Concept/Exemplar : _Inflammation/Inflammatory Bowel Disease (IBD)…

Question Answered step-by-step Concept/Exemplar : _Inflammation/Inflammatory Bowel Disease (IBD)… Concept/Exemplar: _Inflammation/Inflammatory Bowel Disease (IBD)  Student Learning Outcomes (SLOs): See CLM concept/exemplar for SLOs.Scenario: Please use your Pearson Text as a reference Identify the 4 Top client findings requiring immediate follow-up 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 the 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 (157 cm), she weighs 86 lbs (39 kg) and has lost 40 lbs (18 kg) over the past 10 years.She averages 5 to 10 loose stools per day. C.W.’s life has gradually become dominated by her disease, with 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.           (NG NCLEX What matters most? Noticing) Tanner’s Clinical Judgement model  1.    Considering C.W.’s weakness, chronic diarrhea, and lower-than-desired body weight, what nursing interventions need to be implemented to minimize skin breakdown? Name at least 6.   2.    What is the mechanism of action of the mesalamine (Asacol) in relation to the IBD?a. It increases bulk and moisture content in the stool.b. It relaxes the smooth muscle of the intestines, thus reducing motility.c. It slows intestinal motility, prolonging transit time of intestinal contents.d. It blocks prostaglandin production, thus diminishing inflammation in the colon. 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 because of probable SBO and is readmitted to your unit from the postanesthesia care unit. During surgery, 38 inches (96 cm) of her small bowel was found to be severely stenosed, with 2 areas of visible perforation. Much of the remaining bowel is severely inflamed and friable.  A total of 5 feet (152 cm) of the distal ileum and 2 feet (61 cm) of the 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 2 peripheral IV lines, 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 3.    The nurse begins a thorough postoperative assessment of C.W.’s abdomen. What does your assessment include? List the steps in the order in which the assessment should be completed.  4.    Complete a concept map on C.W.’s care adding additional information as the case changes. (Deliverable) 5.    A nursing student enters C.W.’s room and auscultates her abdomen. She looks at the nurse and excitedly announces that she hears good bowel sounds. The nurse takes the opportunity to teach her the proper method of auscultating bowel sounds on a patient who has NGT to low-continuous wall suction. How would the nurse correct her error?  6.    Four hours later, you measure the drainage from the JP tube. Look at the following figure and state how much drainage you obtained.   7.    What else will the nurse note about the drainage? 8.    Describe the proper method for reestablishing suction on the JP drain after you have emptied the bulb container. 9.    C.W. asks you, “I know why I have the pouch (ileostomy). Why do I have to have this other little tube?” How will you explain the purpose of the JP drain?  CASE STUDY PROGRESSIt is 4 days after C.W.’s surgery. During the routine dressing change, you note a small pool of yellow-green drainage in the deepest part of the wound. The nurse obtains an order for a wound culture. 10. How will the nurse obtain a culture specimen from C.W.’s wound? 11. What information do you need to send to the lab with the wound culture specimen?  12. The nurse obtains a wound culture specimen, completes the dressing change, obtains a full set of VS, notes a temperature of 100.4° F (38° C), and assesses increased tenderness in C.W.’s abdomen. (NG NCLEX What is most likely occurring? Interpreting) What orders does the nurse anticipate receiving once the surgeon is notified of C.W.’s condition?   13. As you assess C.W.’s stoma and drainage, what would indicate that they are healthy? Select all that apply.a. The stoma will be level with the skin.b. The stoma will be in the shape of a donut.c. The drainage will be thick and dark brown.d. The skin around the stoma should be intact.e. The stoma will be a uniform medium cherry red.f. The stoma will be light pink, and an occasional dark spot might appear. 14. What does the nurse document after changing the stoma bag with the patient for the first time?  15. Will any aspect of C.W.’s history significantly affect the wound healing process? If so, how? 16. The surgeon tells you she will be there to examine C.W. As you tell C.W. that her doctor is coming to talk to her, C.W. says that she feels something wet running down her side. You find some leakage of intestinal drainage onto the skin. What are the nurse’s Top 3 actions and why? (NG NCLEX What interventions are needed immediately? Responding)  CASE STUDY PROGRESSYou change the ileostomy appliance before the surgeon arrives. C.W. is evaluated, and it is determined that she has developed peritonitis, and needs to return to surgery for exploratory laparotomy. The surgery revealed another area of perforated bowel and generalized peritonitis. Another 12 inches (30.5 cm) of ileum were resected. The peritoneal cavity was irrigated with normal saline (NS) and 3 drainage tubes were placed: a Jackson-Pratt (JP) drain to bulb suction, a rubber catheter to irrigate the wound bed with NS, and a sump drain to remove the irrigation fluid. The initial JP drain remains in place. A right subclavian triple-lumen catheter was also inserted. 17. A few hours later, C.W. is still experiencing pain from the peritonitis as well as from the surgical incision. Which position may help to make her more comfortable?a. Lying on her left sideb. Lying on her right sidec. Supine with legs extendedd. Head of the bed slightly elevated, with knees, flexed 18. C.W. has been on NPO status since the surgery. The surgeon orders total parenteral nutrition (TPN) at a rate of 50 mL/hr. What is the purpose of these orders? What are the 3 Top Priorities when managing a patient on TPN? 19. The pharmacy delivers C.W.’s first bag of TPN. You have an order to stop the maintenance IV infusion after starting the TPN. What is the purpose of this order? 20. During the night shift the TPN solution bag becomes nearly empty, and the night nurse discovers that the next bag of TPN has not been prepared. The hospital pharmacy does not prepare TPN during the night shift. What does the nurse need to do next?a. Hang a bag of D5b. Hang a bag of D10W when the TPN is finished. c. Convert the line to a saline lock until the TPN solution is ready.d. Slow the TPN rate to 10 mL/hr. until the next TPN bag can be prepared.  CASE STUDY PROGRESSYou discuss your concerns about C.W.’s nutritional status with C.W.’s surgeon. She agrees to request a consultation from a registered dietitian (RD). After gathering data and making several calculations, the RD makes recommendations to the surgeon. The TPN orders are adjusted, C.W. begins to gain weight slowly, and her wound shows signs of healing. 21. You discuss with the RD what specific digestive difficulties C.W. is likely to face. What problems might C.W. be prone to develop after having so much of her bowel removed? 22. The RD talks with C.W. about her dietary needs. You attend the session so you will be able to reinforce the information. What basic information is the RD likely to discuss with C.W.? CASE STUDY OUTCOMEC.W. is successful in her battle with peritonitis. Gradually tubes are removed as she grows stronger with TPN and time. C.W. learns how to change her ostomy appliance and is discharged to home. She attends an enterostomal support group on a regular basis. (NG NCLEX What findings show interventions are working? Reflecting) Reflecting/AnalysisUsing the information from this case, compare and contrast the findings with an ostomy, normal wound healing, and pressure injury or skin excoriation. (NG NCLEX What could it mean? Noticing/Analyzing) TimeClient Findings (above)OstomyHealing wound Pressure injuryOR Skin excoriation DrynessEdemaExudateEscharFoul odorRednessStoolWarmthPainOthersjQuery224008631402711633074_1616869820127?□□□□□□□□□□□□□□□□□□ Name Top 2 nursing interventions for each      e.g. nutrition                                                              Health Science Science Nursing NUR 1035 Share QuestionEmailCopy link Comments (0)