ALMIN, RAZELLE S.

BSN3Y2-2

LECTURE

WEEK 1. COURSE
TASK LEC CU1
CASE STUDY: (60 POINTS)
A 55-year-old man is transferred to your unit from the intensive
care unit following a head injury. During your admission assessment,
he complains of a burning sensation in his mi epigastric area. On
examination, you note a distended abdomen with tenderness in the
epigastric area.
1. What questions would you ask the patient?
Answer: The first step is to employ one of the three most widely used
methods for quantifying pain intensity, which are verbal rating scales,
numeric rating scales, and visual analogue scales. Verbal Rating Scales
(Verbal Descriptor Scales) grade pain intensity using common words (e.g.,
mild, severe). Second, ask the client to pinpoint the location of the pain by
pointing to a specific area of the abdomen. Make certain to inquire about
bowel and urinary habits. Understanding when patient’s body is not
functioning in accordance with what is "normal" (for him or her) might offer
signs about a potential illness.

2. What diagnostic tests would you anticipate and how would you prepare your patient
for these?
Answer:

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 A. Endoscopy When a patient comes to the endoscopy unit, the first step should to
identify the patient. Patient identification can be accomplished through the use of a
hospital registration number, name, social security number, date of birth, and so on. One
of the most popular methods of identifying the patient is to match the name. Instead of
pronouncing the patient's name on the record and asking if it is accurate, offer open-
ended inquiries, such as "What is your name?" Because patients with the same name
might exist, identifying the patient only by name is insufficient. As a result, it is typically
suggested that the patient be identified by validating at least two of the patient data,
ideally in an open-ended way wherever feasible. If contact with the patient is impossible
due to the patient’s inability to communicate or because the patient is a foreigner, a
picture identity card check may be an alternative. Most endoscopic procedures can be
adequately performed with the patient under moderate sedation, which is also commonly
referredto as "conscious sedation." However, more complex procedures that require
prolonged procedure time may need to resort to deep sedation. If a patient is to undergo
endoscopic procedures with moderate or deep sedation, patient status should be
monitored accordingly. The standard parameters of patient status that need to be
periodically checked before, during, and after the procedure include blood pressure,
oxygen saturation, pulse rate (heart rate), and level of consciousness. Blood pressure is
generally measured noninvasively with blood pressure cuffs. Oxygen saturation can be
monitored with pulse oximeter to detect oxygen desaturation and hypoxemia. However, if
prolonged procedure time is anticipated as is the case with ERCP, EUS±FNA, and
EMR/ESD, capnography may prove to be of more benefit in measuring respiratory
activity. Oxygen supplementation is recommended for both moderate and deep sedation
to reduce the degree of oxygen desaturation. Pulse rate is normally monitored using pulse
oximeter, which is generally sufficient for the majority of endoscopic procedures.
However, electrocardiogram monitoring may be beneficial when the procedure time is
expected to be prolonged; it is also recommended for patient with significant
cardiopulmonary disease, arrhythmia, and advanced age. Level of consciousness should
be monitored directly by evaluating the patient.

B. Urea Breath Test Educate the client the she/he must not eat or drink anything
including water for at least 4-6 hrs. before the test and inform the client that he/she must
not smoke for at least 2hrs prior to the test. Educate the client to Avoid proton pump
inhibitors including Prilosec, Peracid, Nexium, Protonix, Aciphex, and Dexilant within
two (2) weeks prior to the urea breath test. Avoid antibiotics two (2) weeks prior to the
urea breath test. Avoid bismuth preparations (Pepto Bismol) within two (2) weeks prior
to the urea breath test

C. Stool Test

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  Assess the patient’s level of comfort. Collecting stool specimen may produce feeling of
embarrassment and discomfort to the patient.
 Encourage the patient to urinate. Allow the patient to urinate before collecting to avoid
contaminating the stool with urine.
 Avoid laxatives. Advise patient that laxatives, enemas, or suppositories are avoided three
days prior to collection.
 Instruct a red-meat free and high residue diet. The patient is indicated for an occult blood
test, must follow a special diet that includes generous amounts of chicken, turkey, and
tuna, raw and uncooked vegetables and fruits such as spinach, celery, prunes and bran
containing cereal for two (2) days before the test. The nurse should note of the following
nursing interventions after fecal analysis:
 Instruct patient to do handwashing. Allow the patient to thoroughly clean his or her hands
and perianal area.
 Resume activities. The patient may resume his or her normal diet and medication therapy
unless otherwise specified.
 Recommend regular screening. The American Cancer Society recommends yearly occult
blood test as part of the screening for colorectal cancer starting at the age of 45 years old
for people with average risk.

3. Describe your plan of nursing care for this patient.

Answer: I will provide nursing care to patients for epigastric tenderness and burning
sensation by assessing any difficulty in breathing due to dispensed, if so, I will place him
in the High Fowler position, advise him to eat a low fat and high protein diet, advise him
to take small feeds to avoid eating right before bed, drink plenty of fluids, take pentazole
to reduce secretions, and not to take stress.

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