Bowel Elimination Unfolding LPN Case Study An 81-year-old client is being seen by the nurse in an extended care living f
Posted: Wed Jul 06, 2022 10:23 am
Bowel Elimination Unfolding LPN Case Study
An 81-year-old client is being seen by the nurse in an extended care living facility. The client is stating they are having abdominal pain and describes his pain as sharp, 8/10 and in the hypogastric region. The client stated that the pain has been off and, on all night, and does not radiate. Denies any vomiting, diarrhea, or nausea during the night. LBM was yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has contractures. The client states they have pain to left leg where lower leg used to be and describes that pain as a 4/10. The client can transfer from bed to wheelchair with assistance pivoting on their unaffected right leg. The client has a past medical history of a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO qHS, aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID, methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily.
An 81-year-old client is being seen by the nurse in an extended care living facility. The client is stating they are having abdominal pain and describes his pain as sharp, 8/10 and in the hypogastric region. The client stated that the pain has been off and, on all night, and does not radiate. Denies any vomiting, diarrhea or nausea during the night. LBM was yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has contractures. The client states they have pain to left leg where lower leg used to be and describes that pain as a 4/10. The client can transfer from bed to wheelchair with assistance pivoting on their unaffected right leg. The client has a past medical history of a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO qHS, aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID, methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily.
2. Use an X to indicate which potential assessment finding is associated with each of the listed client’s health problems. All assessment findings should be used and can be used only once.
Assessment Finding
Bowel elimination
Mobility
Abdominal pain in hypogastric region
Left arm contracture
Unaffected right leg
Denies vomiting, diarrhea or nausea
History of rheumatoid arthritis
Methotrexate 6 mg one PO daily
Left below the knee amputation (BKA)
The client’s breakfast tray is served. The client calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to their hypogastric area. The patient’s breath has a foul odor and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H.Pylori lab test. AM VS BP 100/70, P 100, R 18, T 98.4 F, O2 94%.
3. Based on the client’s condition, the client’s priority need will be to prevent_______1_______
In addition, he will need interventions to prevent life-threatening complications of bowel elimination, especially ___________2____________ and ___________2______________.3.
Options for 1
Options for 2
Gastric Ulcer
Ruptured appendix
Appendicitis
GI bleeding
Ascities
Gall stones
Cholecystitis
GI perforation
The client’s breakfast tray is served. The client calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to their hypogastric area. The patient’s breath has a foul odor and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H. Pylori lab test. AM VS 100/70, P 100, R 18, T 98.4 F, O2 94%.
4. Use an X for the nursing actions listed below that are Indicated (appropriate or necessary, Contraindicated (could be harmful) or Non-Essential (makes no difference or not necessary) for the client’s care at this time. Only one selection can be made for each nursing action.
Nursing Action
Indicated
Contraindicated
Non-Essential
Give AM meds as prescribed
Perform a test for rebound tenderness
Give toradol IM for phantom limb pain
Place NGT to decompress
Call lab results to HCP
Perform a through abdominal assessment
The client’s breakfast tray is served. The client calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to their hypogastric area. The patient’s breath has a foul odor and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H.Pylori lab test. AM VS 100/70, P 100, R 18, T 98.4 F, O2 94%. The client is given pantoprazole and ondesetron. The client has a large black tarry stool. The client states their nausea is relieved, but their pain is still unchanged.
5. Use an X (or drag and drop) to indicate which actions listed in the left column would be implemented.
Actions
Implemented
Call the HCP about stool
Send stool for stool culture
Hold ASA and clopidigrel
Place warm kpad to abdomen
Perform FOBT on stool
Order a high fiber diet
The client’s breakfast tray is served. The client calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to their hypogastric area. The patient’s breath has a foul odor and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H.Pylori lab test. AM VS BP 100/70, P 100, R 18, T 98.4 F, O2 94%. The client is given pantoprazole and ondesetron. The client has a large black tarry stool. The client states their nausea is relieved, but their pain is still unchanged.
6. The nurse evaluates the effectiveness of actions. Which of the following findings indicate effectiveness? Select all that apply.
1. Able to tolerate a bland diet.
2. Vomits once blood tinged material
3. H.Pylori test is negative
4. Verbalizes pain to abdomen of 8/10
5. BP 90/40, P 114, R 26, O2 sat 94%
6. Bowel sounds are hyperactive In all 4 quads
7. Pain stated as 2/10 to L BKA
An 81-year-old client is being seen by the nurse in an extended care living facility. The client is stating they are having abdominal pain and describes his pain as sharp, 8/10 and in the hypogastric region. The client stated that the pain has been off and, on all night, and does not radiate. Denies any vomiting, diarrhea, or nausea during the night. LBM was yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has contractures. The client states they have pain to left leg where lower leg used to be and describes that pain as a 4/10. The client can transfer from bed to wheelchair with assistance pivoting on their unaffected right leg. The client has a past medical history of a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO qHS, aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID, methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily.
An 81-year-old client is being seen by the nurse in an extended care living facility. The client is stating they are having abdominal pain and describes his pain as sharp, 8/10 and in the hypogastric region. The client stated that the pain has been off and, on all night, and does not radiate. Denies any vomiting, diarrhea or nausea during the night. LBM was yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has contractures. The client states they have pain to left leg where lower leg used to be and describes that pain as a 4/10. The client can transfer from bed to wheelchair with assistance pivoting on their unaffected right leg. The client has a past medical history of a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO qHS, aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID, methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily.
2. Use an X to indicate which potential assessment finding is associated with each of the listed client’s health problems. All assessment findings should be used and can be used only once.
Assessment Finding
Bowel elimination
Mobility
Abdominal pain in hypogastric region
Left arm contracture
Unaffected right leg
Denies vomiting, diarrhea or nausea
History of rheumatoid arthritis
Methotrexate 6 mg one PO daily
Left below the knee amputation (BKA)
The client’s breakfast tray is served. The client calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to their hypogastric area. The patient’s breath has a foul odor and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H.Pylori lab test. AM VS BP 100/70, P 100, R 18, T 98.4 F, O2 94%.
3. Based on the client’s condition, the client’s priority need will be to prevent_______1_______
In addition, he will need interventions to prevent life-threatening complications of bowel elimination, especially ___________2____________ and ___________2______________.3.
Options for 1
Options for 2
Gastric Ulcer
Ruptured appendix
Appendicitis
GI bleeding
Ascities
Gall stones
Cholecystitis
GI perforation
The client’s breakfast tray is served. The client calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to their hypogastric area. The patient’s breath has a foul odor and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H. Pylori lab test. AM VS 100/70, P 100, R 18, T 98.4 F, O2 94%.
4. Use an X for the nursing actions listed below that are Indicated (appropriate or necessary, Contraindicated (could be harmful) or Non-Essential (makes no difference or not necessary) for the client’s care at this time. Only one selection can be made for each nursing action.
Nursing Action
Indicated
Contraindicated
Non-Essential
Give AM meds as prescribed
Perform a test for rebound tenderness
Give toradol IM for phantom limb pain
Place NGT to decompress
Call lab results to HCP
Perform a through abdominal assessment
The client’s breakfast tray is served. The client calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to their hypogastric area. The patient’s breath has a foul odor and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H.Pylori lab test. AM VS 100/70, P 100, R 18, T 98.4 F, O2 94%. The client is given pantoprazole and ondesetron. The client has a large black tarry stool. The client states their nausea is relieved, but their pain is still unchanged.
5. Use an X (or drag and drop) to indicate which actions listed in the left column would be implemented.
Actions
Implemented
Call the HCP about stool
Send stool for stool culture
Hold ASA and clopidigrel
Place warm kpad to abdomen
Perform FOBT on stool
Order a high fiber diet
The client’s breakfast tray is served. The client calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to their hypogastric area. The patient’s breath has a foul odor and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H.Pylori lab test. AM VS BP 100/70, P 100, R 18, T 98.4 F, O2 94%. The client is given pantoprazole and ondesetron. The client has a large black tarry stool. The client states their nausea is relieved, but their pain is still unchanged.
6. The nurse evaluates the effectiveness of actions. Which of the following findings indicate effectiveness? Select all that apply.
1. Able to tolerate a bland diet.
2. Vomits once blood tinged material
3. H.Pylori test is negative
4. Verbalizes pain to abdomen of 8/10
5. BP 90/40, P 114, R 26, O2 sat 94%
6. Bowel sounds are hyperactive In all 4 quads
7. Pain stated as 2/10 to L BKA