While you are working as a nurse

While you are working as a nurse on GI/GU floor, you receive a call from your affiliate outpatient clinic notifying you of a direct admission. Estimated time of arrival is 60 minutes. She gives you the following information: Agnes Giotta is an 87-year-old woman with a three-day history of intermittent abdominal pain, abdominal bloating, and nausea and vomiting. Mrs. Giotta moved from Italy to join her grandson and his family only two months ago, and she speaks little English. All information was obtained through her grandson. Past medical history includes colectomy for colon cancer 6 years ago and ventral hernia repair 2 years ago. She has no history of coronary artery disease, diabetes mellitus, or pulmonary disease. She takes only ibuprofen occasionally for mild arthritis. Allergies include sulfa drugs and meperidine. Her tentative diagnosis is small bowel obstruction secondary to adhesions. She is being admitted to your floor for diagnostic work-up. Her vital signs are stable, and she has an IV of D5 1/2NS with 20 mEq KCl at 100 mL/hour and oxygen by nasal cannula. The NG tube suddenly drains 575 mL; then it slows down to 250 mL over 2 hours. Is this an expected amount? You enter the patient’s room to initiate your shift assessment. Mrs. Giotta has been hospitalized for 3 days, and her abdomen seems to be more distended than yesterday. How should you determine whether Mrs. Giotta’s abdominal distention has changed?

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