Gabriella Schwarz Concepts Map #5

Medications Medical History Pathophysiology

 Docusate Sodium (Colace): 100 mg P.O.
PRN for constipation.
Previous Surgeries:
Promotes Colectomy “Endometriosis development depends on
water into lap (03/01/18),
abnormal hormonal activity related to the
stool, resulting hysterectomy
in softer fecal (03/01/18),
mass. May appendectomy,
also
interaction of the enzyme aromatase, an
colonoscopy
promote electrolyte (1960),
and water tonsillectomy
secretion into (1955)
enzyme involved in the synthesis of estrogen.
 Health: Pelvic pain and ovarian cyst before
the colon. Endometriosis tissues have an increased
hysterectomy amount of aromatase in them that is not found
 Psychological: Depression and Anxiety in normal endometrium. Endometrial tissue is
 Hospitalizations: 02/28/2018 for pelvicfound pain outside the uterus implanted on other
 Diagnoses: Under active, Endometriosis, body colonicstructures. “ (Hoffman & Sullivan, pg.
1443)
mass, dysphagia, hypertension, impaired gas
exchange, insomnia

Physical Assessment
Lab Data
 VS: BP 133/67, Pulse 71 bpm, Temp 98.1,
SpO2 94%, RR 16 bpm, Pain 0/10
 Protein: 5.7 (6.3-8)
Skin: regarding
Bruising clear incisions on
on abdomen,
Nursing
liquid diet and Diagnosis caused by
malnutrition
abdomen, cool temp
Riskobstruction
bowel 
for constipation related
Head: Nasal cannula in place
 to clear
WBC: 3,800
 liquid diet, post-
(4,500-11,000)
Wound: No dressing regarding
in place, glue used for
surgical procedure
colectomy bowel obstruction,
incisions
 and abdominal
Legs: Bed rest, no movement
distension/pain
Equipment: 2as IV sites (LR), SCD on both legs,
evidenced by colectomy
and nasal cannula
 procedure
Elimination/GU: Clear liquid diet, last BM 4
** Next Page **
days ago
 Chest: Non-productive cough
 Abdomen: 6 incisions in place, distended,
striae
Education
Coping / Family
Nursing Interventions
1. Goal: The patient will form and
1. Educate patient on the effects of
Patient’s
evacuate diet
husband on elimination
a semi very
solid medium sized
involved
stool byand in the4,room
March 2018 without
2. Instruct the patient onwith
consequences
patient of long-term
laxative use laxative.
 2. Patient
Goal: talks of family and
The patient’s fiber intake will be
3. seems to
Instruct the patient on increased have
avoiding stress a close
by during
adding 1 serving of fiber
defection to prevent arelationship
change with dizziness,
in vitals, family
to the breakfast
members and lunch meal by
or bleeding
03/04/2018
 Encourage the family to
3. support
Goal: The patient’s
the patient andgastrointestinal
functioning
take will show improvement by
care of during
auscultation
recovery periodof hyperactive bowel
sounds inpatient
 Encourage all 4 quadrants
to by
03/04/2018
continue talking to family
when anxious about
** Interventions health
on Next Page**
 Gabriella Schwarz Concepts Map #5

Diagnosis cont.
2. Risk for infection related to invasive procedures, malnutrition, altered peristalsis, and loss of skin integrity as evidenced by
colectomy procedure

3. Moderate anxiety related to decreased productivity, extraneous movement, insomnia, and fearfulness as evidenced by colectomy
procedure

Interventions cont.
1. The nurse will move the patient q1h from alternating R & L sides with a pillow to increase gastrointestinal motility.
- Rationale: In order for the patient to form and evacuate a semi solid stool by Monday the gastric motility must
increase, moving the patient will increase the motility of the intestines. (Wilkinson & Barcus, pg 177

1a. The nurse will also perform ROM exercises in all 4 extremities q4h to stimulate gastrointestinal motility.
o Rationale: In order for the patient to form and evacuate a semi-solid stool by Monday the patient’s
gastrointestinal motility must increase, mobility will increase motility. (Wilkinson & Bacus, pg 177)

2. The dietitian will add 1 serving of dietary fiber to the patient’s breakfast and lunch meal Q.D.
- Rationale: In order for the patient to form and evacuate a stool by Monday, dietary fiber must be added to the diet
to increase gastrointestinal functioning. (Wilkinson & Barcus, pg 177)

2a. The R.N. will feed the patient 100% of the dietary fiber serving and provide educational teaching regarding fiber intake
during the breakfast and lunch meal time.
o Rationale: In the case of the patient being a quadriplegic, the nurse must feed the patient all meals. The
nurse must make sure the patient is getting all the fiber he needs, to improve his gastrointestinal
functioning. (Wilkinson & Barcus, pg 177)

3. The nurse will palpate the patient’s abdomen q4h along with ROM exercises to monitor the patient’s pain level. Once the
patient has defecated, the nurse will palpate the patient’s abdomen again to ensure the patient is not feeling any pain in the
abdomen.
- Rationale: In order for the patient to form a semi solid stool by Monday the pain from constipation must end after
the defecation to ensure the client is no longer constipated. (Wilkinson & Barcus pg 178)
 Gabriella Schwarz Concepts Map #5

Other Pathophysiology:

Diabetes: Diabetes Mellitus, a disorder of carbohydrate metabolism, is characterized by high levels of blood glucose resulting from the body’s
inability to produce or utilize insulin. Diabetes comes along with chronic high levels of blood glucose that can predispose the patient to
cardiovascular disease, renal damage, peripheral vascular disease, and disorders of the eyes and nervous system. The patient was not ordered to be
on a diabetes diet, he loved some snacks! (Capriotti & Frizzell, Page 553)
 Gabriella Schwarz Concepts Map #5

Reference Page

Newsome, & Melton. (n.d.). Quadriplegia. Retrieved March 31, 2017, from http://www.brainandspinalcord.org/quadriplegia