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Case Study - Clinical Approach -Nausea and constipation in an older woman

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PROBLEM 17 Nausea and constipation in an older woman Robert Ludemann A 68-year-old woman presents with a 2-day history of nausea and constipation. She has not been able to eat or drink anything in the last 2 days because of the nausea. Her co-morbidities include obesity (BMI = 41), type II diabetes, hypertension, sleep apnoea and carcinoma of the rectum treated 2 years previously by abdoperineal excision and end colostomy. Her medications include simvastatin, perindopril and gliclazide. The patient has now developed colicky and generalized abdominal pain and has vomited once. On examination the patient appears uncomfortable and in pain. Her pulse is 90 bpm and blood pressure 148/88 mmHg. The cardio­ pulmonary examination is unremarkable. Her abdomen is obese and appears distended with mild tenderness to palpation. She has a lower midline scar from umbilicus to pubis and a left iliac fossa colostomy. There is no palpable mass in the abdomen or either groin. The stoma appears healthy. Q.1 What is your preliminary diagnosis for this patient and what are the most common causes? Q.2 What investigations would be appropriate at this stage? The results of the investigations are shown below and in Figures 17.1 and 17.2. Investigation 17.1 Summary of results White cell count 8.6 × 109/L 145 mmol/L Calcium 2.16 mmol/L 4.6 mmol/L Phosphate 1.15 mmol/L Chloride 105 mmol/L Total protein 62 g/L Bicarbonate 27 mmol/L Albumin 35 g/L Urea 9.1 mmol/L Globulins 27 g ...
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Tags: Patient With Debilitating Pain Nursing Classifications and Languages Pain Management nursing care Nursing Test Board Pathophysiology of Pain Nociceptors Pain Syndromes and Unusual Severe Pain Problems Postmastectomy Pain Syndrome Burn Pain Gate Control Theory Pain and Analgesia Guidelines for Assessing Pain in Patients With Disabilities Establishing the NursePatient Relationship and Teaching Identifying Goals for Pain Management Managing Anxiety Related to Pain Pain at the End of Life DVERSE INTERACTIONS OF HERBAL SUBSTANCES OR FOODS WITH ANALGESIC AGENTS Agents used to Reverse and treat Pain Inadequate Pain Management PRN Range Opioid Analgesic Orders Safe Use of Transdermal Fentany Transcutaneous Electrical Nerve Stimulation Care of the Patient With Pain Homeostatic Mechanisms Kidney Functions Heart and Blood Vessel Functions ReninAngiotensinAldosterone System Antidiuretic Hormone and Thirst Osmoreceptors Pathophysiology Gerontologic Considerations Medical Management Electrolyte Imbalances Assessment and Diagnostic Findings Detecting and Controlling Hyponatremia POTASSIUM DEFICIT HYPOKALEMIA Emergency Pharmacologic Therapy HYPERPHOSPHATEMIA HYPOCHLOREMIA Nursing Management of the Patient Receiving Intravenous Therapy Guidelines for Starting an Intravenous Infusion When Should a Peripheral IV Catheter Be Changed Assessing for Phlebitis Shock and its Stages Recognizing Shock in Older Patients Gastrointestinal Effects Hematologic Effects Cardiovascular effects Crystalloid and Colloid Solutions Vasoactive Medication Therapy Fluid Administration Cardiogenic shock Circulatory Shock Earlier Treatment of Patients With Sepsis Neurogenic Shock NAPHYLACTIC SHOCK Epidemiology of Cancer Characteristics of Malignant Cells CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS Lymphatic and Hematogenous Spread Angiogenesis Etiology Oncology Management of the Patient with Cancer American Cancer Society ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention DIAGNOSTIC AIDS USED TO DETECT CANCER Tumor Staging and Grading Oncology Nursing Management SELECTED TECHNIQUES USED TO REMOVE OR DESTROY TUMORS INDICATIONS FOR PALLIATIVE SURGERY Nursing Management in Cancer Surgery Radiation Therapy and Dosage Chemotherapy Cell Kill and the Cell Cycle CLassification of Chemotherapeutic Agents ANTINEOPLASTIC AGENTS Use of Acupressure to Reduce Chemotherapyinduced Nausea and Vomiting Malignant Skin Lesions Pain Management for Cancer Patients Nutritional Problems Potential Consequences of Impaired Nutrition in Patients With Cancer ONCOLOGIC EMERGENCIES MANIFESTATIONS AND MANAGEMENT Palliative Care Hospice Care Responding With Sensitivity to Difficult Questions Breaking Bad News The SPIKES Strategy Assessing EndofLife Care Beliefs Preferences and Practices Assessing the Patient and Family Perspective Goal Setting in Palliative Care Managing Physiologic Responses to Terminal Illness Palliative Nursing Interventions for Dyspnea MEASURES FOR MANAGING ANOREXIA KBLERROSSS FIVE STAGES OF DYING Recovering From Abdominal Surgery CATEGORIES OF SURGERY BASED ON URGENCY Patients Undergoing Ambulatory Surgery Emergency Surgery Preoperative Nursing Intensive Care Preoperative Instructions to Prevent Postoperative Complications Providing Psychosocial Interventions Nursing Intervention Following Day Surgery for Breast Cancer Intraoperative Nursing Management Postoperative Nursing Management ith Impaired Cough Reflex A Patient With Impaired Cough Reflex Assessment of Respiratory Function Anatomy of the Respiratory System harynx Tonsils and Adenoids Causes of Increased Airway Resistance Pulmonary Diffusion and Perfusion VentilationPerfusion Ratios Management of Patients With Upper Respiratory Tract Disorders Chest and Lower Respiratory Tract Disorders Patients With Chronic Pulmonary Disease Respiratory Care Modalities
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