Nursing Care of a Patient with Altered Gastro-Intestinal Function - Case Study Example

Running Head: Nursing Care Nursing саrе оf а раtiеnt with аltеrеd gаstrо-intеstinаl funсtiоn Name Institution Date Nursing саrе оf а раtiеnt with аltеrеd gаstrо-intеstinаl funсtiоn The patient I am taking care of today is Nigel, who has an altered gastrointestinal function. I have not met Nigel, however, as a nurse, there are various signs and symptoms that expect to see, hear and feel when I first meet Nigel at his bedside. I expect to see Nigel having abdominal pain. I will also see Nigel experiencing constipation, diarrhea, and nausea. I also expect to see a feeble and uncomfortable Nigel. The reason as to why I expect to see these symptoms is because they are highly associated with patients who have altered gastrointestinal function. According to the Gastrointestinal Society (2015), the first symptoms that can be seen in patients with altered gastrointestinal function are abdominal pains, constipation, and diarrhea or both. Abdominal pain for these patients is usually related to altered bowel habits of diarrhea. Patients with this illness are seen to be weak from their lack of eating. They do not have an appetite and have bad eating habits. Pain and diarrhea also make them vulnerable. They also have a lot of discomfort from bloating and excessive hurting. Longstreth et al., (2006) describes that altered gastrointestinal function is characterized by a patient experiencing pains that are related to an abnormal bowel pattern. The bowel behaviors are altered, and a patient may be constipating, diarrhea or interchanging between the two extremes of stool consistency. Corsetti et al., (2004) denote that the prominent symptoms for altered gastrointestinal function include bloating, incomplete bowel emptying, urgency as well as excessive straining and visible abdominal distension. Patients are very uncomfortable most of them experiencing headache, muscle pain, fatigue and urogenital symptoms (Maxton et al., 1991). A patient with a functional gastrointestinal disorder is usually fragile with an impaired health that reduces their quality of life (Simren et al., 2006). Nigels’ condition requires continuous assessment as well as monitoring. It will enable me detect any changes in his condition. In assessing Nigel, there is a sequence of evaluations that I will make. The assessment will involve inspection, auscultation, percussion and palpation (Ellchuk, 2005). I will assess Nigel’s mouth and throat. I will monitor any complications in swallowing chewing, pain in the mouth, odor and gas reflex. Any presence of these signs will show the condition of Nigel is worsening. I will assess the abdomen for any presence of sounds, tenderness, air bubble, rigidity, and pain. I will monitor any complications of pressure on the abdomen and minimize when necessary since its presence may start peristalsis as well as audible bowel sounds. Auscultation is essential to provide information about the stomach on bowel motility as well as vascular information. Monitoring the sounds is important to note any complications of hypoactive and inconsistency with postoperative ileus. The absence of sounds shows that Nigel’s condition is improving. I will assess the anus for pigmentation. I will monitor any complications of pain, burning, lesions, excoriation, hemorrhoids, itching, tenderness, and rashes that signals need for medication. I will also evaluate the elimination patterns. I will monitor frequent deletions that need to be stopped. The route of elimination is important to be assessed whether it is through rectal, colostomy or ileostomy. Monitor complications of the colostomy. I will also determine the character of removal in terms of color, constipation, consistency, and diarrhea. I will observe any blood presence in diarrhea. Any presence of colostomy, constipation and diarrhea shows Nigel’s condition is not improving. I will assess the nutrition of Nigel to evaluate his weight, recent weight change, height, weight and ideal body weight. I will also evaluate the method of intake. The condition of the skin will also be evaluated. Any weight loss for Nigel is a danger sign that he is not doing well. I will also be monitoring complications like vomiting and nausea. About the skin, I will watch for any paleness that is a danger sign for an unhealthy skin. Any vomiting and paleness of the skin shows his condition is not improving. Any weight loss indicates that he is not improving. In assessing the body temperature of a patient, the acceptable equipment for measuring temperature is a thermometer. A thermometer is usually inserted in a patient’s tongue or under the arm for measuring temperature (Springer, 2009). There are various methods of measuring temperatures in patients. They include neonate, tympanic temperature, Oesophageal, skin, and nasopharyngeal. Neonate is a method used for measuring the temperature on the admission of a patient. Neonate takes the temperature every 3 to 4 hours, not unless the temperature drops outside the normal limits (Ellis, 2005). When it falls outside the normal limits, neonates should be taken hourly until the temperature drops back to normal limits (The Royal Children’s Hospital Melbourne, 2015). Neonate is used for taking the temperature in children of 3 months and below. Rectal or axilla temperature is taken using a digital thermometer. Tympanic temperature is a method used to measure the temperature in children of 3 months and above. Tympanic temperature usually reflects the accurate pulmonary artery temperature even when the temperature of the body is rapidly changing (Block, Lilienthal, Cullen, White, 2012). Oesophageal, skin and nasopharyngeal methods are used to take the temperature when monitoring specific areas like in theater and PICU (Springer, 2009). According to Ganio, Brown, Casa et al., (2009) the acceptable time frame required to assess accurately body temperature is 5 minutes using any method. There are various factors that can prevent or enhance accurate assessment of body temperature. They include; the method of measurement, the location of the instrument, insertion, and lag phenomenon. The method of analysis determines the accuracy of temperature assessment. The method that is most accurate is the rectal temperature measurement. According to Casa, Becker, Ganio, et al., (2007), rectal thermometers are usually the gold standard measurement method of temperature. The reason is that they are accurate as well as reliable in all conditions. The location and insertion of the thermometer affect the accuracy of assessment since it may be uncomfortable (Moran & Mendal, 2002). The lag phenomenon may lead to inaccuracy due to interference with poor blood supply in the rectum. It may also be inaccurate due to presence of feces and postural differences at the time of recovery (Ganio, Brown, Casa, et al., 2009). Based on the above information, below is evidence-based best practice statement on how to accurately assess body temperature for medical-surgical setting. Assessment of temperature for medical-surgical setting should be done using the rectal method, with proper insertion for best results. Based on medication management, Nigel has been prescribed with an opioids infusion using a patient controlled analgesia device. The reason for giving this medication to Nigel is to reduce postoperative pain to the patient. The use of a patient controlled analgesia device to administer opioids is to improve pain management to Nigel. The method helps in reducing the risks that are associated with the patient-centered technology (Grissinger, 2008). Intravenous opioids can be administered to postoperative patients to control pain using PCA that is designed for that purpose (Hudcova, McNicol, Quah, 2006). Nigel has been prescribed with aminoglycoside antibiotic since it is good and recommended medication that is effective in treating severe abdominal infections (Gonzalez, Pharm, & Spencer, 1998). Prescribing the dopamine antagonist antiemetic, metoclopramide medication to Nigel was necessary so as to prevent nausea and vomiting (Smith, Cox, & Smith, 2012). There are various nursing responsibilities associated with the medication of the three drugs. Continual measurement of pain on Nigel to monitor the level of pain is necessary after administration of opioid using PCA. This will help in establishing whether the medication is active, and pain is diminishing (Hudcova, McNicol, Quah, 2006). The nurse also has the responsibility of monitoring any signs of over-sedation, hypoxia, and hypoventilation. A nurse should also be keen not to overdose the patient. Using flow sheets is important for documenting the doses as well as patient monitoring. Overdosing Nigel may lead to cardiovascular problems like cardiac arrest. High doses of metoclopramide should be avoided to reduce the extrapyramidal symptoms. The nurse should also monitor the dosage of aminoglycosides antibiotics to avoid overdosage. The dosage should be in the ordinary range of Read More