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Bowel Resection 1Running head: SMALL BOWEL RESECTIONSmall Bowel ResectionElisabeth FandrichMontana Tech Nursing Department NURS 1566 Core Concepts of Adult NursingMarch 31, 2008 Noel Mathis RN, BSN, MSNSmall Bowel ResectionA resection of the small bowel is a surgical procedure in which a section of the intestine isremoved. Common reasons that necessitate this surgery are Crohn’s disease, ulcers, cancer,
Bowel Resection 2intestinal obstruction, injury, and precancerous polyps. Patient 350
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, C, T was brought to theemergency room on March 30, 2008 by her family complaining of severe abdominal pain,constipation lasting more than five days and a large bulge of the left groin. It was determined thatthe patient had developed a left inguinal hernia with possible bowel obstruction. Surgery wasindicated. As with any type of surgery, a signed consent form is required. The procedure, whatcan be expected, risks, and goals are discussed with the patient. The patient must take no food or fluids after midnight the night before the surgery. Blood and urine labs will be collected as well asimaging tests. It is standard practice to administer prophylactic antibiotics, insert a nasogastrictube and foley catheter. After 350
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,C,T was admitted to the emergency department, routinehematology and chemistry labs were drawn. When it was determined that she would requiresurgery, labs were drawn for coagulation and blood bank tests. The initial blood work showed anelevated WBC of 18.70 indicating acute infection, elevated platelet count of 448 (normal 140-400), elevated % neuts, absolute neuts and % lymphs. Sodium, potassium, chloride, and totalCO
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were low indicating dehydration and electrolyte imbalance. Serum glucose was slightlyelevated at 127 (normal range 65-110) may be attributed to the stressful situation, but will mostlikely be monitored to rule out diabetes mellitus. BUN was elevated at 40 (normal range 7-23)due to dehydration. Calcium was slightly elevated at 10.8 which may be related to the patient’shistory of osteoperosis. Serum protein was slightly elevated at 8.2 (normal range 6.2-8.1) whichmay be attributed to dehydration. A/G ratio was slightly low perhaps because of vitamin Csupplementation or malnutrition. The ALT was also low at 18 (normal level 20-55) which might be attributed to stress.The small bowel resection is routinely done by placing the patient under general anesthesia,making a midline incision, removing the diseased or damaged bowel then suturing or stapling theremaining sections together. Upon entering 350
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,C,T’s abdominal cavity, the surgeon found a
Bowel Resection 3large amount of dilated bowel. The surgeon followed this down to the hernia and found that asection of the bowel and some of the omentum was reduced and strangulated. The surgeondetermined that the creation of a stoma was not necessary. The incision is then closed. Theremoved sections of 350
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,C,T’s intestine and omentum were sent for pathologic diagnosis. Thefinal pathologic diagnosis showed that there was an area of ulceration of the mucosa. The wall of this area was very thing and had focal necrosis of the mucosa. The findings were consistent withischemic necrosis. The patient developed a hernia into which an area of intestine slipped and became strangulated causing necrosis of the tissue and obstruction of the bowel.The surgery performed on 350
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,C,T was completed without complication and she was admitted tothe surgical floor after being monitored in the post anesthesia care unit. Mild pain at the incisionsite is expected after a bowel resection surgery. This pain was experienced by 350
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,C,T andtreated with patient controlled analgesia (PCA) effectively. The patient was instructed on the useof splinting when coughing and deep breathing and the importance of incentive spirometry. The patient has a history of COPD so O
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at a flow rate of 3-4L was administered. The nasogastrictube and foley catheter were left in place. The NPO status was maintained but the patient wasallowed to relieve dry mouth with ice chips. The surgeon ordered TED hose and sequentialcompression devices to help prevent the formation of DVT. Bed rest is normally enforced for thefirst few days post-surgery.The length of time required for recovery from a small bowel resection surgery depends on manyvariables (i.e. overall pre-operative heath status, age, amount of intestine removed, the conditionwhich led to the need for bowel resection). 350
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,C,T is an 81 year old female with a history of COPD and osteoporosis. The patient lives independently and has an extensive social and familysupport system. No complications are anticipated for this patient’s recovery, but some potentialcomplications are infection, injury related to falling, impaired skin integrity, ineffective pain
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| Upload Date: | 05/14/2009 |
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