ILOILO DOCTORS’ COLLEGE

College of Nursing
West Avenue, Molo, Iloilo City

NCM 118 (RLE)

Care of Clients with Life-Threatening Conditions, Acutely Ill/ Multi-Organ
Problems,
High Acuity and Emergency Situations

Finals Case Scenario

FOREIGN BODY OBSTRUCTION

Patient’s Data:
Bong Dela Rosa, a 60-year-old, male, residing in Kalibo, Aklan presented
to the Emergency Room last October 12, 2021 with complaints of mild odynophagia
and abdominal pain associated with large amount of non-bilious foul smelling vomitus
since 20 days following accidental ingestion of metal spoon while cleaning his tongue
with it. He also gave history of failed endoscopic extraction of the spoon in some other
hospital. There was no significant medical or surgical history, but his wife claimed
that he had a psychiatric history and recently under medication. In spite of recurrent
vomiting, client was still taking food in order to push the spoon distally.
According to his wife, his husband was a former janitor of Kalibo
National High School. They have two children which has already a family of their own.
Mr. Dela Rosa is a smoker (consumed 10-15 sticks/day) and occasionally drink
alcoholic beverages. According to him, his mother was brought to a mental facility
when he was 10years old, and later on died due to cardiac arrest.
Upon examination, the client was dehydrated and with the following vital
signs: BP-100/60mmHg, CR- 110bpm, RR- 26cpm, Temp.- 37.8C and O2 sat- 97%.
D5LR 1L x 125cc/hr was started as venoclysis, oxygen at 2liters/min via nasal
cannula was administered and started on NPO as ordered by Dr. Delima. On
abdominal examination, client had tenderness and fullness over hypogastrium with
tympanic sound upon percussion and succussion splash sound upon auscultation.
His initial laboratory are as follows: Serum potassium- 2.1mmol/L, sodium-
110mmol/L, chloride- 88mmol/L, Hgb- 14g/dl, Hct- 38, WBC- 25/L. ECG shows ST
elevation and some other tests are normal.
A nasogastric tube was inserted and a large amount of foul smelling
undigested food particles were aspirated. After which, an X-ray of the abdomen was
done. It showed para-vertebral radio-opaque shadow of a spoon. Ultra sonography of
the whole abdomen showed intra luminal foreign body lodged partly inside the distal
stomach and proximal duodenum based on the history presented and investigated. A
diagnosis of gastric outlet obstruction secondary to accidental spoon ingestion was
made. Client and his wife was informed of the urgency to remove the said foreign body
and consented.
 Mr. Dela Rosa was brought to the Operating Room for an Emergency
exploratory laparotomy with juxta-pyloric gastrotomy. He was under epidural and
general anesthesia. Foley catheter French16 was inserted. Foul smelling food was
removed, the spoon was found to be tightly occluding the pylorus and proximal
duodenum. The spoon was maneuvered with due precautions to minimize further
trauma to the stomach and duodenum. Gastric lavage and thorough washing was
done. A Jackson pratt drain was placed and abdomen was closed in layers. Post
operatively, client is awake, transferred to Surgical ICU for monitoring, still with NGT
to gravity drain and maintained on NPO. Post-op meds are as follows: Parecoxib 40mg
IVTT ANST every 12hrs, Cefazolin 2grams IVTT ANST post op then decrease to
Cefazolin 1gram IVTT every 8hrs, Metronidazole 500mg IV every 8hrs, Omeprazole
40mg IVTT every 12hrs, Ketorolac 30mg IVTT ANST every 8hrs x 3 doses, Tramadol
50mg every 6hrs IVTT PRN for severe breakthrough pain, Ondansetron 8mg IVTT
every 12hrs PRN for nausea & vomiting, Dexketoprofen 50mg IVTT post-op ANST,
resume Clozapine 25mg/tab, 1tab once a day once on diet and Bactidol Mouthwash,
gargle TID. After 24hrs his NGT was pulled out as ordered. On his 3rd day post-op,
foley catheter and JP drain was removed and was able to ambulate. Mr. Dela Rosa was
discharged ambulatory on the 6th day. May go home instructions were given with the
following medications: Cefuroxime 500mg, 1tab TID x 7days, Celecoxib 200mg, 1tab
BID x 5days, Clozapine 25mg, 1tab OD, Ascorbic Acid 1tab OD, Multivitamins 1tab
OD, Bactidol mouthwash, gargle TID and advised to come back after 1week for follow
up.

STUDY QUESTIONS:
1. Discuss the anatomy and physiology of the upper gastro intestinal tract.
Determine the organs that may be affected by the patient’s condition.
2. What is foreign body obstruction? What are the predisposing factors that may
cause its occurrence? What may be the reason that led for his condition?
3. Present the pathophysiology of foreign body obstruction basing on the situation.
Present this in a diagram and discuss thereafter.
4. Identify the signs and symptoms presented by the patient and correlate this to
the pathophysiology.
5. What are the necessary diagnostic tests and procedures to determine the
foreign body obstruction and conditions relating to this?
6. What are the specific diagnostic tests and procedures that the patient
undergone? Present results that correlate or identify his condition and discuss
the significance.
7. What has been done to the patient to treat his condition? Identify and discuss
the specific managements (medically & surgically) that were done?
8. What were the medications given? Identify and discuss specific medications for
treating the patient.
9. Transcribe the treatment and record to the appropriate monitoring sheets.
10.Make a Nursing Care Plan for the management of the patient. Present
appropriate nursing diagnoses as basis for planning and intervention.
11.Make a continuing management plan to improve the patient’s condition.
12.Present a case relating to patient’s condition. Discuss the situation which led to
this problem. Identify and narrate what are your roles as a nurse in managing
this patient.