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Discussion

Appendectomy

Ok, I need some help. I had a pt yesterday who had an appendectomy a week ago and came back because pain and now was dx with a small bowel obstruction. I am clueless on what to do for a dx. I though Fluid Volume Deficit because he is on TPN and has an NG tube, but I don't think this fits! HELP! Thanks!

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The first thing you need to do is read about the patient's medical condition, a postop ileus: http://www.merck.com/mmpe/sec02/ch011/ch011g.html. You need to see if this patient has any of these same symptoms in case you missed any of them and to help you get a better understanding of what is going on.

Care planning is based upon the abnormal data (signs and symptoms) you discover in the patient during your assessment. You take your list of abnormal data and match them with the defining characteristics of nursing diagnoses that are likely to apply to the patient. Every nursing diagnosis has lists of defining characteristics (signs and symptoms) that belong with it.

The TPN and NG tube are medical treatments ordered by the physician to address symptoms he discovered during his assessment of the patient when he diagnosed the medical condition of the small bowel obstruction. Ask yourself why these treatments would be ordered. When you determine this patient's nursing problems (nursing diagnoses) you will order nursing interventions for them.

In my nursing class we are studying the GI system this week ... Without knowing much about small bowel obstruction except pt would be NPO and looking at the two treatments you mentioned, you would certainly have nursing diagnoses of Risk for hyperglycemia (with TPN) and Risk for aspiration (with NG tube).

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