- 5 43 5g Done Mrs Dolan Diverti A D Mr Dolan The Cast Other Company Enemenpalveitsingeniet Die Diens With Client Pro 1 (34.6 KiB) Viewed 50 times
- 5 43 5g Done Mrs Dolan Diverti A D Mr Dolan The Cast Other Company Enemenpalveitsingeniet Die Diens With Client Pro 2 (26.4 KiB) Viewed 50 times
GenderFemaleAge46Setting■ HospitalEthnicity■ White AmericanCultural considerationsPreexisting conditionCoexisting condition■ Acute diverticulitis; urinary tract infection (UTI)CommunicationDisabilitythe digestive systemLevel of difficulty: EasyOverview: This case requires the nurse to prepare Mr. and Mrs. Dolan for Mrs. Dolan’s emer-gent surgical procedure. Following surgery, the nurse must provide discharge teaching to educate Mrs. Dolan on the care of her temporary colostomy. Priority nursing considerations for the client living with a colostomy are reviewed.
Gender
Female
Age
46
Setting
■ Hospital
Ethnicity
■ White American
Cultural considerations
Preexisting condition
Coexisting condition
■ Acute diverticulitis; urinary tract
infection (UTI)
Communication
Disability
the digestive system
Level of difficulty: Easy
Overview: This case requires the nurse to prepare Mr. and Mrs. Dolan for Mrs. Dolan’s emer-
gent surgical procedure. Following surgery, the nurse must provide discharge teaching to educate
Mrs. Dolan on the care of her temporary colostomy. Priority nursing considerations for the client living
with a colostomy are reviewed.
Client Profile Mrs. Dolan is a 46-year-old female who presented to the emergency depart-
ment three days ago with complaints of abdominal pain, fever, and diarrhea for
almost two weeks. Upon examination in the emergency room, Mrs. Dolan was
found to be dehydrated with a potassium (K+) level of 2.8 mEq/L, erythrocyte
sedimentation rate (ESR) of 37 mm/hr, and white blood cell (WBC) count of
16,000 cells/mm3. She was positive for a urinary tract infection and an abdominal/
pelvic computed tomography (CT) scan confirmed the diagnosis of diverticulitis.
Mrs. Dolan was admitted to the hospital. She was started on intravenous (IV) fluids
with potassium chloride (KCl) supplementation. She was also prescribed IV antibi-
otics and morphine sulfate for pain management. She has been nothing by mouth
(NPO) since admission three days ago.
Case Study After three days of IV fluids, antibiotics, and bowel rest, Mrs. Dolan’s K1 level
is 3.7 mEq/L, ESR is 30 mm/hr, and WBC count is 15,000 cells/mm3. Her vital
signs are blood pressure (BP) 114/68, radial pulse/heart rate (HR) 102, respira-
tory rate (RR) 18, and temperature of 1038F (39.48C). Mrs. Dolan has a follow-up
abdominal/pelvic CT scan. The CT scan reveals that Mrs. Dolan’s diverticultitis
has not responded to conservative medical management and an abscess has devel-
oped. Surgical intervention is necessary and she is scheduled for surgery the next
morning.
Questions
1. Briefly discuss the potential complications
associated with acute diverticulitis.
2. Which assessment findings are of concern in
Mrs. Dolan’s case?
3. Describe Mrs. Dolan’s preoperative care needs.
4. What are the potential complications associated
with abdominal surgery that Mrs. Dolan should be
informed of prior to giving consent for the surgical
procedure?
5. Describe the purpose of the following advance
directive alternatives: living will, health care proxy,
durable power of attorney.
6. During the immediate postoperative phase of
Mrs. Dolan’s care, what should the nurse assess?
7. What is a stoma and how are the following three
types of stomas surgically created: end stoma,
double-barrel stoma, and loop stoma?
8. Generate two to three key points to address
when providing Mrs. Dolan with colostomy care
education regarding each of the following: stoma
assessment, skin protection, pouch care, diet, medications,
sexuality issues, and community resources.
9. Prioritize three nursing diagnoses appropriate
for the client living with a colostomy.
10. It has been three weeks since discharge, and
Mrs. Dolan and her husband are eating at a
restaurant. Mrs. Dolan is trying to decide between
the following three meal choices: (a) corned beef
and cabbage, (b) spaghetti with tomato sauce, and
(c) salmon with baked potato. Which meal should
Mrs. Dolan chose in order to follow the nurse’s
instructions regarding appropriate diet guidelines?
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