entire care plan (diagnosis, goal determination and nursing interventions) is based on what is found from assessing the patient.
step 1 assessment - assessment consists of these components:
- a health history (review of systems) - nothing is provided. does this patient have a prior history of abdominal surgery? any history of gi disease? what other medical problems does this patient have? did you read the doctor's progress notes? what does the doctor suspect might be going on?
- performing a physical exam - no physical exam information was posted. did you listen to the patient's bowel sounds? what was the abdominal assessment? any distension? rebound tenderness? where is the patient's abdominal pain? any nausea (you want to use the nursing diagnosis of nausea so there must be symptoms of this)? any diarrhea? what labs and tests were done and what were the results?
- assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) - what adls does the patient need help with?
- reviewing the pathophysiology, signs and symptoms and complications of their medical condition - small bowel obstruction creates a number of problems in patients. reading about the pathophysiology, signs and symptoms is necessary to understand the symptoms the patient has and in order to develop the etiologies for the nursing diagnostic statements you will have.
- http://www.merck.com/mmpe/sec02/ch011/ch011h.html - intestinal obstruction - "the most common causes of mechanical obstruction are adhesions, hernias, and tumors. . . diverticulitis, foreign bodies (including gallstones), volvulus (twisting of bowel on its mesentery), intussusception."
- reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - none listed. is the patient npo? have ivs? on pain medication? the ng tube was a medical intervention. the doctor also treats the patient's symptoms with interventions of his own. as nurses we work in a collaborative role to care for things like ng tubes and keep them patent.
- improve it
- stabilize it
- support its continuation (some problems cannot be "resolved")
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you were specifically asking about pain. the nursing diagnosis for this is acute pain r/t abdominal distension. assessment and description of pain includes the following:
- where the pain is located
- how long it lasts
- how often it occurs
- a description of it (sharp, dull, stabbing, aching, burning, throbbing)
- have the patient rank the pain on a scale of 0 to 10 with 0 being no pain and 10 being the worst pain
- what triggers the pain
- what relieves the pain
- observe their physical responses
- behavioral: changing body position, moaning, sighing, grimacing, withdrawal, crying, restlessness, muscle twitching, irritability, immobility
- sympathetic response: pallor, elevated b/p, dilated pupils, skeletal muscle tension, dyspnea, tachycardia, diaphoresis
- parasympathetic response: pallor, decreased b/p, bradycardia, nausea and vomiting, weakness, dizziness, loss of consciousness
- assess and document patient's level and intensity of pain using the 0 to 10 rating scale with 0 being no pain and 10 being the worst possible pain
- assess and document where the pain is located and what, if anything, makes it worse or better
- observe and document any of the following physical responses: frequent changing of body position, moaning, sighing, grimacing, crying, restlessness, dyspnea, tachycardia, diaphoresis, pallor
- give pain medication as ordered
- provide emotional support by spending time talking to the patient and reassuring them that measures are being taken to relieve their pain
- reposition the patient
- give a back massage
- use short, simple relaxation exercises to distract the patient's attention
- dim the lights in the room and keep noise down
- play soft, soothing music
- reassess and evaluate the patient's response to each method employed. ask the patient which techniques work better for them.
- monitor for side effects of narcotic therapy: respiratory depression, constipation, nausea/vomiting
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here are previous student care plan threads that are about small bowel obstruction cases that you should look at:
- http://allnurses.com/nursing-student...lp-280901.html - care plan help
- http://allnurses.com/nursing-student...is-342582.html - help with nursing diagnosis
- http://allnurses.com/nursing-student...el-292294.html - nursing diagnosis for bowel obstruction
- http://allnurses.com/nursing-student...lp-385214.html - nursing diagnosis help with deficient fluid volume