Question

^{_{Mason is a 15-year-old who had megacolon and had a small bowel reconstruction. He is 2 days post-op. In the report, you were told that he went for a walkabout an hour ago, sat in the chair. When the nurse helped him back in bed he said he was having a lot of pain in his abdomen.}}

^{_{Doctor’s Orders:}}

^{_{IV fluids: D5 . 45 NS at 78 cc/hr until po intake is over 500cc}}

^{_{Morphine 1.5 mg IV Q 2 hours prn for pain greater than 5}}

^{_{Tylenol 650mg Q 6 hours prn via Ng tube for pain}}

^{_{Oxycodone 5 mg Q 4 hours prn for pain}}

^{_{Colace 120 mg BID per NG tube}}

^{_{Zofran 4 mg IV Q 6 hours prn for nausea}}

^_NPO

^{_{NG to suction, may disconnect to ambulate, chart NG output Q 4 hours}}

^{_{Strict I&Os}}

^{_{Ambulate 6 times a day}}

^{_{Out of bed to chair QID}}

^{_{Daily weights}}

^{_{Vs per protocol (Q 4 hours 48 hours post op than q shift)}}

^{_{Please answer the following questions based on your findings and the information in the patient PowerPoint.}}

^{_{1. What are the Top 3 priority assessments or cues for Mason?}}

^{_{1. ____________________________________________}}

^{_{2. ____________________________________________}}

^{_{3. ____________________________________________}}

^{_{2. What are the Top 3 priority nursing actions/interventions for Mason based on your assessment findings throughout the shift?}}

^{_{1. ____________________________________________}}

^{_{2. ____________________________________________}}

^{_{3. ____________________________________________}}

^{_{3. After looking over his labs, what results are abnormal and what is a possible cause for them being abnormal?}}

^{_{4. Identify 3 things you evaluated to ensure your interventions were effective in helping Mason?}}

^{_{1. _____________________________________________}}

^{_{2. _____________________________________________}}

^{_{3. _____________________________________________}}

^{_{5. Please write the dosage for all of the medications you would/should have given and or did give during your shift, based on the concentrations found on the medication slide.}}

^{_{6. Assessment findings:}}

^{_{7. Answers for any other questions posed in the power point:}}

Basic Metabolic Panel	Results	Reference Range
Sodium	125	135-145 mmol/L
Potassium	3	3.5-5 mmol/L
Chloride	100	97-110 mEqu/L
Calcium	2	2-2.6 mmol/L
Hematology	Results	Reference Range
Hemoglobin	13 g/dL	12-16 g/dL (female) 14-17 g/dL (male)
Hematocrit	39%	36-47% (female) 41-51% (male)
Platelets	400	150-450 x 103 /mm3
White blood cells	5,000 / mm3	3,200-9,800/mm3

Answer 1

1.To determine the cause of pain address the issue to the physician

Correction of hyponatremia and hypokalemia

Correction of hypocalcemia

2.Correction of hyponatremia with 3 per cent NaCl

Correction of hypocalcemia with calcium gluconate administration

Analgesic administration for pain.

3.Hyponatremia can be due to continuous NG tube aspiration and lack of normal saline in iv fluids.

Hypocalcemia can be due to lack of calcium supplements in the diet.

4.Ask the patient for symptom relief. Repeat serum electrolyte and calcium to see whether it is corrected or not.