9 "More Than One Problem" returns John, a 48-year-old unemployed mechanic, is admitted to the emergency room with the fo

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9 More Than One Problem Returns John A 48 Year Old Unemployed Mechanic Is Admitted To The Emergency Room With The Fo 1 (75.94 KiB) Viewed 68 times

9 More Than One Problem Returns John A 48 Year Old Unemployed Mechanic Is Admitted To The Emergency Room With The Fo 2 (63.62 KiB) Viewed 68 times

9 "More Than One Problem" returns John, a 48-year-old unemployed mechanic, is admitted to the emergency room with the following symptomy acute upper left abdominal pain, abdominal distention, febrile, elevated WBC, nausea, and vomiting. Initial med also has a diagnosis of chronic schizophrenia, undifferentiated type and has lived in a group home milieu for the ical assessment leads to a diagnosis of a perforated diverticulitis of the splenic flexure with peritonitis. The cliera past 6 months. John is given sedation prior to the emergency abdominal surgery performed. When John r clavian IV line, a right jugular IV line with TPN infusion, and an open abdominal incision with wet-to-dry packing to the medical-surgical unit, he has a nasogastric tube connected to intermittent suction, a left triple-lumen sub secured with ABD pads and Montgomery straps. from sedation and Because John also has a diagnosis of schizophrenia, his behavior may be altered by the events of anesthesia and surgery. What response might the nurse expect as John emerges f anesthesia? How might he misinterpret the array of "tubes" connected to his body? Do you think John will understand that the pain is related to his surgery? What approach might the nurse use to help John understand the reality of the pain? Ha The second postoperative day, John begins to question the invasive equipment lines entering his body. The nurse enters his room to find him drinking water with his nasogastric tube lying on the floor beside the bed. He tells the nurse he was thirsty, and "that hose was siphoning all the water out of my body to water the plants neglected by my inability to turn the shower on, and I got some water so I can water the shower. What type of psychotic behavior is seen in John's actions? Hallucinations 1 Plusion What M S How The int tal tu F
CHAPTER 2 The Delivery of Mental Health Care What physical assessments related to his surgical care would be import to report? Mental Status How should the nurse respond to John's altered thinking? The nurse assesses that bowel sounds are present and that no nausea or vomiting has occurred with the oral intake. The provider orders a liquid diet for John. While passing his room several hours later, the nurse hears John talking. When entering the room, no one is present except John. The water faucet in the sink and the shower are both turned on with hot water running. John tells the nurse, "It can't flow through me if it is not running. Don't turn it off or I will shrivel up!" How could the nurse use the IV and TPN fluid to divert John's delusional thinking back to reality? The nurse proceeds to change the packing and dressing on John's abdominal incision. John tells the nurse, "If you take that off, the water will become contaminated and kill the plants." What misperception does John have concerning the open abdominal incision? How could the nurse use the wet-to-dry packs to reinforce reality?