Small Bowel Obstruction? Perceived CP Help.

[2bnurselovescoffee]

I can't seem to prioritize for this patient I worked with on Friday for my care plan. Here's situation:

62yo, admitted for abd pain, n/v, and dehydration. Has hx: of SBO, and pt thought s/s were the same this time as they were the last time they had an SBO. When I worked with pt: pt denied abd pain, was treated for dehydration with D5W NaCl, and was discharged the day I worked with them. Assess: + bowel sounds, soft non tender abd, passing gas, LBM 2 days prior. XRAY showed no evidence of obstruction or perforation.

NOW as far as priority what is my main concern????? I have gone back and forth between bowel and pain and now I'm thinking nutrition education b/c when I worked with pt, they had no pain and had + bowel sounds but no BM... Am I just overthinking this situation. I'm trying to write a care plan which is no problem except I don't know what my priority would be?

[Daytonite, BSN, RN]

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology - he was admitted for and treated for the dehydration. did his labs reflect that? how did he get dehydrated in the first place? how is he going to prevent that from happening on discharge? i was hospitalized for dehydration once and was in for 4 days because of it and watch my fluid intake now so it doesn't happen again. you might want to think about addressing this as a teaching item with the patient in the care plan.

• dehydration
  
• hx: of sbo

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data - is no bm for 2 days a regular occurrence? perhaps this is related to the dehydration? or he is worried it is related to a sbo? i would have explored his worry about the bowel obstruction more. he needs information about what the signs and symptoms of a bowel obstruction are and what he needs to do if they occur. this is definitely a symptom (defining characteristic) of a deficient knowledge, specify or anxiety.

• lbm 2 days prior
  
• patient was worried he had a bowel obstruction

step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use. i would consider these (in this priority):

• constipation (physiological need for elimination)
  
• anxiety r/t worry about threat to health (safety need)
  
  
• deficient knowledge, dehydration (self-actualization need)
  
• or, risk for deficient fluid volume (anticipated physiological need)
  

[2bnurselovescoffee]

Thanks, I just got so hung up on the fact that how can someone who had a BM 2 days ago be constipated? So I was going all around the issues that I could use and none of them made sense, and I kept going back to constipation. I ended up with Risk for constipation r/t decreased gastrointestinal motility, insufficient fluid intake, and insufficient fiber intake. I didn't feel that the evidence pointed to constipation especially since his XRAY showed no obstruction.

It does help to have someone look at the info and reply though, I'm grateful...out of all the people who viewed nobody would post anything. Thanks daytonite I appreciate your help!

[Daytonite, BSN, RN]

You're welcome. As I said, I was hospitalized for dehydration a couple of years ago as a result of taking Lasix. I didn't drink enough and I should have seen the symptoms (I was getting dizzy and had tingling around my mouth) but a lot of other things were going on in my life and I wasn't paying attention until I started getting dry heaves and was very nauseated. In the ER my BUN was in the 60s. My situation was complicated with gastritis. Just a guess, but your patient probably stopped eating and drinking thinking he had a SBO and he didn't want to aggravate it since the last time it happened that's what they did for it. Educate him--at least on the care plan.