NR 511 Week 5 iHuman Case - Deborah Arnaudin

General: denies generalized weakness and fever. Head Eye Ears Nose: Throat: denies swollen lymph nodes Neck: Cardio: denies chest pain, heart disease, heart palpita琀椀ons and HTN Respiratory: denies SOB, coughing, wheezing. GI: Abdominal pain, vomi琀椀ng, cons琀椀pa琀椀on (-sensa琀椀on of incomplete bowel emptying; did not usually have cons琀椀pa琀椀on un琀椀l two days ago; it has been days since she passed gas, -greasy foul smell stools, black-tar-like or foul-smelling stool, blood in stool +N/V (started yesterday, greenish color; ea琀椀ng makes it worse) GU Musculoskeletal: denies joint or bone pain. Neuro: Integumentary/Breast: Psych: Endocrine: denies periods of excessive swee琀椀ngs, chills Hematologic/Lympha琀椀c Allergic/Immunologic Abdomen: GU/Rectal Musculoskeletal/ Neuro: Skin Lympha琀椀c Psych: Diagnos琀椀c Tests : CBC: Abnormal (elevated WBL) CMP: Elevated BUN/Crea琀椀nine ra琀椀o, consistent with mild dehydra琀椀on Low-normal potassium and hypochloremia due to emesis CT: Dilated loops of proximal small bowel measured up to 4 cm in caliber. There is the transi琀椀on to non-distended loops in the distal small bowel in the right hemipelvis. Lac琀椀c acid and lipase are normal Di昀昀eren琀椀al Diagnoses : Small bowel obstruc琀椀on (SBO) K56.60 Medica琀椀ons/Treatments: NPO for bowel rest and possible surgery. Fluid therapy due to 昀氀uid deple琀椀on/dehydra琀椀on and electrolyte abnormali琀椀es. Start LR or NS Give 昀氀uid 1L bolus, and then resume at a rate of 125ml/hr. Potassium replacement protocol should be started as well before surgery to prevent arrhythmias and hypotension related to induc琀椀on during surgery. Insert the NG tube into low intermi琀琀ent suc琀椀on. GI decompression is more bene昀椀cial in proximal obstruc琀椀ons with gastric disten琀椀on than in distal ileal obstruc琀椀ons (Ten Broek et al., 2018). NG tube decompression is recommended for pa琀椀ents with signi昀椀cant disten琀椀on, nausea, and vomi琀椀ng. Detz, D. J., Podrat, J. L., Castro, J. C. M., Lee, Y. K., Zheng, F., Purnell, S., & Pei, K. Y. (2021). Small bowel obstruc琀椀on. Current problems in surgery, 58(7), 100893. h琀琀ps://www.sciencedirect.com/ science/ar琀椀cle/abs/pii/S0011384020301635 Ten Broek, R. P. G., Krielen, P., Di Saverio, S., Coccolini, F., Bi昀툀, W. L., Ansaloni, L., Velmahos, G. C., Sartelli, M., Fraga, G. P., Kelly, M. D., Moore, F. A., Peitzman, A. B., Leppaniemi, A., Moore, E. E., Jeekel, J., Kluger, Y., Sugrue, M., Balogh, Z. J., Bendinelli, C., … van Goor, H. (2018). Bologna guidelines for diagnosing and managing adhesive small bowel obstruc琀椀on (ASBO): 2017 update of the evidence-based guidelines from the World Society of Emergency Surgery ASBO working group. World Journal of Emergency Surgery, 13(1), 24–24. h琀琀ps://doi.org/10.1186/s13017-018- 0185-2