Questions and Answers
What is the location and time of Stan Checketts' arrival in the Emergency Department?
Emergency Department, 04:00
What is suspected to be the cause of Stan Checketts' abdominal pain?
Small bowel obstruction
The nurse suspects that Mr. Checketts' medical diagnoses are hypovolemia and bowel obstruction. The nurse will anticipate the provider's order to include _____________ to treat hypovolemia and insertion of a _______.
What is the case scenario for Stan Checketts?
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Which assessment findings support the nurse's suspicion of an obstruction in Stan Checketts? (Select all that apply)
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To treat hypovolemia, the nurse will anticipate the provider's orders to include _____________ and insertion of a _______.
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What is the location and time of Stan Checketts' case scenario?
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Which assessment findings support the nurse's suspicion of obstruction? (Select all that apply)
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The nurse will anticipate the provider's order to include _____________ to treat hypovolemia and insertion of a _______ as the primary intervention.
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Which complaints would cause concern requiring immediate intervention for Stan Checketts? (Select all that apply)
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Which conditions contribute to the development of bowel obstructions? (Select all that apply)
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What protocols should the nurse anticipate when managing a client with an NG tube? (Select all that apply)
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Prolonged complications of bowel obstruction could result in ______, which would warrant a _______.
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What is the most common cause of small bowel obstruction?
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Which type of shock can untreated small bowel obstruction progress to?
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What is the initial symptom of abdominal pain that would lead the nurse to suspect a small bowel obstruction?
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What signs and symptoms might indicate a patient is experiencing hypokalemia?
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Study Notes
Case Scenario
- Stan Checketts, a 52-year-old widower, arrived at the Emergency Department with severe abdominal pain, nausea, and vomiting suggestive of small bowel obstruction.
- His medical history includes cholecystectomy, appendectomy, and right inguinal hernia repair; all surgeries were performed over five years ago.
- He shows signs of dehydration: weak, dizzy, low blood pressure (108/73), elevated heart rate (110), fever (100.9 °F), and poor skin turgor.
- Abdominal examination reveals distention, and he has not urinated in the past day.
Assessment Findings
- Concerns include dizziness, poor skin turgor, hypotension (BP 90/58), dark yellow urine, and distended abdomen.
- Clinical manifestations of intestinal obstruction: dizziness, hypotension, poor skin turgor, and concentrated urine due to dehydration.
- Normal findings: soft abdomen, pulse of 88 bpm, and respiratory rate of 18.
Anticipated Medical Orders
- Anticipated treatment includes infusion of normal saline to address hypovolemia and insertion of a nasogastric (NG) tube to prevent complications of bowel obstruction.
- Isotonic solutions like normal saline are preferred for fluid replacement, while NG tube helps decompress the stomach to relieve nausea and vomiting.
- Inserting a rectal or chest tube is not appropriate for small bowel obstruction management.
Monitoring Concerns
- Immediate intervention is required for: increased pain after medication, bright red NG drainage, significant changes in blood pressure and heart rate, increased dizziness and altered level of consciousness, and decreased urine output over 12 hours.
- Positive signs include stable abdominal girth and passing flatus or liquid stool.
Contributing Conditions for Bowel Obstruction
- Conditions linked to bowel obstructions include abdominal hernia, adenocarcinoma, abdominal adhesions, and volvulus.
- Conditions not associated with bowel obstruction: pilonidal cyst, proctocolitis, Kock pouch, and peritonitis.
NG Tube Management
- Confirm placement via radiographic techniques and secure the tube to the nares.
- Keep accurate records of NG drainage, provide oral and nasal hygiene every 4 hours, and maintain head elevation at 30-45 degrees to prevent aspiration.
- Avoid administering enteric-coated and time-release medications via NG tube as it can compromise their effectiveness.
Complications of Bowel Obstruction
- Untreated bowel obstruction can lead to tissue necrosis, potentially requiring bowel resection.
- Common cause of small bowel obstruction includes adhesions, followed by hernias and neoplasms; volvulus is less common.
Shock Related to Bowel Obstruction
- Untreated bowel obstruction can progress to hypovolemic shock due to significant fluid loss associated with vomiting and resultant dehydration.
Acid-base Disturbances
- Reflux vomiting can lead to metabolic alkalosis due to loss of hydrogen ions and potassium, resulting in low serum chloride and potassium levels.
Symptoms and Signs of Hypokalemia
- Characteristic symptoms of decreased potassium levels include hypotension, muscle weakness, fatigue, anorexia, nausea/vomiting, and decreased bowel motility.
Initial Pain Symptom
- Initial abdominal pain in small bowel obstruction is typically described as crampy and colicky, reflecting ongoing peristalsis both above and below the blockage.
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Description
This quiz focuses on the case scenario of Stan Checketts, a 52-year-old patient presenting with severe abdominal pain in the Emergency Department. It explores the potential diagnosis of small bowel obstruction and includes relevant clinical background and symptoms. Test your knowledge on recognizing signs and understanding surgical history critical for emergency care.
