Case study...Peds...GI - page 3

Hey all, Been assigned a case study for Peds.... Would appreciate any insight, but I will tell you what I have thought of thus far and am trying to narrow it to top two choices.....We were to try... Read More

  1. by   hopefornursing
    Quote from FlyingScot
    Well now that's just ridiculous. The first sign of constipation is lack of bowel movements which wasn't mentioned. In addition if the kid is so backed up that he's vomiting there would be other significant signs like a distended abdomen and abdominal/rectal pain. Anybody here who's been backed up for even a few days can attest to that. While I don't recommend it I'd want to let that instructor know that a bunch of peds nurses with YEARS of experience think that diagnosis is a bunch of hooey!!!!! Although, in the end, you did learn a bunch...I hope!
    I agree, and i am just a student....I mean, you are a peds. nurse, have you ever, ever ran across a case of persistant regurgitation whose cause was constipation??? And really, for months this had went on, and wouldn't the kid had c/o bloating, distention,leakage and most of all pain? I would never be able to tell this particular instructor that she might be the one that's full of "it" pardon the pun!

    And I did learn a bunch, thank you!!!
  2. by   leslie :-D
    you know, i truly DID think of partial bowel obstxn...
    which is waaaay beyond constipation.

    i know you gave us all pertinent data...
    and nothing was indicative of "CONSTIPATION"!!

    sheesh.

    leslie
  3. by   hopefornursing
    Quote from leslie :-D
    you know, i truly DID think of partial bowel obstxn...
    which is waaaay beyond constipation.

    i know you gave us all pertinent data...
    and nothing was indicative of "CONSTIPATION"!!

    sheesh.

    leslie

    Doesn't this make you miss nursing school sooo very much?
  4. by   FlyingScot
    NOPE!!!!!!!!!!!
  5. by   leslie :-D
    Quote from hopefornursing
    Unresponsive to Zantac, Prevacid and Prilosec.
    does this mean, the doc missed the mark as well??
    seriously, i am so baffled.

    leslie
  6. by   FlyingScot
    Maybe this is one of those examples about overthinking something but if so it was certainly a lousy one. I, for one, would like to hear the instructors rationale for the answer.
  7. by   hopefornursing
    Quote from leslie :-D
    you know, i truly DID think of partial bowel obstxn...
    which is waaaay beyond constipation.

    i know you gave us all pertinent data...
    and nothing was indicative of "CONSTIPATION"!!

    sheesh.

    leslie
    OK< a partial bowel obstruction, would that show up on a reg. xray, or would that have been covered with a barium swallow/ enema study???
  8. by   FlyingScot
    It might show up on a regular x-ray. Doubtful on a barium swallow unless they did a follow through which is watching (with subsequent x-rays) the barium go through the entire GI tract. Might have shown on the enema if the obstruction was low enough.
  9. by   Daytonite
    the first step in diagnosing is pulling together all the abnormal data that you have in front of you. then you look for patterns in the symptoms that lead to clues about possible answers as to the conditions you are dealing with. obviously, there were objective and subjective cues in the case study that were critical to getting to the correct answer. the recognition of the abnormal objective and subjective cues (data) is something we all strive to perfect. to assist you in this there are several publishers that have put together books of signs and symptoms that will help tell you what diseases you are dealing with. here are two of them:
    • signs & symptoms: a 2-in-1 reference for nurses
    • nurse's 5-minute clinical consult: signs & symptoms
  10. by   hopefornursing
    Ok, we have been given "the rest of the story" by our instructor...
    Apparently, when the child finally got to a ped. GI, that is who zeroed in on constipation, and an abd xray was done, which showed significant fecal matter in the intestines.....
    Our instructor explained it to us in simple terms, think of a simple plumbing setup, if the bottom pipes are clogged whatever is trying to get thru will have to come out one way or other and since the intestines were slow/constipated/.clogged and the child already prone to reflux d/t previous hx, this is how it manifested....
    Guess what the tx was? Miralax.
    I guess this was a case of the ped, and all of us nursing students seriously overthinking the whole thing....
  11. by   leslie :-D
    Quote from hopefornursing
    Ok, we have been given "the rest of the story" by our instructor...
    Apparently, when the child finally got to a ped. GI, that is who zeroed in on constipation, and an abd xray was done, which showed significant fecal matter in the intestines.....
    i certainly understand what your instructor is saying...no brainer, actually.
    but what i don't understand is how could you have arrived at this dx if you didn't have this info in your case study?
    or was it included, about fecal matter in (LG) intestines?

    leslie
  12. by   hopefornursing
    Quote from leslie :-D
    i certainly understand what your instructor is saying...no brainer, actually.
    but what i don't understand is how could you have arrived at this dx if you didn't have this info in your case study?
    or was it included, about fecal matter in (LG) intestines?

    leslie
    Nope, it was not in the initial info, I am just so glad that this thing was not graded, but really, part of me could say "a bit of a waste of time" and another part says, "I really learned alot, but geez I wish all of this would have been given to us with the info."
    AGH, one more year of this, repeat one more year of nursing school (unless of course I decide to go for a BSN_MSN) which I really am thinking about......
    Sometimes I think these instructors have been at it so long, they forget how easy it is to frustrate a nursing student!

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