Case 1

CASE 1: SMALL BOWEL OBSTRUCTION (SBO)
VICTORIA C. TAMAYO | ALLIED 3.2 | PROF. TERESITA V. AGUIRRE, RN

DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING
TAMAYO, VICTORIA C. FEBRUARY 12, 2021

ALLIED 3.2 TERESITA AGUIRRE, RN
DEMOGRAPHIC DATA
Name : A.G.
Age : 87 y/o
Gender : Female
Ethnicity : Italian
PATIENT HISTORY
Chief Complaint
Cramping abdominal pain
History of Present Illness
- Before admission, px had 3-day history of intermittent abdominal pain, abdominal bloating, N/V,
and loss of appetite
- Upon admission, px had distended abdomen, hypoactive bowel sounds, urge to vomit, and
cramping abdominal pain
Past Health History

Medical History Colon cancer
Surgical History Colectomy 6 years ago; Ventral hernia repair 2 years ago
Medications Ibuprofen (Motrin) for mild arthritis
Allergies Sulfa drugs and Meperidine
Family Health History
Not specified
Social Health History
Patient moved from Italy 2 months ago and speaks very little English
Psychological History
Not specified
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REVIEW OF RELATED LITERATURE
Bowel Obstruction
INTRODUCTION
A bowel obstruction can either be a mechanical or functional obstruction of the small or large intestines. The
obstruction occurs when the lumen of the bowel becomes either partially or
completely blocked. Obstruction frequently causes abdominal pain, nausea, vomiting, constipation-to-
obstipation, and distention. This, in turn, prevents the normal movement of digested products. Small bowel
obstructions (SBOs) are more common than large bowel obstructions (LBOs) and are the most frequent
indication for surgery on the small intestines. Bowel obstructions are classified as a partial, complete, or
closed loop. A closed-loop obstruction refers to a type of obstruction in the small or large bowel in which
there is complete obstruction distally and proximally in the given segment of the intestine.
ETIOLOGY
There are many potential etiologies of small and large bowel obstructions that are classified as either
extrinsic, intrinsic, or intraluminal.
Extrinsic (SBO)
- The most common cause of SBOs in industrialized nations is from extrinsic sources, with post-
surgical adhesions being the most common. Significant adhesions can cause kinking of the
bowel leading to obstruction. It is estimated that at least two-thirds of patients with previous
abdominal surgery have adhesions.
- Other common extrinsic sources include cancer, which causes compression of the small bowel
leading to obstruction.
- Less common but still prevalent extrinsic causes are inguinal and umbilical hernias.
Untreated or symptomatic hernias may eventually become kinked as the small bowel
protrudes through the defect in the abdominal wall and becomes entrapped in the hernia
sack. Hernias that are not identified or are not reducible may progress to obstruction of the
bowel and are considered a surgical emergency with the strangulated or incarcerated bowel
becoming ischemic over time.
Intrinsic (SBO)
- Other causes of SBO include intrinsic disease, which can create an insidious onset of bowel
wall thickening. The bowel wall slowly becomes compromised, forming a stricture. Crohn
disease is the most common cause of benign stricture seen in the adult population.
Intraluminal (SBO)
- Intraluminal causes for SBOs are less common. This process occurs when there is an ingested
foreign body that causes impaction within the lumen of the bowel or navigates to the ileocecal
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valve and is unable to pass, forming a barrier to the large intestine. However, it is noted
that most foreign bodies that pass through the pyloric sphincter will be able to pass through
the rest of the gastrointestinal tract.
LBOs are less common and compromise only 10% to 15% of all intestinal obstructions. The most common
cause of all LBOs is adenocarcinoma, followed by diverticulitis and volvulus. Colonic obstruction is most
commonly seen in the sigmoid colon.
EPIDEMIOLOGY
Small and large bowel obstructions are similar in incidence in both males and females. The overriding factor
affecting incidence and distribution depends on patient risk factors.
RISK FACTORS
- prior abdominal surgery;
- colon or metastatic cancer;
- chronic intestinal inflammatory disease;
- existing abdominal wall and/or an inguinal hernia;
- previous irradiation; and
- foreign body ingestion
TYPES OF BOWEL OBSTRUCTION

Mechanical Obstruction
- Divided into obstruction of the small bowel (including the duodenum) and obstruction of
the large bowel.
- May be cause by an occlusion of the lumen of the intestinal tract from pressure on the
intestinal wall.
- Obstruction may be partial or complete. About 85% of partial small-bowel obstructions
resolve with nonoperative treatment, whereas about 85% of complete small-bowel
obstructions require surgery.
- Common causes of mechanical obstruction are adhesions, hernias, and tumors.
Functional Obstruction
- The intestinal musculature cannot propel the contents along the bowel example are
amyloidosis, muscular dystrophy, endocrine disorder such as Diabetes Mellitus or
neurologic disorder such as Parkinson’s disease.
SIGNS AND SYMPTOMS

- Abdominal (stomach) cramps and pain
- Bloating
- Vomiting
- Nausea
- Fever
- Rapid Heartbeat
- Dehydration
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- Malaise (an overall feeling of illness)

- Lack of appetite
- Fever
- Blood in the stool
- Severe constipation.
- In cases of complete obstruction, a person will not be able to pass stool (feces) or gas
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ANATOMY AND PHYSIOLOGY
DIGESTIVE SYSTEM
The human gastrointestinal tract refers
to the stomach and intestine, and
sometimes to all the structures from
the mouth to the anus.
FUNCTIONS
- Acquires nutrients from
environment
- Anabolism. Uses raw materials
to synthesize essential compounds
- Catabolism. Decomposes
substances to provide energy cells need
to function
ACTIONS OF THE GI TRACT
- Ingestion. Occurs when material enters via the mouth.

- Mechanical Processing. Crushing / shearing makes material easier to move through the
tract.
- Digestion. Chemical breakdown of food into small organic compounds for absorption.
- Secretion. Release of water acids, buffers, enzymes & salts by epithelium of GI tract and
glandular organs
- Absorption. Movement of organic substrates, electrolytes, vitamins & water across
digestive epithelium.
- Excretion. Removal of waste products from body fluids.
DIVISIONS OF THE DIGESTIVE SYSTEM

1. Gastrointestinal Tract or Alimentary Tube
a. Continuous tube that extends from the mouth to the anus, about 5 to 7 meters long.
b. Contains food from the time it is eaten until it is digested, absorbed or eliminated from the
body.
c. Consists of the mouth, pharynx, esophagus, stomach, small intestine, and large intestine.
2. Accessory Organs
a. Include the teeth, tongue, salivary glands, liver, gallbladder, & pancreas.
b. Generally secrete substances into the GI tract or perform other functions.
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Mouth – first part of the digestive system

a. Roof Palate: soft palate, hard palate, uvula
b. Floor Tongue: in cooperation with the lips and
cheeks, holds the food in place during
mastication
c. AnteriorTeeth: 32 teeth in adult
d. Lateral Cheek
Pharynx “throat” – connects the mouth with the

esophagus
Epiglottis- closes to prevent food and fluids from
going down the trachea toward the lungs.
Consists of three parts: (Nasopharynx, Oropharynx-
transmit food, Laryngopharynx- transmit food)
Esophagus – is a muscular tube, lined with moist
stratified squamous epithelium, which extends from
the pharynx to the stomach.
- Transports food from the pharynx to the
stomach.
- 25 cm long
- Upper and lower esophageal sphincters, located
at the upper and lower ends of the esophagus, respectively, regulate the movement of food
into and out of the esophagus.
Stomach- is an enlarged segment of the digestive

tract in the left superior part of the abdomen.
- The stomach functions primarily as storage and
mixing chamber for ingested food
- It has a pH of about 2
- As the food enters the stomach, it is mixed with
stomach secretions to become a semifluid mixture
called chyme.
- Stomach secretions from the gastric glands
include mucus, hydrochloric acid, and pepsin.
- Mucus coats the cells of the stomach lining to
protect them from being damaged by acid and
enzymes.
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- Hydrochloric acid provides the highly acidic environment needed for pepsin to break down
proteins. Also serves as a barrier against infection by killing most bacteria.
- Pepsin is the only enzyme that digests collagen, which is a protein and a major constituent of
meat.
- Parts:
o Fundus
o Body – lesser curvature, greater curvature
o Pyloric opening
o Pyloric sphincter
Small intestine - 6 meters long

- major site of digestion and absorption of food, which are
accomplished by the presence of a large surface area
- secretions from the mucosa of the small intestine mainly
contain mucus, ions and water
- intestinal secretions lubricate and protect the intestinal
wall from the acidic chime and the action of the digestive
enzymes.
Three parts:
- Duodenum – 25 cm long (Receives pancreatic enzymes
from the pancreas and bile from the liver and gallbladder)
- Jejunum – 2.5 meter long
- Ileum – 3.5 meter long
Liver – The liver weighs about 1.36 kilograms and is located

in the right upper quadrant of the abdomen, tucked against
the inferior surface of the diaphragm.
Functions:
- store and processes nutrients, synthesizes new
molecules, and detoxifies harmful chemicals.
- secretes about 700mL of bile each day
- bile contains no digestive enzymes, but it plays an
important role in digestion by diluting and neutralizing
stomach acid and by dramatically increasing the efficiency
of fat digestion and absorption
- It can also store fat, vitamins, copper and iron. This
storage function is usually short term.
Gallbladder – a vital organ that acts as storage place for bile which is a liquid produced in the liver.
- The normal function of bile is to help your body digest fats.
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- After eating fats, as your body begins the digestive process, your gallbladder contracts and pushes
the stored bile into the common bile duct, which brings the liquid to your small intestine to aid
digestion.
- Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin - a waste product.
- Bile salts break up fat, and bilirubin gives bile and stool a yellowish-brown color.
- If the liquid bile contains too much cholesterol, bile salts, or bilirubin, it can harden into
gallstones.
Pancreas – is a fish-shaped spongy grayish-pink organ about 6 inches (15 cm) long that stretches across the
back of the abdomen, behind the stomach.
- 3 hormones produced: insulin (lowers the level of sugar in the blood by moving sugar into cells;
glucagon (raises the level of sugar in the blood by stimulating the liver to release its stores;
somatostatin (prevents the other two hormones from being released.
- It is a complex organ composed of both endocrine and exocrine tissues that perform several
functions.
- Endocrine part: pancreatic islets- produce the hormones insulin and glucagon.
- The exocrine function of the pancreas involves the synthesis and secretion of pancreatic juices.
- The pancreas makes pancreatic juices and hormones, including insulin.
- The pancreatic juices are enzymes that help digest food in the small intestine.
Large Intestine – consists of the cecum, colon, rectum,

and anal canal. Usually 18- 24 hours is required for
material to pass through the large intestine.
Colon
Ascending colon – extends superiorly from the cecum

to the right colic flexure, near the liver, where it turns
to the left.
Transverse colon – extends from the right colic flexure

to the left colic flexure near the spleen, where the
colon turns inferiorly.
Descending colon – extends from the left colic flexure to the pelvis, where it becomes the sigmoid colon.
Sigmoid colon – forms an S- shaped tube that extends medially and then inferiorly into the pelvic cavity an
ends at the rectum.
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Cecum – is the proximal end of the large intestine and is where the large and small intestine meets at the
ileocecal junction. It is located in the right lower quadrant of the abdomen near the iliac fossa. Attached to
the cecum is a tube about 9 cm long called the appendix.
Rectum – is a straight, muscular tube that begins at the termination of the sigmoid colon and ends at the
anal canal. The rectum has little shelves in it called transverse folds. These folds help keep stool in place until
you’re ready to go to the bathroom. The rectum intestinum acts as a temporary storage facility for feces.
Anal canal – it begins at the inferior end of the rectum and ends at the anus (external GI tract opening).
(Internal anal sphincter, External anal sphincter); allows the feces to be passed by muscles pulling the anus
up over the exiting feces
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III. REVIEW OF SYSTEM / PHYSICAL ASSESSMENT
UPON ADMISSION 2 DAYS AFTER ADMISSION

Vital Signs BP 100/70 mmHg Subjective:
RR 25 cpm Lethargy
PR 75 bpm
T 38.6°C
Abdomen Subjective: Subjective:
Cramping abdominal pain Strong abdominal pain
Objective:
Distended
Hypoactive bowel sounds
GI Vomiting N/V
Bones and Joints Subjective:
Weaker hand grips
Cramps
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PATHOPHYSIOLOGY
Predisposing Factors Precipitating Factors

- Advanced age (87y/o) - Colectomy (Colon Cancer)
- Ventral hernia repair
Adhesions
Loops of intestine become adherent to areas that
heal slowly or scar after abdominal surgery;
produce kinking of an intestinal loop
SMALL BOWEL OBSTRUCTION
Increase Gases and fluids

contraction of accumulate in the
proximal intestine area
Severe colicky Distention of

Increase intraluminal
abdominal pain intestine
pressure
Symptom Increase secretion Persistent vomiting

Patient reports severe
abdominal pain into the intestine
Signs
Compression of veins Abnormal levels of fluids and
Nursing Diagnosis 1 electrolytes
Acute pain related to increased Patient’s frequent urgency to
contraction of intestine as Increase venous pressure vomit
manifested by patient’s report
of severe abdominal pain.
Decrease absorption Nursing Diagnosis 3
Electrolyte imbalance related to
decreased absorption as
Edema of the intestine manifested by lab test results and
presence of vomitus.
Decrease arterial blood supply

Compression of terminal
branches of mesenteric artery
Ischemia
Necrosis
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Perforation of necrotic segments
Bacteria or toxins leak
Inflammation
Fever
Sign
T 38.6 degree Celcius
Nursing Diagnosis 2
Altered body temperature
related to inflammation as
manifested by increased body
temp (T 38.6)
SMALL BOWEL OBSTRUCTION

Small-bowel obstruction (SBO) leads to proximal dilatation of the intestine due to accumulation of
gastrointestinal (GI) secretions and swallowed air. Bowel dilatation stimulates cell secretory activity, resulting
in more fluid accumulation. This, in turn, leads to increased peristalsis above and below the obstruction, with
frequent loose stools and flatus early in its course (Ramnarin, 2017). Distention and increased peristalsis
cause severe colicky abdominal pain.
Vomiting occurs if the level of obstruction is proximal. Increasing small-bowel distention leads to increased
intraluminal pressures. This can cause compression of mucosal lymphatics, leading to bowel wall
lymphedema. With even higher intraluminal hydrostatic pressures, increased hydrostatic pressure in the
capillary beds results in massive third spacing of fluid, electrolytes, and proteins into the intestinal lumen.
The fluid loss and dehydration that ensue may be severe and contribute to increased morbidity (Ramnarin,
2017). This is apparent with the case of A.G. as she has been experiencing N/V and her laboratory results
show that she’s starting to have electrolyte imbalances despite the initial medications provided.
Bowel wall lymphedema decreases arterial blood supply in the distal areas making them ischemic. Tissues
that are not supplied with blood from the arteries become necrotic and soon perforates with bacteria and
toxins to leaking out. This causes inflammation and may be associated with fever.
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LABORATORY RESULTS AND DRUG STUDY
LABORATORY FINDINGS
Results Upon Results After
Test Normal Range Clinical Significance Preparations
Admission 2 Days
Sodium 135 – 145 136 mEq/L v130 mEq/L Low None
Can cause kidney failure
Fatigue
Potassium 3.5 – 5.0 3.7 mEq/L v2.5mEq/L Low None
Muscle cramps
Chloride 96 – 106 108 mEq/L 97 mEq/L Normal Do not apply any cream
or lotion on skin 24 hours
before
Carbon 23 – 29 25 mEq/L ^31 mEq/L Abnormal None
dioxide Indicates electrolyte
imbalance
BUN 7 - 20 19 mg/dL ^38 mg/dL High None
Indicates dehydration
Presence of kidney
injury or disease
Creatinine 0.84 – 1.21 1 mg/dL ^2.2 mg/dL High Note prescription or OTC
Indicates dehydration drugs
Signifies impaired kidney
function
Glucose < 140 126 mg/dL v65 mg/dL Normal 8 – 14 hour fasting
Albumin 3.4 – 5.4 3.0 g/dL ^3.1 g/dL Normal None

Protein 6.0 – 8.3 6.8 g/dL v4.9 d/dL Low Note prescription or OTC
Indicates liver or kidney drugs
problem
*Identify the patient
**Explain the procedure and indications of each test to the patient
****Notify the laboratory practitioner about any medications that may affect the results of any of the lab tests
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DRUG STUDY
(1) IBUPROFEN (MOTRIN)
Generic Name/
Brand Name/ Therapeutic Action Side Effect/s Contraindication/s
Classification
Oral: Dyspepsia, vomiting,
abdominal pain, heartburn,
nausea, diarrhoea, epigastric
pain, oedema, fluid retention,
Generic Name:
dizziness, rash, tinnitus.
Ibuprofen exhibits anti-
Active peptic ulcer;
inflammatory, analgesic
Parenteral: Intraventricular hypersensitivity.
Brand Name: Motrin and antipyretic activities.
haemorrhage, skin irritation,
Its analgesic effect is
hypocalcaemia, Neonates with congenital
Class: NSAID, independent of anti-
hypoglycaemia, GI disorders, heart disease, suspected
Analgesic inflammatory activity and
anaemia, apnoea, respiratory necrotising enterocolitis and
(nonopioid), has both central and
infection, sepsis. active bleeding (parenteral)
Propionic acid peripheral effects
derivative
Potentially Fatal: Severe CV
thrombotic events. Severe GI
bleeding, ulceration and
perforation.
Dosage and Route
ADULTS: Do not exceed 3,200 mg/day
Mild to moderate pain: 400 mg q 4–6 hr PO. Osteoarthritis or rheumatoid arthritis: 1,200–3,200 mg/day PO (300
mg qid or 400, 600, 800 mg tid or qid; individualize dosage. Therapeutic response may occur in a few days, but
often takes 2 wk).
Primary dysmenorrhea: 400 mg q 4 hr PO.
OTC use: 200–400 mg q 4–6 hr PO while symptoms persist; do not exceed 1,200 mg/day. Do not take for more
than 10 days for pain or 3 days for fever, unless so directed by health care provider.
PEDIATRIC PATIENTS
Juvenile arthritis: 30–40 mg/kg/day PO in three to four divided doses; 20 mg/kg/day for milder disease.
Fever (6 mo–12 yr): 5–10 mg/kg PO q 6–8 hr; do not exceed 40 mg/kg/day.
Nursing Considerations
Assessment
• History: Allergy to ibuprofen, salicylates or other NSAIDs; CV dysfunction, hypertension; peptic ulceration,
GI bleeding; impaired hepatic or renal function; pregnancy; lactation
• Physical: Skin color, lesions; T; orientation, reflexes, ophthalmologic evaluation, audiometric evaluation,
peripheral sensation; P, BP, edema; R, adventitious sounds; liver evaluation, bowel sounds; CBC, clotting
times, urinalysis, LFTs, renal function tests, serum electrolytes, stool guaiac
Interventions
• BLACK BOX WARNING: Be aware that patient may be at increased risk of CV event, GI bleeding, monitor
accordingly.
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•Administer drug with food or after meals if GI upset occurs.

•Arrange for periodic ophthalmologic examination during long-term therapy.
•Discontinue drug if eye changes, symptoms of hepatic impairment, or renal impairment occur.
•WARNING: Institute emergency procedures if overdose occurs: Gastric lavage, induction of emesis, and
supportive therapy.
Teaching points
• Use drug only as suggested; avoid overdose. Take the drug with food or after meals if GI upset occurs. Do
not exceed the prescribed dosage.
• Avoid over-the-counter drugs. Many of these drugs contain similar medications, and serious overdosage
can occur.
• You may experience these side effects: Nausea, GI upset, dyspepsia (take drug with food); diarrhea or
constipation; drowsiness, dizziness, vertigo, insomnia (use caution when driving or operating dangerous
machinery).
• Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers, changes in vision, black
or tarry stools.
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(2) PARACETAMOL (AEKNIL)
Generic Name/
Side Effects/
Brand Name/ Therapeutic Action Contraindication/s
Adverse Effects
Classification
Generic Name: Produces analgesia by Side effects: Hypersensitivity to
Paracetamol, raising the threshold of Dyspepsia • skin rash • itching Paracetamol. Repeated
Acetaminophen the pain center in the • hives administration is
brain and by obstructing contraindicated in patients
Brand Name: Aeknil impulses at the pain- Adverse Effects: with anemia, cardiac,
mediating Hematologic: hemolytic pulmonary, renal, and
Class: Non-narcotic chemoreceptors. The anemia, leukopenia, hepatic disease
analgesic, Antipyretic drug produces neutropenia, pancytopenia,
antipyresis by an action thrombocytopenia. Hepatic:
on the hypothalamus; liver damage, jaundice
heat dissipation is Metabolic: hypoglycemia Skin:
increased as a result of rash, urticuria
vasodilation and
increased peripheral
blood flow.
Dosage and Route
Parenteral (IV)
Adults & Children above 12 years / > 33 kg: 2 to 4 ml.
Children (2 -12 years): 0.5 to 3 ml every 4-6 hours OR 12-15 mg/kg b.w.
Or as may be desired by the Physician.
Do not administer to neonates and infants.
1. Check I&O ratio decreasing output may indicate renal failure (long term therapy)
2. Assess for fever and pain: type of pain, location, intensity, duration, temperature diaphoresis.
3. Assess for chronic poisoning: rapid, weak pulse, dyspnea report immediately to the physician.
4. Assess heaptoxicity: dark urine, clay colored stools, yellowing of skin and sclera, itching, abdominal pain, fever,
diarrhea (long term use)
5. Assess allergic reactions: rash, urticarial, if these occur, drug may have to be discontinued.
6. Do not give children more than 5 doses in 24 h unless prescribed by physician
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(3) PLAIN NSS
Generic Name/
Side Effects/
Adverse Effects
Classification
Generic Name: Source of water and Side effects: Contraindicated in any
Sodium Chloride electrolytes hypotension situation where salt
Injection retention is undesirable
Induces diuresis Adverse Effects: such as edema, heart
Brand Name: PNSS depending on the clinical febrile response; disease, cardiac
condition of the patient infection at the site of decompensation, and
Class: Isotonic injection; primary and secondary
Intravenous Solution Crystalloid given venous thrombosis or aldosteronism.
intravenously in case of phlebitis extending from the
shock, dehydration, and site of injection;
diarrhea to increase the extravasation; and
plasma volume hypervolemia.
Dosage and Route

Parenteral (IV)
Upto 10kgs + 50 ml/kg/day above 10kg
10-20 kg: 100ml/kg/day pto 10kgs + 50 ml/kg/day above 10kg
Above 20 kg: 100ml/kg/day upto 10 kg + 50ml/kg/day for 10 – 20 kg + 20ml/kg/day above 20kg
1. Document baseline vital signs, edema, lung sounds, and heart sounds, and continue monitoring during and
after the infusion.
2. Monitor for continued signs of hypovolemia, including urine output < 0.5 mL/kg/hour, poor skin turgor,
tachycardia, weak pulse, and hypotension.
3. Monitor for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea,
shortness of breath, peripheral edema, jugular vein distension (JVD) and extra heart sounds such as S3.
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(4) KCl
Generic Name/
Side Effects/
Adverse Effects
Classification
Generic Name: Principal intracellular Adverse Effects: Severe renal impairment;
Potassium Chloride cation; essential for GI:Nausea, vomiting, diarrhea, severe hemolytic reactions;
maintenance of abdominal distension. untreated Addison’s
Brand Name: KDur, intracellular isotonicity, Body Whole:Pain, mental disease; crush syndrome;
Slow K, Kaon Cl 10, transmission of nerve confusion, irritability, early postoperative oliguria
KCl, K10, Klor-Con M, impulses, contraction of listlessness, paresthesias of (except during GI drainage);
Klor Con M10, Klor cardiac, skeletal, and extremities, muscle weakness adynamic ileus; acute
Con M15, Klor Con smooth muscles, and heaviness of limbs, dehydration; heat cramps,
M20, KlorCon, maintenance of normal difficulty in swallowing, flaccid hyperkalemia, patients
Klotrix, KTab, MicroK, kidney function, and for paralysis. receiving potassium-sparing
and K8 enzyme activity. Plays a Urogenital: Oliguria, anuria. diuretics, digitalis
prominent role in both Hematologic: Hyperkalemia. intoxication with AV
Class: Electrolytic formation and correction Respiratory: Respiratory conduction disturbance.
and water balance of imbalances in acid– distress.
agent; Replacement base metabolism. CV: Hypotension, bradycardia;
solution cardiac depression,
arrhythmias, or arrest; altered
sensitivity to digitalis
glycosides. ECG changes in
hyperkalemia: Tenting
(peaking) of T wave (especially
in right precordial leads),
lowering of R with deepening
of S waves and depression of
RST; prolonged P-R interval,
widened QRS complex,
decreased amplitude and
disappearance of P waves,
prolonged Q-T interval, signs
of right and left bundle block,
deterioration of QRS contour
and finally ventricular
fibrillation and death.
Dosage and Route

Hypokalemia Adult: PO 10–100 mEq/d in divided doses IV 10–40 mEq/h diluted to at least 10–20 mEq/100 mL
of solution (max: 200–400 mEq/d, monitor higher doses carefully)
Child: PO 1–3 mEq/kg/d in divided doses; sustained release tablets not recommended in children IV Up to 3
mEq/kg/24 h at a rate <0.02 mEq/kg/min
PREPARE IV Infusion: Add desired amount to 100–1000 mL IV solution (compatible with all standard solutions).
Usual maximum is 80 mEq/1000 mL, however, 40 mEq/L is preferred to lessen irritation to veins. Note: NEVER add
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KCl to an IV bag/bottle which is hanging. After adding KCl invert bag/bottle several times to ensure even
distribution.
ADMINISTER IV Infusion: KCl is never given IV push or in concentrated amounts by any route. Infuse at rate not
to exceed 10 mEq/h. Adult patients with severe potassium depletion may be able to tolerate 20 mEq/h. Too rapid
infusion may cause fatal hyperkalemia.
Take extreme care to prevent extravasation and infiltration. At first sign, discontinue infusion and select another
site.
Assessment & Drug Effects
• Monitor I&O ratio and pattern in patients receiving the parenteral drug. If oliguria occurs, stop infusion
promptly and notify physician.
• Lab test: Frequent serum electrolytes are warranted.
• Monitor for and report signs of GI ulceration (esophageal or epigastric pain or hematemesis).
• Monitor patients receiving parenteral potassium closely with cardiac monitor. Irregular heartbeat is usually
the earliest clinical indication of hyperkalemia.
• Be alert for potassium intoxication (hyperkalemia, see S&S, Appendix F); may result from any therapeutic
dosage, and the patient may be asymptomatic.
• The risk of hyperkalemia with potassium supplement increases (1) in older adults because of decremental
changes in kidney function associated with aging, (2) when dietary intake of potassium suddenly increases,
and (3) when kidney function is significantly compromised.
Patient & Family Education
• Do not be alarmed when the tablet carcass appears in your stool. The sustained release tablet (e.g., Slow-K)
utilizes a wax matrix as carrier for KCl crystals that passes through the digestive system.
• Learn about sources of potassium with special reference to foods and OTC drugs.
• Avoid licorice; large amounts can cause both hypokalemia and sodium retention.
• Do not use any salt substitute unless it is specifically ordered by the physician. These contain a substantial
amount of potassium and electrolytes other than sodium.
• Do not self-prescribe laxatives. Chronic laxative use has been associated with diarrhea–induced potassium
loss.
• Notify physician of persistent vomiting because losses of potassium can occur.
• Report continuing signs of potassium deficit to physician: Weakness, fatigue, polyuria, polydipsia.
• Advise dentist or new physician that a potassium drug has been prescribed as long-term maintenance
therapy.
• Do not open foil-wrapped powders and tablets before use.
• Do not breast feed while taking this drug without consulting physician.
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(5) CEFAZOLIN (ANST)
Generic Name/
Side Effects/
Adverse Effects
Classification
Generic Name: An antibiotic used to Adverse Effects: Hypersensitivity To
Cefazolin treat a wide variety of CNS: SEIZURES (HIGH Cefazolin Or The
bacterial infections. It DOSES). GI: PSEUDOMEMBRAN Cephalosporin Class Of
Brand Name: Kefzol, may also be used before OUSCOLITIS, diarrhea, nausea, Antibacterial Drugs,
Ancef and during certain vomiting,cramps. Penicillins, Or Other Beta-
surgeries to help prevent Derm: rash, pruritus, urticaria, lactams
Class: infection. This Stevens-Johnson syndrome.
Cephalosporins, 1st medication is known as a Hemat: leukopenia,
Generation cephalosporin antibiotic. neutropenia,
It works by stopping the thrombocytopenia.
growth of bacteria. Local: pain at IM site, phlebitis
at IV site.
Misc: allergic reactions,
including anaphylaxis and
serum sickness, superinfection.
Dosage and Route
Dosage Forms and Strengths
Powder for injection: 500 mg 1 g 2 g 10 g 20 g 100 g 300 g
Dosage Considerations – Should be Given as Follows:

Moderate-to-Severe Infections 0.5-1 g intravenously (IV) every 6-8 hours
Mild Infections With Gram-Positive Cocci Adult: 250-500 mg intravenously (IV) every 8 hours
Infants and children: 25-100 mg/kg/day intravenously/intramuscularly (IV/IM) divided every 6-8 hours; not to
exceed 6 g/day
Neonates (under 28 days) Under 7 days: 40 mg/kg/day IV/IM divided every 12 hours
Greater than 7 days, less than 2 kg: 40 mg/kg/day IV/IM divided every 12 hours
Greater than 7 days, greater than 2 kg: 60 mg/kg/day IV/IM divided every 8 hours
Mild-to-Moderate Cholecystitis 1-2 g intravenously (IV) every 8 hours for 4-7 days
Uncomplicated Urinary Tract Infection 1 g intravenously (IV) every 12 hours
Preparation for Surgery Prophylaxis against infection
There are no dosing recommendations for pediatric patients for perioperative prophylaxis or for pediatric patients
with renal impairment
Examination and Evaluation
• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.
• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in
stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or
nursing staff immediately of these signs.
• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the
throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Skin reactions may
/victoriatamayo 20
COLLEGE OF NURSING

indicate serious hypersensitivity reactions (Stevens-Johnson syndrome). Notify physician or nursing staff
immediately if these reactions occur.
• Assess muscle aches and joint pain (arthralgia) that may be caused by serum sickness. Notify physician if
these symptoms seem to be drug related rather than caused by musculoskeletal injury or if muscle and
joint pain are accompanied by allergy-like reactions (fever, rashes, etc.).
• Instruct patient to report signs of leukopenia and neutropenia (fever, sore throat, signs of infection) or
thrombocytopenia (bruising, nose bleeds, and bleeding gums). Report these signs to the physician.
• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site
reactions to the physician.
Interventions
• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices,
treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or
isolation procedures as indicated for specific patients.
Patient/Client-Related Instruction
• Instruct patient to notify physician of signs of superinfection, including black, furry overgrowth on tongue,
vaginal itching or discharge, and loose or foul-smelling stools.
• Instruct patient and family/caregivers to report other troublesome side effects such as severe or
prolonged skin problems (rash, hives, itching) or GI problems
/victoriatamayo 21
COLLEGE OF NURSING

(6) SEVOFLURANE
Generic Name/
Side Effects/
Adverse Effects
Classification
Generic Name: Induces a state in which Side effects: Hypersensitivity
Sevoflurane the CNS is altered so that Agitation, dizziness, History of malignant
varying degrees of pain drowsiness, increased cough, hyperpyrexia
Brand Name: Ultane relief, depression of increased saliva,
consciousness, skeletal lightheadedness, nausea,
Class: General muscle relaxation and shivering, vomiting
Anesthetics reflex reduction are
reduced Adverse Effects:
Anaphylaxis, irregular
heartbeat, seizure, yellowing
of the skin or eyes,
hypotension
Dosage and Route

Dosage Forms & Strengths
Liquid 100%
Anesthesia
12-25 years: 2.6% in oxygen or 1.4% with 65% N2O/35% oxygen
1. Check the name of the patient and time of administration
2. Monitor vital signs
3. Monitor all the body systems
4. Continuous. Monitoring of pulse oximetry
5. Postural BP should be taken
6. Take note of the time that the drug has expired
If any adverse effect is noted:

Stop drug immediately
Start rapid fluid resuscitation
Make sure client is well-ventilated
Administer epinephrine
/victoriatamayo 22
COLLEGE OF NURSING

(7) PROPOFOL
Generic Name/
Side Effects/
Adverse Effects
Classification
Generic Name: The action of Propofol in Side effects: Contraindicated in patients
Propofol volves a positive Nausea; Cough; Burning or hypersensitive to propofol
modulation of the stinging around the IV needle; or components of the
Brand Name: inhibitory function of the Itching or skin rash; Numbness emulsion, including
Diprivan Propoven neurotransmitter gama- or tingly feeling; Confusion; soybean, oil, egg lecithin,
aminobutyric acid (GABA) Agitation; Anxiety; Muscle and glycerol. Because drug
Classification: through GABA-A pain; or Discolored urine is administered as an
Pharmacologic receptors. Rapid - time to emulsion, administer
Classification: Phen onset of unconsciousness Adverse Effects: cautiously to patients with a
ol derivative is 15-30 seconds, due to CNS: headache, dizziness, disorder of lipid metabolism
rapid distribution from twitching, clonic-myoclonic (such as pancreatitis,
Therapeutic plasma to the CNS. movement, fever, pain. primary
Classification: Anest CV: hypotension, bradycardia, hyperlipoproteinemia, and
hetic Sedative-hypnotic used in hypertension, arrhythmias in diabetic hyperlipidemia).
the induction and children. Use cautiously if patient is
maintenance of Metabolic: hyperlipidemia. receiving lipids as part of a
anesthesia or sedation Respiratory: apnea. total parenteral nutrition
Skin: rash, pruritus, injection infusion; I.V. lipid dose may
site burning or stinging. need to be reduced. Use
Other: tingling or numbness, cautiously in elderly or
coldness. debilitated patients and in
those with circulatory
disorders.
Don’t use drug in obstetric
anesthesia because safety of
fetus hasn’t been
established. Also avoid in
patients with increased
intracranial pressure or
impaired cerebral
circulation because the
reduction in systemic
arterial pressure caused by
drug may substantially
reduce cerebral perfusion
pressure. Don’t use drug in
children younger than age 3.
Don’t use for sedation in
children in intensive care
units or under monitored
anesthesia care sedation.
/victoriatamayo 23
COLLEGE OF NURSING

Drug should be
administered under direct
medical supervision familiar
with airway management
and the administration of
I.V. anesthetics.
Some products may contain
sodium metabisulfite. Some
patients, especially those
with asthma, may be
sensitive.
• Monitor hemodynamic status and assess for dose-related hypotension;
• Take seizure precautions;
• Tonic-clonic seizures have occurred following general anesthesia with propafol;
• Be alert to the potential for drug induced excitation (e.g., twitching, tremor, hyperclonus) and take
appropriate safety measures; and
• Provide comfort measures; pain at the injection site is quite common especially when small veins are
used.
/victoriatamayo 24
COLLEGE OF NURSING

(8) MIDAZOLAM
Generic Name/
Side Effects/
Adverse Effects
Classification
Generic Name: Short-acting parenteral Side effects: Intolerance to
Midazolam benzodiazepine. Headache; Drowsiness; benzodiazepines; acute
Mechanism of action Nausea; Vomiting; Hiccups; narrow-angle glaucoma;
Brand Name: unclear. Intensifies coughing; or pain, redness, or shock, coma; acute alcohol
Versed activity of gamma- hardening of the skin at the intoxication; intraarterial
aminobenzoic acid injection site injection. Safety in
Classification: (GABA), a major pregnancy (category D),
Benzodiazepines inhibitory Adverse Effects: labor and delivery, or
neurotransmitter of the CNS: Retrograde lactation is not established.
brain, by interfering with amnesia, headache, euphoria,
its reuptake and drowsiness, excessive
promoting its sedation, confusion.
accumulation at neuronal CV: Hypotension
synapses. This calms the Special senses: Blurred vision,
patient, relaxes skeletal diplopia, nystagmus, pinpoint
muscles, and in high pupils.
doses produces sleep. GI: Nausea,
vomiting.
Respiratory: Coughing, laryng
ospasm (rare), respiratory
arrest.
Skin: Hives, swelling, burning,
pain, induration at injection
site, tachypnea.
Body as a Whole: Hiccups,
chills, weakness.
• Inspect insertion site for redness, pain, swelling, and other signs of extravasation during IV infusion.
• Monitor for hypotension, especially if the patient is premedicated with a narcotic agonist analgesic.
• Monitor vital signs for entire recovery period. In obese patient, half-life is prolonged during IV infusion;
therefore, duration of effects is prolonged (i.e., amnesia, postoperative recovery).
• Be aware that overdose symptoms include somnolence, confusion, sedation, diminished reflexes, coma,
and untoward effects on vital signs.
Patient & Family Education
• Do not drive or engage in potentially hazardous activities until response to drug is known. You may feel
drowsy, weak, or tired for 1–2 d after drug has been given.
• Be prepared for amnesia to prevent an upsetting postoperative period.
• Review written instructions to assure future understanding and compliance. Patient teaching during
amnestic period may not be remembered. Even if dose is small and depth of amnesia is unclear, relearn
information.
/victoriatamayo 25
COLLEGE OF NURSING

(9) KETOROLAC
Generic Name/
Side Effects/
Adverse Effects
Classification
Generic Name: an anti-inflammatory Adverse Effects: 1. hearing, allergies, and
Ketorolac that inhibits leukotriene Respiratory: rhinitis, cardiovascular/gastrointe
Tromethamine and prostaglandin stinal/hepatic conditions;
synthesis hemoptysis, dyspnea 2. during labor and delivery
Brand Name: GI: GI pain, diarrhea, vomiting, and mothers who give
Toradol nausea breastfeeding to their
babies;
Classification: CNS: dizziness, fatigue, 3. wear soft contact lenses;
NSAID insomnia, headache 4. use NSAIDs
Hematologic: neutropenia, simultaneously;
5. have a history of
leukopenia, decreased Hgb or gastrointestinal bleeding
Hct, bone marrow depression or peptic ulcer; and
Dermatologic: sweating, dry 6. suspected or confirmed
cerebrovascular bleeding
mucous membrane, pruritus
• Don’t forget to assess first the patient before administering this drug: know the history (e.g. allergies,
renal impairment, etc.) and physical condition of the patient (reflexes, ophthalmologic and audiometric
evaluation, orientation, clotting times, serum electrolytes, etc.)
• In case of hypersensitivity, be sure that emergency equipment is available.
• Drug vials should be protected from light.
• To maintain serum levels and control pain effectively, administer it every six hours.
• Report any signs of itching, swelling in the ankles, sore throat, easy bruising, etc.
/victoriatamayo 26
COLLEGE OF NURSING

(10) CIPROFLOXACIN
Generic Name/
Side Effects/
Adverse Effects
Classification
Generic Name: Ciprofloxacin promotes Adverse Effects: Hypersensitivity. Not to be
Ciprofloxacin breakage of double- GI disturbances; headache, used concurrently with
stranded DNA in tremor, confusion, tizanidine. Avoid exposure
Brand Name: susceptible organisms convulsions; rashes; joint pain; to strong sunlight or sun
Ciloxan, Cipro, Cipro and inhibits DNA gyrase, phototoxicity. Transient lamps during treatment.
HC Otic, Cipro I.V., which is essential in increases in serum creatinine.
Cipro XR, Co reproduction of bacterial Hematological, hepatic and
Ciprofloxacin (CAN), DNA. renal disturbances. Vasculitis,
Proquin XR pseudomembranous colitis
and tachycardia.
Classification: Phototoxicity.
Antibacterial,
Fluoroquinolone Potentially Fatal:
Anaphylactoid reaction;
cardiopulmonary arrest.
Assessment
History: Allergy to ciprofloxacin, norfloxacin or other quinolones; renal dysfunction; seizures;
lactation
Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; LFTs,
renal function tests
Interventions
Arrange for culture and sensitivity tests before beginning therapy.
Continue therapy for 2 days after signs and symptoms of infection are gone.
Be aware that Proquin XR is not interchangeable with other forms.
Ensure that the patient swallows ER tablets whole; do not cut, crush, or chew.
Ensure that patient is well hydrated.
Give antacids at least 2 hr after dosing.
Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and
sensitivity.
Encourage patient to complete full course of therapy.
Teaching points
If an antacid is needed, take it at least 2 hours before or after dose.
Take Proquin XR with the main meal of the day.
Do not touch tip of eye ointment or solution for this may contaminate the product.
Drink plenty of fluids while you are taking this drug.
You may experience these side effects: Nausea, vomiting, abdominal pain (eat frequent small meals);
diarrhea or constipation; drowsiness, blurring of vision, dizziness (observe caution if driving or using
dangerous equipment).
Report rash, visual changes, severe GI problems, weakness, tremors.
/victoriatamayo 27
COLLEGE OF NURSING

NURSING CARE PLANS
Assessment Nursing Diagnosis Planning/Goal

V/S Acute pain related to abdominal Short Term
BP 100/70mmHg distention as manifested by patient’s After 2h of NI, patient will
RR 25 cpm self report of cramping abdominal pain verbalize relief from pain.
PR 75 bpm and rapid breathing (25 cpm)
T 38.6°C After 2h of NI, patient will obtain a
R: Patient’s previous surgeries predispose her to
adhesions where loops of intestine become normal breathing pattern from 25
Subjective:
adherent to tissues that heal slowly or scar after cpm to 20 cpm
Px reports cramping abdominal surgery. This kinks the intestinal loop causing
pain small bowel obstruction. An obstruction to the
small intestine causes increased contraction and After 8h of NI, patient will have no
Objective: gas accumulation of gases and fluid in the area bouts of vomiting.
which then produces severe colicky pain to the
Distended abdomen upon patient.
palpation
Rapid breathing (RR 25 cpm)
Intervention
Independent NI
Assess pain characteristics (quality severity, location, onset, duration, precipitating and relieving factors) R: These data can
be used to identify the extent of the pain as well as serve as a baseline information.
Observe or monitor signs and symptoms associated with pain such as BP, heart rate, temperature, color and moisture of
skin, restlessness and ability to focus R: Some people deny the experience of pain when it is present. Attention to associated signs
may help the nurse in evaluating pain.
Assess probable cause of pain R: Different etiological factors respond better to different therapies.
Assess patient’s knowledge of or preference for the array of pain-relief strategies available R: Some patients may be
unaware of the effectiveness of nonpharmacological methods and may be willing to try them either with or instead of traditional
analgesic medications. Often a combination of therapies (analgesic with distraction or heat may prove most effective.
Assess patient’s willingness or ability to explore a range of techniques aimed at controlling pain R: Some patients will feel
uncomfortable exploring alternative methods of pain relief. However, patients need to be informed that there are multiple ways to
manage pain.
Anticipate need for pain relief R: One can most effectively deal with pain by preventing it.
Respond immediately to complaint of pain R: Prompt responses to complaints may result in decreased anxiety in the
patient.
Eliminate additional stressors or sources of discomfort whenever possible R: Demonstrated concern for patient’s welfare
and comfort fosters the development of a trusting relationship.
Encourage to assume position of comfort R: Reduces abdominal tension and promote sense of control
Dependent NI
Administer analgesic for relief of pain as prescribed R: Relieves abdominal pain by reducing the peristaltic activity
Interdependent NI
Refer to dietitian if indicated R: Collaboration with the dietician in order to guide the client about dietary medications
/victoriatamayo 28
COLLEGE OF NURSING


V/S Altered body temperature related to Short Term
BP 100/70mmHg inflammation as evidenced by elevated T After 2h of NI, will maintain a body
RR 25 cpm (38.6) and increased RR temperature from (38.6) within
PR 75 bpm normal levels (36-37)
T 38.6°C R: When there’s an obstruction in the intestine, it
will produce simultaneous effect of increased After 2h of NI, patient’s RR will
contraction and distention which increases
Objective intraluminal pressure. This compresses the vein decrease from 25 cpm to normal
(↑) T 38.6 degree Celcius and causes decrease absorption followed by range 12-20 cpm.
edema of the intestine. It impedes the supply of
blood from the artery and compresses the terminal
branches of mesenteric artery that leads to tissue
death. The bacteria and. Toxins from these dead
tissues leaks out causing inflammation to certain
areas.
Intervention
Independent NI
Identify the triggering factors R: Determination and management of the underlying cause are necessary for recovery.
Monitor the patient’s HR, BP, RR and T R: HR and BP increases as the hyperthermia progresses.
Determine the patient’s age and weight R: Extremes of age or weight increase the risk for the inability to control body
temperature.
Review serum electrolytes, especially serum sodium. R: Sodium losses occur with profuse sweating and accidental hyperthermia.
Adjust and monitor environmental factors like room temperature and bed linens as indicated R: Room temperature may be
accustomed to near normal body temperature and blankets and linens may be adjusted as indicated to regulate temperature of the
patient
Eliminate excess clothing and covers R: Exposing skin to room air decreases warmth and increases evaporative cooling
Administer tepid sponge bath at lukewarm water temp (32.2-35C) R: Reduces heat through conduction
Encourage ample fluid intake by mouth R: If the patient is dehydrated or diaphoretic, fluid loss contributes to fever
Educate patient and family members about the signs and symptoms of hyperthermia and help in identifying factors
related to occurrence of fever; discuss importance of increased fluid intake to avoid dehydration R: Providing health
teachings to the patient and family aids in coping with disease condition and could help prevent further complications of hyperthermia
Dependent NI
Give antipyretic medications as prescribed R: Antipyretic medications lower body temperature by blocking the synthesis of
prostaglandins that act in the hypothalamus.
Administer antibiotics as ordered by physician R: To treat infectious process, reducing inflammation
Interdependent NI
Refer to dietitian for a high caloric diet R: Appropriate diet is necessary to meet the metabolic demand of the patient
/victoriatamayo 29
COLLEGE OF NURSING


V/S Electrolyte imbalance related to Short Term
BP 100/70mmHg decreased absorption as After 3h of NI, patient’s V/S will
RR 25 cpm manifested by lethargy, remain within the normal limit.
PR 75 bpm weakness, muscle cramps, N/V,
T 38.6°C low sodium and potassium After 3h of NI, patient will regain
levels and high CO2 level. energy and will have no symptoms of
Subjective: muscle weakness and cramping.
Lethargy R: An obstruction in the intestine causes
Weakness persistent vomiting because of After 8h of NI, the patient’s will
distention (gases and fluids accumulate
Muscle cramps in one area). In addition, the intestinal
display lab results within normal
muscles are contracting at a higher rate limits.
Objective: which increases abdominal pressure.
N/V As intraluminal pressure increases,
absorption of water and sodium
Low Sodium 130 mEq/L (135 – 145) decreases and luminal secretion of
Low Potassium 2.5 mEq/L (3.5 – 5.0) water, sodium, and potassium
High CO2 31 mEq/L (23 – 29) increases.
Intervention
Independent NI
Monitor V/S R: Imbalances in electrolytes causes significant effect on patient’s circulation and breathing.
Monitor respiratory rate, depth, and effort. Encourage deep breathing and coughing exercise. Encouraged frequent re-
positions. R: Respiratory muscle weakness may progress to paralysis leading to respiratory arrest.
Monitor heart rate and rhythm R: Abnormalities in heart conduction and contractility are associated with hypokalemia.
Tachycardia may develop as well as potentially life-threatening atrial and ventricular dysrhythmias–AV blocks, AV
dissociation, ventricular tachycardia and PVCs.
Monitor level of consciousness and neuromuscular function, noting movement, strength, and sensation R: Tetany,
paresthesia, apathy, drowsiness, irritability, and coma may occur
Encourage high potassium and sodium diet R: Potassium and sodium may be replaced and level maintained through the
diet when the client is allowed oral food and fluids
Monitor rate of IV infusion t R: Ensures controlled delivery of medication to prevent bolus effect and reduce associated
discomfort such as burning sensation at IV site. When a solution cannot be administered via central vein and slowing of
rate is not possible or effective, applying an ice pack to the infusion site may help relieve discomfort.
Dependent NI
Administer PNSS infusion as ordered R: Replaces fluid and electrolyte losses
Administer potassium orally or intravenously R: Correct deficiencies when changes in medication, therapy, and dietary
intake are inadequate
Interdependent NI
Monitor lab results as indicated R: Assess whether treatments are taking effect
Refer to dietitian for appropriate food intake R: Dietary intake plays a big role in replacing electrolyte losses
/victoriatamayo 30
COLLEGE OF NURSING

VII. DISCHARGE PLANNING
DISCHARGE PLAN FOR OPEN CHOLECYSTECTOMY
Medication Ciprofloxacin 500 mg/tab for 5 days
1. Regularly sanitize areas where the px frequents to minimize risk for

infection
2. Frequently perform hand and overall hygiene to minimize risk for infection
3. Instruct and assist patient to ambulate such as walking
4. Avoid lifting heavy objects
Environment 5. Avoid driving while on pain medication
6. Sexual activity may resume as tolerated
7. Sleep pattern may likely be disturbed because of the hospital stay and
major surgery but this should gradually return to normal.
8. Patient may return to usual activities as long it does NOT involve HEAVY
lifting.
Instruct patient to
1. eat and follow suggested diet (low cholesterol);
Treatment
2. increase fluid intake; and
3. religiously comply to medications
Incision care
1. Patient may shower if she feels up to it after surgery
2. There’s no need to keep the incision covered if there are no drainage.
3. Do not scrub the incision, soap and water may run over to clean them.
4. Pat dry with clean towel or gauze.
5. Do not put ointment, creams or lotions unless otherwise instructed.
6. Minor drainage of clear yellow or red-yellow from the incision is
normal. Thick, opaque, dark yellow fluid or redness spreading around
Health Teaching the incision site indicates infection. Call doctor immediately.
7. Most healing takes place within 6 weeks after surgery, but the scar will
soften over time. The final appearance of the scar may not be final until
one year after surgery.
Pain
1. Pain from the incision is normal. It will vary. From day to day with
activity level, but should gradually decrease over time.
2. Crampy abdominal pain and bloating is not uncommon but should
gradually improve over time.
Emphasize the importance of complying to follow up appointments to the
Outpatient
patient and family;
/victoriatamayo 31
COLLEGE OF NURSING

Call healthcare provider immediately if experiencing any of these symptoms:

1. N/V
2. Diarrhea that doesn’t go away
3. Pain that doesn’t go away or is getting worse
4. A swollen or tender belly
5. Little or no gas or stools to pass
6. Fever or chills
7. blood in stool
Instruct patient to:
1. Space out small meals in a day (Do not eat 3 large meals)
2. Add new foods back into diet slowly
Diet
3. Take sips of clear liquids throughout the day
4. Avoid foods that may cause gas, loose stools or constipation while
recovering
/victoriatamayo 32

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CASE 1: SMALL BOWEL OBSTRUCTION (SBO)

VICTORIA C. TAMAYO | ALLIED 3.2 | PROF. TERESITA V. AGUIRRE, RN

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Past Health History

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

REVIEW OF RELATED LITERATURE

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

TYPES OF BOWEL OBSTRUCTION

SIGNS AND SYMPTOMS

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

- Malaise (an overall feeling of illness)

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

ANATOMY AND PHYSIOLOGY

ACTIONS OF THE GI TRACT

- Ingestion. Occurs when material enters via the mouth.

DIVISIONS OF THE DIGESTIVE SYSTEM

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Mouth – first part of the digestive system

Pharynx “throat” – connects the mouth with the

Stomach- is an enlarged segment of the digestive

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Small intestine - 6 meters long

Liver – The liver weighs about 1.36 kilograms and is located

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Large Intestine – consists of the cecum, colon, rectum,

Ascending colon – extends superiorly from the cecum

Transverse colon – extends from the right colic flexure

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

III. REVIEW OF SYSTEM / PHYSICAL ASSESSMENT

UPON ADMISSION 2 DAYS AFTER ADMISSION

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Predisposing Factors Precipitating Factors

SMALL BOWEL OBSTRUCTION

Increase Gases and fluids

Severe colicky Distention of

Symptom Increase secretion Persistent vomiting

Decrease arterial blood supply

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Perforation of necrotic segments

Bacteria or toxins leak

SMALL BOWEL OBSTRUCTION

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

LABORATORY RESULTS AND DRUG STUDY

Albumin 3.4 – 5.4 3.0 g/dL ^3.1 g/dL Normal None

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

•Administer drug with food or after meals if GI upset occurs.

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Dosage and Route

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Dosage and Route

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Dosage Considerations – Should be Given as Follows:

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

Dosage and Route

If any adverse effect is noted:

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

TAMAYO, VICTORIA C. FEBRUARY 12, 2021

TAMAYO, VICTORIA C. FEBRUARY 12, 2021