Why is a pt admitted on the med-surg floor?

[ackirom]

Hi, all! I'm a new student nurse on the med-surg unit, and my teacher always asked me, why is your patient here? I'd always say the chief of complaint. One of my patients hadn't had a BM in 3 days, hx of stroke, pressure ulcers and all, and I told my teacher that but then she goes, "so, why not just give him a stool softener? an enema? why keep him here? I just couldn't answer her. So my question is, after being admitted to the ER, what is the reason patients are kept on the med-surg floor? What part of their chart is going to tell me that? Is it the labs? I don't know where to look :imbar

Thanks!

[Bumashes, MSN, APRN, NP]

Many reasons. Perhaps they saw some kind of full or partial bowel blockage on an X-Ray or CT. I'm going to assume that the stroke made the pt pretty bad off physically, especially since you say he's got ulcers, which tells me that he doesn't move around much. So another reason is that folks with limited mobility can become wickedly impacted and worse. Plus, they probably already tried the enemas and stool softeners in the ER, and they obviously didn't work. Perhaps due to a recent procedure he has had done the pt has developed a paralytic ileus. Or, maybe something like a hernia that necroses part of the bowel, which then by turn would prevent him from pooing. For some of these reasons, the pt may be awaiting a surgical consult to see if the surgeon thinks it's serious enough for an operation to take place. As you can see, there are many things that can contribute to needing to remain in the hospital. There are many many more, but I'm too tired to type anymore.

[delta32]

you should read the H&p section of the chart, this will give you the complaint and that was done such as testing with a impression listing what the possible dx is.

now looking at no bm x 3 days

causes can be:

dehydration

illeus

bowel obstruction

etc

the labs are really not going to tell you too much with this case. you can look at the bun/creat for dehydration and wbc for poss infections, but your answers are going to be with the xrays and ct scan of the abdomen.