Question

Edward (Ted) Williams is an 82year old male who is day 4 post-operative following a bowel resection and formation of a temporary colostomy. Ted had previously had a coloscopy and biopsy that confirmed a malignant mass. He has a past medical history of; heart failure, type II diabetes melilites, obesity and gout. (BMI 37.6m2; Height 175cm; weight 115kgs) Ted is a widower and lives alone. His wife died 3 years ago following a bout of pneumonia. One year ago, Ted moved into a retirement village located in a regional area two and a half hours from the city. The retirement village is near where he lived with his wife and children until they left home. Ted has 2 grown up children, a son Christopher who lives overseas with his wife and son, and a daughter Janice who lives with her husband and 3 children in the city. While Ted lives alone, he has a partner Gwen 78, who also lives in the same retirement village as Ted. Current medication: Metformin 500mg Mane Captopril 12.5mg mane Frusemide 40mg mane Allopurinol 100mg Daily Paracetamol 1g QID Ted is now day 4 post op. He was Nil By Mouth (NBM) for the first 48 hours after surgery. Yesterday he commenced on a full fluid diet and has upgraded to a light diet yesterday evening. Today, Ted was given his regular metformin and ate breakfast. Since then Ted has vomited twice and feels nauseous. He has been given ondansetron 4mg for nausea. Teds vital signs at 10am are as follows: T 38.1; HR 98 reg; BP 135/85; RR 26; SpO2 94% on 3L NP. He has right sided inspiratory coarse crackles and he has a moist productive cough. He has PCA morphine in situ for effective pain regulation. Ted has some abdominal pain that he says is at a scale of 4-5/10, he says the pain worsens on palpation to 7/10 and you note that his abdomen is distended. The colostomy bag is intact and the stoma can be sighted through the bag. The stoma is warm, pink, moist and slightly raised above the skin. There has been no output since his surgery. He has sluggish bowel sounds and has not passed flatus. The abdominal laparotomy has a clear occlusive dressing (opsite) and there is minimal ooze present. He has a redivac drain with 30mls of haemoserous fluid, and a urinary catheter in situ and is passing approx. 60-70mls of urine/hr.

Q. Expected diseases ==>Pulmonary Oedema, Hyperosmolar Hyperglycaemic and Electrolyte imbalance/Fluid overload.

Please let me know above pt care goals clearly and FIVE nursing care interventions.

Answer 1

Goals

* patient has balance intake, output and stable weight.

* Patient should maintain clear lung sounds as manifested by absence of pulmonary crackles.

* Patient will get rid of pain with in 48 hours.

NURSING INTERVENTIONS

1) Instruct patient care givers and family regarding importance of fluid restrictions.

2) Maintain intake output chart.

3) Provide diuretics as prescribed.

4) Consider interventions related to other complaints(eg. Heart failure, DM etc, )

5)Educate the family and patient regarding modification of life habits, food habits, proper nutrition and hydration.

6) Provide medication for pain as per doctor's order.