Question

11. Musevelupeu a Small Tecal impaction. 5. What teaching points and interventions are appropriate to prevent fecal impaction? (USLO 1, 6) ********* Group Two: Ulcerative Colitis J.L, a 33-year old female, presents to the ED reporting the following: • 10 liquid, bloody stools in past 24 hours • Tenesmus (unpleasant and urgent sensation to defecate) • Severe lower abdominal cramping • Pain level 7 • Denies history of GI disorders V.S are 122/74, 110, 24, 100.3 The provider has ordered IV fluids, complete blood count (CBC), and complete metabolic panel (CMP). The patient is NPO. 1. Explain the rationale for the provider's orders, (USLO 1) 2. What additional physical assessment data would you obtain? Explain. (USLO 1) 3. Explain the nursing care necessary. (USLO 1, 6) J.L is diagnosed with severe ulcerative colitis (UC). It has been 4 hours since J.L came to the E.D. and she has had 3 bloody liq stools. Reassessment of V.S reveal the following: 98/66, 122, 22, 100.1. 4. Two hours later when assisting J.L up to the restroom, J.L reports feeling lightheaded and nauseous. Explain your next act What do you think may be happening in your patient? What are your concerns? (USLO 1, 6) de tirer and hysical assessment findings:

Answer 1

1) The patient is NPO(nil per mouth) because taking food orally might trigger the already existing symptoms.

IV Fluids are ordered as he has severe fluid loss due to bloody stools. So, to compensate for fluid loss and to prevent him from hypotension IV fluids needs to be given.

CBC to check for anemia due to blood loss, also to check for WBC count (if it's elevated due to any infection, most likely due to UTI).

CMP to check for electrolytes, hyperkalemia is common in diarrhea, if not corrected, causes arrythmias, muscle weakness fatigue etc.

2)Additional physical assessment would be looking out for clubbing in nails which is common in ulcerative colitis.

To look out for pallor, episcleritis, inflammation of joints, abdominal examination to look out for tenderness, masses.

3)Close monitoring of patient's vital signs is needed, inform the phyiscian if she develops hypotension, fever, tachycardia.

Assist her to washroom.

If she is anxious, calm her down, give reassurance.

If she has abdominal pain give pain medications after informing the physician.

4) Light headedness and nausea are due to excessive fluid loss. Hypotension can be also due to sepsis (more likely UTI). As her bp came down, have to give DNS 2 pints bolus and paractemol injection for fever and inform the physician regarding the status of the patient.