NR 511 Week 5 iHuman Virtual Patient Encounter Attempt 3741013 - Dorothy Jones

History Notecard by Sarah Wright on case Dorothy Jones 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 Location Duration Characteristics Aggravating Relieving Timing / Treatments Severity Attempt: 3741013 Report generated on 11/28/2025, 8:50:29 AM America/Denver Management Plan by Sarah Wright on case Dorothy Jones Dx:Small Bowel Obstruction Diagnostic test: Imaging:Ct Abdomen/pelvis with contrast: Dilated small bowel loops measuring up to 4cm with a transition point in in the distal small bowel, consistent with ,mechanical SBO- Labs: - Complete blood count (CBC)-WBC 11,000 indicates mild leukocytosis - Comprehensive metabolic panel (CMP)-WNL - Lactic Acid-Normal Lactate - Lipase: Normal Lipase Pharmacological: -Intravenous Hydration (while in hospital): Normal Saline bolus then maintain maintenance at 125ml/hour - Ondansetron(Zofran) IV 4mg, repeat PRN every 8 hours an needed for nausea and vomitting. -Morphine every 4mg IV every 6 hours as needed for pain ( Opioids may make SBO worse so will give sparingly, as SBO starts to resolve pain will lessen, NPO, NG tube will help decrease in pain) Education:. Reviewed while in hospital patients status of NPO (nothing by mouth) until further instructed, reviewed need for possible surgery if SBO does not resolved on its own, and need for Nasogastric tube. Bowel rest is needed to encourage SBO to resolve (Ghimire & Maharjan,2023). Ensure adequate hydration and ensure physical activity when able to resume to help return gastric motility. Report any worsening pain as this may be a sign of additional complications and need for possible surgery (Klingbeil et al, 2022) Consult/Referrals: General surgery for early evaluation. Watch and wait with conservative management. Will intervene if signs and symptoms of strangulation present. Follow up: Must report any signs of infection (fever, vomiting ,and increased abdominal pain). Follow up with General surgery and primary care provider in 1-2 week. Go to emergency room if signs of infections present after discharge (fever, increased abdominal pain, not able to pass flatus) Reference: Ghimire, P., & Maharjan, S. (2023). Adhesive Small Bowel Obstruction: A Review. Journal of Nepal Medical Association, 390-396 Klingbeil, K. D., Wu, J. X., Osuna-Garcia, A., & Livingston, E. H. (2022). Managment of small bowel instructions and systematic review of treatment without nasogastric tube decompression. Surgery open Science, 12, 62-67. https://doi.org/10.1016/j.sopen.2022.10.002 Attempt: 3741013 Report generated on 11/28/2025, 8:50:29 AM America/Denver Family History Category Data entered by Sarah Wright Family History Mother-Age (84) history of Hypertension,Hyperlipidemia, Uterine Fibroids Father-Age (85) History of hypertension