Nursing Interventions:

Medications: Pre OP:

Medications (at home) - Verify that an appropriate informed consent form has been signed and that the form is in the patient's
Rivaroxaban- 15 mg tab PO daily--- stopped last night in preparation for surgery today medical record.
Brimonidine Ophthalmic- 1 drop per eye B.i.d.
-Verify that laboratory and imaging studies have been completed as ordered and that the results are in
Timolol- 1 drop per eye b.i.d
Lab Work Values the patient's medical record; notify the physician of elevated PT.
WBC 10.5
Lactated ringer 1000 ml Q13H20M @75ml/hr Post OP:
RBC 4.63 1st PRIORITY: Assess level of pain and administer prescribed opioid medication.
Fentanyl 50 mcg Q5 min PRN (1st choice pain med)
HgB 13.6 -monitor vitals closely for changes and adverse effects.
-Inject slowly over 3-5 min
Monocytes 13 (high)
2nd pain med—Hydromorphone HC1 Q10 min PRN 0.5mg IV -always have reversal on hand in case of emergency.
MCHC 31.5 (low)
-Max dose:4mg if pain not relieved -Assess for pain, distention, and auscultate bowel sounds.
Neutrophils 75 (high)
-IV slowly over 3-5min
Potassium 4.8
Ondansetron HCL 4 mg Q4H PRN IV Goals/Outcomes: -Assess pain goals and the expectations for relief.
BUN 47 (High)
-For nausea undiluted 4mg dose IV push over 30 sec -Encourage coughing and deep breathing; urge the patient to splint the incision when coughing.
Creatine 7.7 (high)
-8mg: dilute n 4ml NS & give over 1 min
Glucose 134 (random) The patient will verbalize optimal relief -Educate on the use of incentive spirometry and encourage deep breathing and coughing.
Calcium 7.9 (low) of pain within 30 min of prescribed
PTT 12.2 (high) -Educate patient on safety measures with ambulating after surgery.
opioid. -Educate patient on infection precautions and surgical site care upon discharge.
aPTT 24.4
INR 1.2 The patient will remain free
2nd PRIORITY: Assess and monitor patient for signs and symptoms of thromboembolism events.
from thromboembolism events post OP.
-Apply and maintain intermittent compression stockings, as ordered.
Objective (Signs) The patient will remain free of signs and -Monitor ECG for changes in rhythm.
Vitals: (08:43 & 1112)- Temp: 36.4, 36.5 C temporal; Pulse: 66, 100 R radial; Respiration’s: -Monitor input and output and weight daily.
symptoms of bleeding complications
Other tests: 18,18; Blood pressure: 94/51, 101/63 lying; Pulse ox: 96,98 room air -Encourage frequent turning and position changes.
Alert awake oriented after surgery.
CT of pelvis revealed small bowel obstruction Cardio: Arterial fib, telemetry on-slightly elevated HR (tachycardia) -Encourage early and frequent ambulation; apply intermittent compression devices or antiembolism
Respiratory: upon auscultation- exertion slightly diminished; left lower lung sounds Surgical incision will remain free of stockings as appropriate.
X-ray of stomach revealed persistent small bowel diminished infection and heal within normal limits. -Encourage fluids and maintain hydration
obstruction (max diameter 5) as well as parenchymal Abdomen: distended and firm. No bowel sounds noted on auscultation. Small bowel -Administer anticoagulation medications as ordered.
opacities in left lung bas (likely atelectasis). obstruction- denies pain with palpitation.
Extremities: Moves all, no edema
Patient’s tubing and IV lines will remain
Musculoskeletal: normal inspection, ambulatory with walker-on standby patient, and dressings will remain dry
skin: dry, intact and intact throughout stay.
Emesis throughout the night and morning

Subjective (symptoms)
Abdominal discomfort (2/10)
Nausea
2 Nursing Diagnoses/Prioritize:
Bloating ASSESSMENT:
Shortness of breath
Psych: normal affect Risk for acute pain related to surgical incision.

Risk for thromboembolism related to surgery

and recent halt of anticoagulants
(prophylactic for surgery).

Patient Story; Medical Diagnosis & Past

Medical History:
07/15/20
Patient is a 81 year old male who was admitted to the medical oncology unit at Conclusion/reflection:
1806 on 07/12/20 for small bowel obstruction, abdominal pain and vomiting.
-Four other interventions that I completed on my shift:
Multiple emetics episodes overnight and AM. Going into surgery at 1230 for -Drew up and administered opioid analgesics IV push.
Pathophysiology: exploratory exam and possible lysis of adhesions in small bowel.
-Prepared PO medications from pixis and administered to patient.
-Assisted patient down to another floor to receive a scheduled EGD
-Auscultated lungs, heart and bowels and assessed pain.
-Two interdisciplinary team members I worked with:
Small bowel obstruction is blockage that occurs in the small intestine, causing fluid, History of A fib on chronic anticoagulation, ESRD on dialysis-Chronic kidney -I collaborated a lot with one of my classmates, on both interventions and assessment findings.
air, or gas to accumulate near the site of obstruction. Peristalsis increases for a disease, DM2, hypertension-now low BP since starting dialysis , DVT. Surgical -I collaborated with the CAN a lot as well, for I helped her fulfill patient needs and get equipment.
-Something I will take away:
short period, in an effort to break through the area of blockage. Intestinal lining is history includes: colon resection secondary to intussusception 5 years ago, -Sometimes even the registered nurses, who have done this for years, have several questions as well. Don’t be afraid
to ask questions and follow your gut and knowledge learned.
injured, distention occurs at and above obstruction site. The stomach and small Multiple spin surgeries, Hernia x2, Left knee arthroscopy, and Left AV fistula.
intestine closest to the blockage dilate; the bowel distal to the blockage
decompresses. Water, sodium, and potassium are secreted by the bowel into the No known allergies
fluid pooled in the lumen causing this swelling and distention (Lippincott Advisor,
2020).

Arterial fibrillation is a very common heart rhythm problem that results because of
abnormal electrical signals that control the heart. A-fib puts one at risk for stroke
and blood clots (Lippincott Advisor, 2020).
"Intestinal Obstruction” (2020). In Lippincott advisor. Retrieved https://advisor-
edu.lww.com/lna/document.do?did=840038

Evaluation:
“Arterial Fibrillation” (2020). In Lippincott advisor. Retrieved from https://advisor-
edu.lww.com/lna/document.do?bid=19&did=902720&searchTerm=a-fib&hits=fib -Patient verbalized understanding of the procedure and provided signed consent forms.
-Patient went to surgery at 1200, and did not come back before clinical was over. I was unable to assess patient
post OP.