HELP! Care plan for bowel perforation

  1. I'm doing a care plan of risk for infection on my pt who had a hysterectomy and they perforated her bowel, which lead to a bowel resection. I'm just having a hard time with it and was hoping I could get some direction????

    Any advice would be greatly appreciated...
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    About RN2B73

    Joined: Dec '07; Posts: 248; Likes: 41
    ICU RN; from US
    Specialty: 1 year(s) of experience in ICU


  3. by   Daytonite
    the first direction i have for you is to set aside focusing so much on the medical diagnosis. you have to think more about how the patient is responding to the hysterectomy and bowel resection which was a surgical treatment. so, assessment is the first order of business. gather all the data about what is going on with her:
    this is a postoperative patient who has undergone anesthesia. the possible problems of general anesthesia that need to be monitored for and included in the care plan are:
    • breathing problems (atelectasis, hypoxia, pneumonia, pulmonary embolism)
    • hypotension (shock, hemorrhage)
    • thrombophlebitis in the lower extremity
    • elevated or depressed temperature
    • any number of problems with the incision/wound (dehiscence, evisceration, infection)
    • fluid and electrolyte imbalances
    • urinary retention
    • constipation
    • surgical pain
    • nausea/vomiting (paralytic ileus)
    question: were you having this patient doing deep breathing and coughing? were you checking her incision/incisional dressing? were you checking her blood pressures and temperatures? did you assess her for bowel sounds? there is a nursing diagnosis behind every one of these nursing interventions!

    collecting data is step #1 of the nursing process, assessment. step #2 is determining and identifying the nursing problems where you actually do the diagnosing. to do that you take all the data you collected and make a list of everything that is abnormal. some of the stuff that is abnormal can be grouped together. for example, if a patient verbalizes their pain as an 8 out of 10 and is holding her arms across her abdomen and moaning when moving, this is abnormal data [it is normal to be pain free] and symptoms of the nursing diagnosis acute pain. in step #3, the planning phase, you do problem solving for the problem and its symptoms. my goal for this pain is to get it to a more comfortable level of, let's say, 2. the way i will do that. . .

    • 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

    • give pain medication as ordered
    • monitor for side effects of narcotic therapy: respiratory depression, constipation, nausea/vomiting
    • reposition the patient
    • give a back massage
  4. by   RN2B73
    You have so much knowledge and I see it in every one of your posts....I thought a little more about it and actually changed my dx to pain before I even read your I appreciate your feedback and I'm glad that someone like you actually takes the time to read our student posts and attempts to help us with them It's appreciated more than you know. I'll look at your suggestions and compare them with my care plan which I'm sure I can approve

    Thanks again
  5. by   Daytonite
    you work on this some more and if you have more questions, ask. by the way, i've had a both a right hemicolectomy and a hysterectomy myself, so from a patient perspective i know first-hand what some of the problems your patient is going to have. make sure you understand surgical ileus and how to assess and monitor for it. your instructor will expect you to account for it in your care plan. don't forget in learning about these surgeries to anticipate questions the patient will have about what she will experience when she gets discharged. women worry about having no ovaries and hrt (hormone replacement therapy) and a shortened bowel and how this will affect their bowel movements. nursing interventions for each nursing diagnosis (nursing problem) are of 4 kinds. they:
    • assess/monitor/evaluate/observe (to evaluate the patient's condition)
    • care/perform/provide/assist (performing actual patient care)
    • teach/educate/instruct/supervise (educating patient or caregiver)
    • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
    now, i'll go back to watching inkheart.