98%(131)128 out of 131 people found this document helpful
This preview shows page 1 - 7 out of 28 pages.
INFLAMMATORY BOWEL DISEASE WITH SMALL BOWEL OBSTRUCTIONCase Study #48 Jasline Lee NU 460
SCENARIO C.W., a 36-year-old woman, was admitted several days ago with a diagnosis of recurrent inflammatory bowel disease (IBD) and possible small bowel obstruction (SBO). C.W. is married, and her husband and 11-year-old son are supportive, but she has no extended family in-state. She has had IBD for 15 years and has been taking mesalamine (Asacol) for 15 years and prednisone 40 mg/day for the past 5 years. She is very thin; at 5 feet 2 inches she weighs 86 pounds and has lost 40 pounds over the past 10 years. She has an average of 5 to 10 loose stools per day. C.W.'s life has gradually become dominated by her disease (anorexia; lactase deficiency; profound fatigue; frequent nausea and diarrhea; frequent hospitalizations for dehydration; and recurring, crippling abdominal pain that often strikes unexpectedly). The pain is incapacitating and relieved only by a small dose of diazepam (Valium), oral electrolyte solution (Pedialyte), and total bed rest. She confides in you that sexual activity is difficult: “It always causes diarrhea, nausea, and lots of pain. It's difficult for both of us.” She is so weak she cannot stand without help. You indicate complete bed rest on the nursing care plan.
1. IDENTIFY SIX PRIORITY PROBLEMS FOR C.W.• Diarrhea• Malnutrition • Potential fluid and electrolyte imbalances• Chronic pain• Fatigue• Lactase deficiency
2. CONSIDERING C.W.'S WEAKNESS, CHRONIC DIARRHEA, AND LOWER-THAN-DESIRED BODY WEIGHT, WHAT NURSING INTERVENTIONS NEED TO BE IMPLEMENTED TO MINIMIZE SKIN BREAKDOWN?• Keep the perianal area clean and dry. Use a skin barrier (e.g., zinc oxide) as needed.• Use medicated wipes, such as Tucks, on the anal area as needed.• Monitor pressure areas, especially those in contact with the bedpan.
CASE-STUDY PROGRESSC.W.'s condition deteriorates on the third day after admission; she experiences intractable abdominal pain and unrelenting nausea and vomiting. C.W. is taken to the operating room for probable SBO and is readmitted to your unit from the post anesthesia care unit. During surgery, 38 inches of her small bowel were found to be severely stenosed with two areas of visible perforation. Much of the remaining bowel is severely inflamed and friable. A total of 5 feet of distal ileum and 2 feet of colon have been removed, and a temporary ileostomy was established. She has a Jackson-Pratt (JP) drain to bulb suction in her right lower quadrant (RLQ), and her wound was packed and left open. She has two peripheral IVs, a Salem Sump nasogastric tube (NGT), and a Foley catheter. Her vital signs (VS) are 112/72, 86, 24, 100.8° F (38.2° C) (tympanic). You attach her NGT to low-continuous wall suction per the postoperative orders.