Western Mindanao State University

College of Nursing
Zamboanga City

Alternative Learning System

Related Learning Experience

OPERATING ROOM

Study of the Illness Condition

Submitted by:
LERIOS, ABBY D.
BSN 3C

Submitted to:
MA. JOANETTE F. PAALAN, RN, MN
Clinical Instructor

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  Western Mindanao State University
College of Nursing
Zamboanga City

Alternative Learning System

Related Learning Experience
Operating Room

Instructions: 

Answer the provided questions comprehensively following the subsequent format. 

A. Use the Times Roman Font Style 
B. Utilize at least three (3) or more references
C. References should be 2015 and latest
D. Output should be submitted as posted in the Google Class Assignment in PDF Format
E. Use the templates in pages 5 – 8  as guides in accomplishing your output
F. You will be graded according to the Rubric in page 10

Case Scenario: Peptic Ulcer Disease

    A 45-year-old woman, looking pale and exhausted  was admitted  due to acute pain in the epigastric
region which began more than one day ago ( approximately 30 hours).  The pain was reported as
extreme, remitting, sharp and cramping, and radiating laterally in both directions. The patient  decided to
seek consultation when she had tarry stool in the early morning.

Upon physical examination, significant pain in the epigastric region is noted. The patient was
also found to be hypertensive, with blood pressure of 158/90 mmHg. All other vital signs, abdominal
and cardiologic exams were normal. 

Vital Signs 

1. Blood pressure (BP)        :        158/90mmHg

2. Heart rate    (HR)            :        99 bpm
3. Respiratory rate (RR)        :        21 b/min
4. Temperature             :        36.1 0 C
5. Height                 :        167 cm (5’4)
6. Weight                 :        52.2 kg

History:

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 1. Gastritis with Helicobacter pylori (H. pylori) infection diagnosed 5 years ago. Treated with
pharmacotherapy, frequently recurring
2. Digestive discomfort and bearable pain of almost 6 months before the onset of acute pain
 discomfort worsens after taking NSAID for her knee pain  and drinking coffee but
relieved after taking antacids
3. Osteoarthritis, diagnosed one year ago, use of NSAID since diagnosis
4. Loss of appetite caused by the feeling of bloating and fullness along with digestive
discomfort
5. Weight loss of 10 pounds in 2 months 

Lifestyle factors:

1. Fondness for fried and  spicy foods 

2. Coffee drinker 
3. 24 pack-year tobacco history and is trying to quit 

Laboratory results:

Examinations  Patient’s Result  Normal Value  Indication 

Blood Exam 
RBC 4.4 x 1,000,000/mm3
Hemoglobin 12.0 g/dL
WBC 6.2 x 1000/mm3
Platelets 250 _ 109/L
Urinalysis
Appearance Clear
Color Dark yellow
pH            5.0
Protein          
Negative
   
Sp. Gravity 1.005
Glucose  Negative
Casts  None
WBC 1 – 2 
RBC 0 – 1 
Fecalysis 

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 Color Dark brown
Consistency Soft-formed
Occult blood Positive 
Ova & parasites  None seen
   

Based on the physical exam and history, the patient is diagnosed with bleeding peptic ulcer, and
since the patient is not responding to medical management, the patient is scheduled to undergo
gastroduodenostomy (Billroth I) with the following orders:

1. Nothing Per Orem (NPO)

2. Intravenous hydration – 
1. D5LR 1 liter to run for 8 hours, followed by 
2. 0.9% Normal Saline 1 liter at 30 drops per minute 

After surgery, the patient is wheeled to the Post Anesthesia Care Unit (PACU) with the
following orders:
1. Tramadol hydrochloride (Ultram) 100 mg IV every 6 hours PRN for pain
2. Cefuroxime (Ceftin)  750 mg IV every 8 hours for the first  24 hours then may shift to oral
for 3 days
3. Connect Nasogastric tube to low suction

Your Tasks:

1. Determine the need for the required laboratory and diagnostic examinations 
 Give the indications for the abnormal result/values 
2. Illustrate the organ involved and label accordingly.   
3. Discuss the normal function of the organ involved. 
4. Explain the pathophysiology based on the diagnosis. 
A. Create the  pathologic pathway of the pathogenesis ( the development of the disease and the
chain of events leading to the illness) contributing to the  patient’s illness condition.
B. Synthesize the life-threatening pathway as a consequence of the patient’s refusal / non-
compliance with treatment

5. Explain the Surgical Procedure done on your patient. 

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6. Enumerate the instruments that will be used during surgery. (Use the internet as a source of
reference). Classify them according to their category and indicate their functions (following the
template below)
7. Formulate an IMMEDIATE post-operative Nursing Care Plan of a patient who underwent
gastroduodenostomy  based on the NANDA approved Nursing Diagnosis.  
 Give at least two (2)
 PRIORITIZE the problems and cite your reference/s
8. Develop a Drug Study based on your patient’s preop and postop medications to include
Intravenous Fluid infusions