Can someone help me with a learning need?

[howsoon]

I'm working on my care plan for a pt I recently had. He was there for about a week before I saw him. Admit Dx was NVD & ABD pain. They slowly ruled out reasons & after pelvic ct diagnosis was small bowel obstruction. I currently have diagnoses listed as: Risk for fluid volume deficient due to intestinal obstruction; Nutrition Imbalanced: Less than body requirements due to decreased intake associated with nausea & abd pain; Acute pain: abdominal related to intestinal obstruction; & Nausea related to stimulation of the visceral afferent pathways resulting from inflammation & distention of the intestine. Shortly before I left, drs agreed he would need surgery for obstruction. So, can someone help me come up with a learning need? I don't know why I'm having a hard with this, but I am. Should it be something for the time that I was with the pt or can I state a learning need for once he has surgery?

Thanks guys!!

[Daytonite, BSN, RN]

if the patient is going to have surgery then there is pre-surgical teaching that needs to be done.

• http://www.surgeryencyclopedia.com/fi-la/intestinal-obstruction-repair.html - intestinal obstruction repair, the surgery
  
• http://www.upmc.com/healthatoz/patienteducation/documents/presurgery.pdf - pre- and postsurgery instruction sheet
  
  • deep breathing and coughing
    
  • leg exercises
    
  • post op pain relief
    
  • wound care
    
  • physical activity
    

by the way, your etiology on the acute pain diagnosis is incorrect. it must be something that is causing injury to the tissues or stimulating the pain receptors. saying "intestinal obstruction" isn't identifying the source of the pain well enough. the pain is because of pressure due to abdominal distension. the etiology of the nausea is quite simply due to gastric irritation because of the gi fluids that have no where to go because peristalsis has halted although the gi fluids that the gi track manufactures and secretes continues. it's why the docs make these patients npo and often order ng tubes for them. how you came to "stimulation of the visceral afferent pathways resulting from inflammation & distention of the intestine" is incorrect pathophysiology for the nausea. also, the patient is beyond a risk for fluid volume deficient due to intestinal obstruction. he would already have a fluid volume deficit or it has been corrected with iv fluid replacement since he has been hospitalized for a week. the fluid would be trapped in his intestinal tract where peristalsis has stopped and fluids are third spacing. see and read about paralytic ileus: http://www.merck.com/mmpe/sec02/ch011/ch011h.html (intestinal obstruction); http://www.merck.com/mmpe/sec02/ch011/ch011g.html (ileus)

[howsoon]

Thank you so much for the info. This is my 1st full care plan & I'm struggling:)

This pt had a parital small bowel obstruction so he had been having forceful diarrhea, which I really thought would be his priority diagnosis. We had to turn in a "pre-plan" & my clinical instructor told me to change it, that his top priority was fluid deficiet?? I hate these are so subjective b/c I never feel that my answers are right.

Again, thanks so much for your help.