Care plan help. Vomiting

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    It's the end of the quarter and my brain is fried or something. Here is what I have: 82 yo male, 7 days post op from a hemicolectomy, discharged and then returns to the ER complaining of vomiting and inabilty to eat. Turns out he had a small bowel obstruction. My problem is, I need an "anticipated nursing diagnosis" and one anticipated body system to assess. I'm thinking the GI system, but honestly, how do you assess that? listen for bowel tones? He was NPO so I can't use increase fluids as an intervention. Help, Please!!
  2. 7 Comments so far...

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    Just because he was NPO does not mean he wouldn't be getting fluids....
    Good luck to you. I absolutely hate care plans!
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    You can still assess bowel sounds. His clinical pathway is GI so that should be your point of care. If he is NPO he will have things such as altered nutrition intake, dry mucous membranes, you would need to assess bowel sounds for hyper or hypoactive sounds also palpate the abdomen as (peritonitis) can develop. Assess skin tugor, pain level etc.

    My nursing Dx for this scenario would be:
    1. Imbalanced nutrion less than body requirements
    2. Impaired oral mucous membranes
    3. Dysfunction gastrointestonal motility

    Good Luck!
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    Manage pain
    Administer meds
    Assess vitals
    Assess bowel sounds
    educate patient on NPO status and additional s/s that may cause additional problems
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    I was thinking imbalanced nutrition as well. Just stuck on interventions. Obviously can't give him food, liquids, supplements.
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    Quote from ajrenee
    It's the end of the quarter and my brain is fried or something. Here is what I have: 82 yo male, 7 days post op from a hemicolectomy, discharged and then returns to the ER complaining of vomiting and inabilty to eat. Turns out he had a small bowel obstruction. My problem is, I need an "anticipated nursing diagnosis" and one anticipated body system to assess. I'm thinking the GI system, but honestly, how do you assess that? listen for bowel tones? He was NPO so I can't use increase fluids as an intervention. Help, Please!!
    What is your major concern in someone with a small bowel obstruction? What do you expect he will need once admitted?
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    Once again, you can't make a nursing diagnosis without a nursing assessment merely because you have a medical diagnosis.

    Also, "administer meds" is not part of a nursing plan of care, it's one part of the medical plan of care that nurses implement. Difference. I know it's hard for students (and some nurses) to wrap their minds around this concept, but try. NCLEX is not interested in what physicians order, they're interested in nursing assessment and nursing decisions about nursing care. "Assessment" is not an intervention either-- you can assess until the cows come home, but if you aren't doing anything, you aren't doing anything. You can use assessment as a nursing order, and follow it with, "If... is found, then do this..." statements, though, because that requires some nursing judgment for you to order as part of the nursing plan of care, which you might be delegating.

    I realize the OP has been asked to guess about what she might be seeing (presumably to get ready to do a focused assessment) based on the medical diagnosis. OP, think about what else happens to an old man with a bowel obstruction. He is much more than his GI tract. He'll have NG suction, so he's stuck in bed. Then what? What does an NG tube put him at risk for? If he has pain, what will pain meds do to his gut after he gets them? If he's not taking anything po, what's maintaining his BP and UO, and how do you know? Is he afraid, uncomfortable, unable to care for himself? Lots of things could be going on here. Look at the biggest picture from a nursing standpoint.
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    Quote from ajrenee
    It's the end of the quarter and my brain is fried or something. Here is what I have: 82 yo male, 7 days post op from a hemicolectomy, discharged and then returns to the ER complaining of vomiting and inability to eat. Turns out he had a small bowel obstruction. My problem is, I need an "anticipated nursing diagnosis" and one anticipated body system to assess. I'm thinking the GI system, but honestly, how do you assess that? listen for bowel tones? He was NPO so I can't use increase fluids as an intervention. Help, Please!!
    Care plans are all about the assessment. What is your assessment? I know that many schools give scenarios...is this a real patient?

    What semester are you? Do you have a care plan book? I use Ackley: Nursing Diagnosis Handbook, 9th Edition.

    YOU are looking at it from a medical diagnosis....What is a SBO? what would a patient with a SBO (small bowel obstruction) need? what would you expect to find? What is causing the obstruction? Is it mechanical or paralytic?

    What would you be concerned about if a patient can't eat or drink? Deficient Fluid volume How would you assess their hydration? If they can't eat then they may not have enough protein to heal...
    Imbalanced Nutrition: less than body requirements...does this cause a Delayed Surgical recovery If they are vomiting....they must have Nausea. Are they expereincing any Acute Pain in the abdomen?

    Your nursing care plan book should have some good nursing interventions. How do you normally assess the abdomen. If a patient has a SBO.....do they have bowel sounds? What interventions are usually ordered for a patient with a SBO?


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