Clinical Reasoning Case Study: Total Parenteral Nutrition Chief Complaint CC/History of Present Illness: Mrs. Morris is

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Clinical Reasoning Case Study: Total Parenteral
Nutrition
Chief Complaint CC/History of Present
Illness:
Mrs. Morris is a 66-year-old woman who has been complaining of
nausea, vomiting, weakness, abdominal pain and abdominal fullness
for the past 3 days. She has had a fever for the last 24 hours and
reports that her mid-abdominal pain is colicky and “crampy”.
She states her “Crohn’s” has been acting up for the past 4 weeks
with diarrhea, anorexia, extreme fatigue and weight loss. She is 65
inches tall and weighs 65 kg with a usual weight of 75 kg. Mrs.
Morris was admitted to the Med/Surg unit with a complete small
bowel obstruction, multiple adhesions, and exacerbation of Crohn's
disease. She is NPO and an exploratory lap is scheduled with
lysis of adhesions and small bowel resection to remove diseased
bowel. Mrs. Morris will be NPO postoperatively and it is
expected that her GI tract will not be accessible for at least
10-14 days.
Social and Past Medical History:
Mrs. Morris currently lives alone in a senior living
apartment. Her husband died of pancreatic cancer 2 months ago
and they had no children. She has had Crohn’s disease since
she was 37 years old and was diagnosed with diabetes type 2, five
years ago.
Your Initial Nursing Assessment:
GENERAL APPEARANCE: anxious, appears weak and pale
SKIN/INTEG: skin dry, tenting noted, eyes sunken
RESP: breath sounds clear with equal aeration bilaterally,
non-labored
CARDIAC: skin pale, warm & dry, S1S2, no edema, pulses 2+ in
all extremities
NEURO: alert & oriented x4,
GI/GU: abdomen firm and distended. Absent bowel sounds, has not
voided yet
MISC: complains of crampy, colicky abdominal pain in RLQ, 8/10,
nausea and vomiting
Initial Vital
Signs:
T: 100.8 F
P: 110
R: 22
BP: 100/60
O2 sats: 98%
Lab/diagnostic Results:
CBC
Current
High/Low/WNL?
WBC
15000
HGB
9 g/dL
Basic Metabolic panel
Current
High/Low/
WNL?
Sodium
146
Potassium
3.3
Glucose
165
Albumin
2.9 g/dL
Prealbumin
5 mg
Transferrin
104 mg/dL
BUN
7
Creatinine
1.2