COURSE TASK 2

1. A 92-year-old woman in a long-term care facility is a patient assigned to

your care. With visible discomfort, she tells you that she has noticed blood
in the toilet bowl with her last several bowel movements and she has had
blood on her underwear. What other questions should you ask this woman
to clarify potential causes of this problem? Explain how the patient’s age
might affect your focused assessment.
 To confirm the diagnosis, the nurse or doctor will ask the patient if she has
experienced a consistent improvement in her bowel habits, such as diarrhea or
constipation, or if the quality of her stool has changed, or if she has had rectal
bleeding or blood in her stool, or if she has had persistent abdominal pain,
exhaustion, or nausea, or if she has lost weight unexpectedly.

Because of the regular age-related improvements and the particular clinical

conditions that limit the evaluation process, it is often difficult for a health care
caring for older adults to determine a diagnosis. Elderly persons often have a
variety of illnesses and frequently suffer from memory loss, making it difficult for
the provider to identify their genuine worry. They may be unable to acknowledge
pain because they are afraid of the consequences of doing so, such as the need
for hospitalization, medical testing, or treatment, or because they are afraid of
the consequences of not acknowledging pain, such as the need for
hospitalization, medical testing, or treatment.

2. Rory, an 18 year old girl, is admitted to the hospital with possible diagnosis
of appendicitis. She became symptomatic approximately 24 hours prior to
her hospital admission.
 
1. Since Rory has been symptomatic for 24 hours, what symptoms does the
nurse expect to find when obtaining subjective and objective data that
correlates with diagnosis of appendicitis?
 Vague epigastric or periumbilical pain progresses to right lower quadrant pain
and is usually accompanied by a low grade fever and nausea and sometimes
vomiting
 Loss of appetite
 local tenderness at McBurney's point when pressure is applied
 Rebound tenderness may be present
2. Before the nurse sends Rory to have any diagnostic x-rays, what
procedure should be performed?
 Before any x-rays or medications are given, a pregnancy test should be taken to
rule out pregnancy.

3. Two hours after admission, the nurse observes Rory lying motionless and
supine in bed and tells the nurse that she feels worse. What does the nurse
suspect may have occurred during this time frame?
 It's possible that the nurse suspects the appendix has ruptured.