NR 511 Week 5 iHuman Virtual Patient Encounter Attempt 3693474 - Deborah Arnaudin

History Notecard by Stacia Urban on case Deborah Arnaudin Use this worksheet to organize your thoughts before developing a differential diagnosis list. 1. Indicate key symptoms (Sx) you have identified from the history. Start with the patient's reason(s) for the encounter and add additional symptoms obtained from further questioning. 2. Characterize the attributes of each symptom using "OLDCARTS". Capture the details in the appropriate column and row. 3. Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient's age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case. HPI Sx = Sx = Sx = Sx = Sx = Sx = Onset abdominal pain constipation emesis Location Duration 2 days 2 days 1 days Characteristics watery Aggravating eating Relieving Timing / Treatments none Severity severe 8-9/10 scale Attempt: 3693474 Report generated on 10/4/2025, 2:15:39 PM America/Denver Management Plan by Stacia Urban on case Deborah Arnaudin Plan: 1. Admit to inpatient for non-surgical management of SBO. The most likely cause of SBO is surgical adhesions and most SBO cases can be managed without surgical intervention (Jackson & Vigiola-Cruz, 2018). 2. NG tube for nasogastric decompression and aspiration prevention to low continuous wall suction. a. Chest xray to confirm gastric tube placement 3. IV resuscitation with isotonic crystalloid fluids. Aggressive IV fluid therapy and correction of electrolyte imbalances are crucial during the initial management of acute SBO (Ghimire & Maharjan, 2023) a. Lactated Ringers 1L bolus IV (1000mL/1hr) STAT b. Lactated Ringers at 125mL/hr IV for 24 hours 4. Indwelling urinary catheter for accurate intake and output recordings 5. Zofran 4mg IV every 6 hours as needed for nausea/vomiting 6. Toradol 30mg IV every 6 hours as needed for pain 7. Fentanyl 50mcg IV every 2 hours as needed for severe pain not relieved with Toradol 8. Monitor serum electrolytes and replace as needed. Correction of electrolytes is crucial in preventing hypovolemia (Jackson & Vigiola-Cruz, 2018). 9. Surgical consult 10. NPO a. Bowel rest is needed for resolution of small bowel obstruction (Ghimire & Maharjan, 2023) Patient education: Bowel rest is necessary for resolution of small bowel obstruction and it is important to not eat or drink anything by mouth until symptoms resolve. Most but not all obstructions can be resolved without surgical intervention, however surgery may be required if obstruction does not resolve. Frequent ambulation may help to improve gastric motility. It is important to report any increase in pain, changes to appearance of emesis, or blood noted in emesis. Follow up with surgeon as directed, typically 1-2 weeks after hospital discharge. Follow up with Primary care provider within 1 week of hospital discharge. References: Ghimire, P., & Maharjan, S. (2023). Adhesive Small Bowel Obstruction: A Review. Journal of Nepal Medical Association, 390-396. Jackson, P., & Vigiola-Cruz, M. (2018). Intestinal Obstruction: Evaluation and Management. Amercian Family Physician, 362-367. Attempt: 3693474 Report generated on 10/4/2025, 2:15:39 PM America/Denver Family History Category Data entered by