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

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

"Let me never fall into the vulgar mistake of dreaming that I am persecuted whenever I am contradicted" Ralph Waldo Emerson

I seldom become annoyed. I am annoyed. No one is yelling. These are serious questions. You have lists what the patient has NOT what he needs. Care plans are all about the assessment. Not all schools use real patients and just give scenarios which I believe makes it more difficult. People asked you questions. No one yelled.

In order for me to help you I need more information.

What were his vitals? what did the lnngs sound like? Was the abdominal distension sudden? Are there bowel sounds? Is there an Air leak? What were the chest tubes doing? Were they kinked? Was his abdomen rigid and tender? Was th patient NPO still? Did they have an NGT? What were the labs?

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

Our goal here on AN is to help you become the best nurse you can be. But we do not give answers. You need to show us that you have done research and are willing to participate. If the chest tube on the left side? Is there any drainage in the chest tube? Rib fractures on the left side at usually cause a hemothorax when associated to blunt trauma. If this patient has live disease what were the labs? Could there be an undiscovered liver laceration and hemorrhage? Is this patients coags (PTT,PT) within normal limits?

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

Looking at this 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)

What about this concerns you?

Priorities are always ABC. Airway breathing circulation

HIs output is decreasing...why?

His abdominal girth (which isn't really used much anymore for it is a late sign) in increasing...how much air...or blood...would it take to cause an increase of abdominal girth?

He is SOB and anxious...and ominous sign that something is wrong. Are there lung sounds? Is the chest expanding equally? Would an increased abdominal pressure cause SOB?

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

While I am sure the patient has pain...is this the major reason he has SOB?

Where was the epidural? At what spinal level? Is it affecting the lungs?

Is the urine concentrated? What was the heart rate elevated? What was the O2 sat? What is the B/P?

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

There are several possibilities.

Chest trauma....Flail chest. Increasing pneumothorax. Increased abdominal pressure causing constriction of lung capacity. Pulmonary emboli which the risk increases with abdominal injury, surgery, and bed-rest. Bowel ischemia/death/bowel obstruction.

Increasing abd girth...hemorrhage, abdominal compartment syndrome, liver injury.

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

No one is yelling they just wish to help.....read my thread.... My beloved nursing students

Now....Tell me about this patient.

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

TRAUMA.ORG: Thoracic Trauma

TRAUMA.ORG: Trauma Bank Information Repository

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Now its make sense... I am sorry for my misunderstood. This is very annoying as my uni provided On assessment: Urine output decreasing, Abdominal girth increasing, he is agitated, pain ++ and increasing SOB (shortness of breath) THAT ALl.They did not provided me with the vital signs or lungs sound information. Whether the chest drainage tube leak or not. I provided you exactly what my assignment was given me on paper.

Maybe all they want to know is why on the assessment he is like that. what was the problem?

of course i know the pathophysiology of pneumothorax and their treatment or management.

I picked those priorities of care but still ensure whether those are right or not.

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

I am not sure what your school is looking for....what semester you are in is important as to the detail they expect. I think they may be asking what is important and what would you look for.

So we are back to ABC's Airway breathing circulation. Remember It they "ain't breathin they ain't leavin" and "if they ain't beatin they ain't leavin"

Airway is first. Your patient has a patent airway that we know of...they are talking, can swallow their own saliva. You need to think about problems with the chest tube, re-occurrence/extension of the pneumothorax...Is the trachea midline (a sign of a tension pneumo). What do you look for for CT patency? Is your epidural causing problem with the patients respiratory status?

Your patient is SOB and anxious (anxiety...that sense of impending doom....always a sign something is terribly wrong). They are probably hypoxic. They have suffered a chest trauma. You need to asses the chest. Is there equal expansion? Do you hear breath sounds? Is the chest tube functioning" Is the "crepitus" noted to the chest? Think tension pneumothorax. With trauma to the left side of the chest...you have to think about the organs underneath. Is the heart OK? Are there heart tones? With abdominal trauma and surgery you have to think Pulmonary emboli. What are the vitals? What is the O2 sat? These are questions you would need to ask/answer.

If your U/O is decreasing....you have to think volume. U/O is the most sensitive indicator of end organ perfusion...how that patient is really doing. Is there a volume loss? Could there be bleeding from somewhere that is new? Was there a missed liver injury? Is the patient with a drinking history more susceptible to bleeding and liver injury? Are the intestines bleeding? Why the fluid loss? Waht is the I/O? What was the estimated blood loss in the OR?

Abdominal girth. You think hemorrhage. Abd compartment syndrome....especially three days post op after trauma. Edema of the abdomen become so great that bowel death can occur (I gave you a tome of resources to look this up). Peritonitis...is there a temp. Are there bowel sounds? If the patient has an NGT is it working? You think necrotic bowel...you think paralytic ileus.

Pain of course a priority...but not when other life threatening

Your patient has a history of drinking so delirium tremors needs to be considered in the patients care but NOT one of my top differentials for this moment in time.

Look at the resources I gave you they are very specific. You have 2 weeks so we have time. Look at them and come back with your thoughts and what you have learned....tell me what you think and we can go from there.

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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

Oh dear, I hope you don't think I was yelling. I was trying to be cute and funny. I'm not sure I came across correctly, I thought this case looked incredibly fascinating and I was looking forward to how the care plan came out. Sorry.

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Specializes in Nurse Scientist-Research.

Eeeewwwww! Esme got mad! Not easy! I was always amused when my teenage step-daughter used the phrase "yelled at me" for any interaction that left her feeling unhappy!

Esme, you totally rock for putting out all that fabulous help!

Sent from my iPhone using allnurses

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