Please help me with my written assessment - academic essay

Nursing Students Student Assist

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I have my assignment due in the next 2 weeks and having trouble picking my nursing priorities. I found this forum and hope you guys can share or help me out :)

Here is my scenario

Nick is 50 years old male with heavy drinker. Recently had motorcar accident. He has 3 ribs L side fractured, a pneumothorax, and a lacerated small bowel. He is now on 3 days post op. He had laparotomy with oversewing of the small bowel laceration. He has an intercostal catheter and epidural line analgesia

On assessment: Urine output decreasing, Abdominal girth increasing, he is agitated, pain ++ and increasing SOB (shortness of breath)

The assignment question

* Identify and discuss 3 most important specific priorities of care for Nick and provide rationales.

My priorities of care was: 1. Maintain breathing or airway clearance. 2. Control pain for his post op. 3. Maintain nutrition or maintain bowel function???

Please help me out with the 3 priorities ? thank you very much

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Specializes in L&D, infusion, urology.

Think about the urine and abdominal girth. What might be contributing to the SOB?

Why did you say airway clearance? Can you provide rationales for the priorities you've listed?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Is this a real patient? What semester are you?

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People breathe more rapidly for more than pain or oxygenation reasons (see the SOB/dyspnea thread in the NCLEX forum for a recent discussion). He had a hole in his bowel, even though they sewed it up. His belly is swelling. What other (really bad) thing could be going on, what will happen next, and what should the nurse to to monitor him for its effects? Why?

Nick is a heavy drinker and has been in the hospital for three days. What happens to heavy drinkers if they can't drink for three days? Why do we care? What should we look for, what might we see, and what should we plan on doing? Why?

Go look this stuff up in your med/surg textbook and let us know. I don't usually give such broad hints, but I'm feeling generous, and most of all I wanted you to look waaaaay beyond the low hanging fruit of airway, pain, and nutrition that students usually choose and call it a day. He has more serious problems brewing.

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Specializes in Med/Surg, Academics.

Considering this guy has probably earned a trip to ICU (if he isn't there already), this is a very complicated patient for a student, and I'm glad GrnTea was feeling generous. ;)

A chest tube, a hospitalized alcoholic, and a post-op abdominal surgery. Put away your nursing diagnosis handbook (that will come later) and review your textbook. You'll have to start at the beginning for this one.

Google CIWA protocol, not for what you should do, but rather for the s/s of alcohol withdrawal that are quantified with CIWA.

Look up the pathophysiology of pneumothorax and what a chest tube is supposed to do. Look up the complications/risks of abdominal surgery, specifically how it relates to small bowel injury. Again, not for what you should do, but as a hint toward what may be happening to this patient.

Once you understand what is medically going on based on your assessment data, then you can move forward with your nursing diagnoses and interventions.

While this care plan will most likely drive you crazy, if you really sink your teeth into it, this assignment will indeed get you thinking like a nurse. Take charge of your learning, and have fun with this one.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Tell us your assessment and we will help.

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Specializes in critical care.
Nick is 50 years old male with heavy drinker. Recently had motorcar accident. He has 3 ribs L side fractured a pneumothorax, and a [b']lacerated small bowel[/b]. He is now on 3 days post op. He had laparotomy with oversewing of the small bowel laceration. He has an intercostal catheter and epidural line analgesia On assessment: Urine output decreasing, Abdominal girth increasing, he is agitated, pain ++ and increasing SOB (shortness of breath) The assignment question * Identify and discuss 3 most important specific priorities of care for Nick and provide rationales. My priorities of care was: 1. Maintain breathing or airway clearance. 2. Control pain for his post op. 3. Maintain nutrition or maintain bowel function??? Please help me out with the 3 priorities ? thank you very much

My goodness, I'm almost done my last semester and that patient scares the crap out of me. So much stuff going on with him.

I agree you need to back away from the airway, pain and nutrition stuff. If your vitals reveal an oxygenation issue, stick with airway, but otherwise, look at the clues you have here. I bolded stuff that stands out to me. I may miss stuff, but others may chime in with that.

The fractures and pain seem like a priority, but there are more scary things going on here. I think this case is so complex that they are expecting students to approach this from different directions.

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Oh come on, don't make us wait until next Thurs., like Grey's Anatomy. I'm dying to hear what's going on with this guy ;)

And super thankful this isn't my care plan I'm procrastinating on.

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excuse me??? if you guys dont want to help please stop yelling at me..... all i want is just to make sure my priorities is the right picked. I know of course there is more going on with him... his pain ++ either from pneumothorax or bowel surgery. I picked ineffective breathing pattern just because he had SOB. I thought this website was helpful but now all i know is you guys just yell and yell and yell..... i just started my assignment and picked my priorities based on the scenarios then not sure so i came to this website and ask if i got the right picked then i can continue with my assignment.

If you guy dont want to help just dont replly that it.... end of story

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thank you for replied. I will try to look up those..... i just started my assignment not long ago but i unsure if my priorities is right that is why i asked you guys. please dont be like those peoples dont help but just yell and yell. thank you

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thank you for replied. I will try to look up those..... i just started my assignment not long ago but i unsure if my priorities is right that is why i asked you guys. please dont be like those peoples dont help but just yell and yell. thank you

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thanks you

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