Case Overview: Note* this case could present

Case Overview: Note* this case could present as male/female. The gender is irrelevant to the case. Location: Emergency Department A 52-year-old patient has just arrived in the Emergency Department with complaints of severe abdominal pain, nausea, and vomiting over the last few days. His abdomen is distended. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt “dizzy” and “weak” all evening. He thought it might be the flu but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment and labs have been drawn. Background: Complaining of abdominal pain, nausea, and vomiting that began 1-2 days ago. Noted some “swelling” in his abdomen and feels bloated. Poor appetite and admits to not eating or drinking much for the past few days because of an “upset stomach.”Bowel movement about 3 days ago. COVID test was negative. Past surgical history notable for Cholecystectomy, appendectomy, and right inguinal hernia repair, all more than 5 years ago. The patient has an allergy to Demerol for which rash). The patient’s spouse is deceased, and they live alone. Assessment: Vital Signs: HR 128; BP 108/83; RR 18; SpO2 93% on room air; Temp 99.0F General Appearance: Calm and weak Cardiovascular: ​Sinus Tachycardia Respiratory: Breath sounds clear GI: Hyperactive bowel sounds, Abdomen is distended and tender, Bowel movement 3 days ago GU: Voided last yesterday Extremities: Pale and warm, Pulses strong bilaterally Skin: Pale warm and dry, Skin turgor poor, Dry mucous membrane Neurological: Alert and oriented to person, place, and time, Pupils equal, round, and reactive to light and accommodation, No Neurological deficits IVs: 20G IV with a transparent dressing; Infusing 500ml normal saline bolus Labs: CBC, BMP Fall Risk: High risk for falls Pain: Complaining of pain in abdomen; 4/10 on pain scale Knowledge, Skills, and Attitudes Using the references below, complete the questions below for the knowledge portion. In addition to the knowledge, there are skills and attitudes applied in the scenarios that will need to be reviewed. Answers may be typed or handwritten. Bullet points are acceptable. This preparation will be used as your resource during the SBE. Student References: 1. Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier. ISBN-13: 9780323612425a. Chapter 51 – 1110-1115;b. Chapter 13 – 247-249c. Chapter 14 – 267-2682. Skills reference – could be textbook or Galen skill videoa. This is a link to access all the skill videos These are also hyperlinked below. https://allaccess.galencollege.edu/s/media/page/Home ​ Knowledge Complete the questions below. Answers may be typed or handwritten. Bullet points are fine. The purpose of this knowledge is to provide a resource to use during the SBEs. Complete drug sheet/drug card(s) for all medications listed for the patient; this information can be used during the SBE. 1. Describe the following related to intestinal obstruction: a. Pathophysiology b. Clinical manifestations c. Interventions d. Nursing management for the care/treatment? 2. Describe the following related to fluid imbalance dehydration: a. Pathophysiology b. Clinical manifestations c. Interventions d. Nursing management/treatment? 3. How would you prioritize care for this patient and why? 4. What is the nurse’s responsibility in administering intravenous fluids? 5. List the principles for safe, effective administration of parenteral medication. 6. Describe the key assessment data for a preoperative patient? Pharmacology: Complete the Medication Assessment portion of your clinical packet or make drug cards for each medication listed below. Include medication name, drug classification, dosage/route/frequency/, purpose of medication, nursing considerations, and patient education. If a medicine is administered intravenously include dilution, rate of administration, and compatibility. Bring this with you. 1. Normal saline bolus intravenous 2. Morphine intravenous push 3. Ondansetron intravenous push Skills Review the following Skills that are applied in the scenario. Take notes if needed to guide you during the scenario. 1. Physical assessment of the Gastrointestinal system 2. Insertion of a nasogastric tube 3. Administration of intravenous fluids 4. Medication administration via IV push; 5. Medication administration via IVBP Attitudes Review the following Attitudes that are applied in the scenario. Take notes if needed to guide you during the scenario. 1. What information is important to include in preoperative teaching? 2. Describe the nurse’s responsibility regarding consent for surgery including legal and ethical considerations? 3. What therapeutic communication techniques would be appropriate for a patientwho is anxious? 4. Describe what resources you would use if you were unsure of how to care for this patient. This could be regarding assessment, interventions, or communication. 5. On the contrary, describe how you would support a peer if you recognized they were unsure of how to care for a patient.

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