Intestinal obstruction is a significant mechanical

impairment or complete arrest of the passage of

contents through the intestine. Intestinal
obstructions account for 20% of all acute
surgical admissions. Mortality and morbidity are
dependent on the early recognition and correct
diagnosis of obstruction. If untreated,
strangulated obstructions cause death in 100%
of patients. However, the mortality rate
decreases to 8% with prompt surgical
intervention (Vicky P. Kent, RN, PhD, CNE,
2009).

Nanay Ganda, 84 years old, was admitted last
December 8, 2010 at General Santos Doctors
Hospital under the care of Dr. Albano, had
complaints of inability to defecate by about 4
days. A background of one year history of
intermittent abdominal pain with bloating was
claimed by the patient.
The impression to the result of the ultrasound of
her whole abdomen is to consider ileus; partial
obstruction and fecal stasis. Dr. Albano believed
that the symptoms being manifested were results
of a disorder she has in a long time. Since they
werent able to have that checked and it wasnt
figured out earlier, the signs become more evident
now. Its also because these manifestations
develop and progresses relatively slowly. It was
then that the physician decided to let the patient
undergo exploratory lap to detect what really had
cause the obstruction.
It was December 13, 2010 when the surgeon
discovered a tumor at the site of the obstruction
particularly at the descending colon and
immediately removed it. The found tumor was
then subjected for biopsy.
Intestinal obstruction is a significant mechanical
impairment or complete arrest of the passage of
contents through the intestine. Overall, the most
common causes of mechanical obstruction are
adhesions, hernias, and tumors. Other general
causes are diverticulitis, foreign bodies (including
gallstones), intussusceptions (bowel folding into
itself), and volvulus (twisting of the colon).

The symptoms usually include
cramping pain, vomiting,
constipation, and lack of flatus.
Diagnosis is clinical which is
confirmed by abdominal x-rays.
Treatment is fluid resuscitation,
nasogastric suction, and, in most
cases, surgery.
Intestinal obstructions account for 20% of all
acute surgical admissions. Mortality and
morbidity are dependent on the early
recognition and correct diagnosis of
obstruction. If untreated, strangulated
obstructions cause death in 100% of
patients. However, the mortality rate
decreases to 8% with prompt surgical
intervention (Vicky P. Kent, RN, PhD, CNE,
2009).

In the course of this study, 84 year-old, Nanay
Ganda, admitted last December 8, 2010 at
General Santos Doctors Hospital under the care
of Dr. Albano, had complaints of inability to
defecate by about 4 days. A background of one
year history of intermittent abdominal pain with
bloating was claimed by the patient

Because of this, Dr. Albano believed that the
disorder had a gradual onset and its
symptoms were experienced timely yet later
with age. The patient recently claimed that
pain usually starts at the right upper quadrant
and radiates all throughout the abdomen.
Abdominal distention was also observed with
rounded asymmetric contour of the abdomen.
The bowel sounds were normal at first and
becomes quiet later on. She also had
episodes of vomiting.
Last December 13, 2010, the patient had
undergone exploratory laparotomy and the
surgeon found out that there was a
presence of tumor and immediately removed
it. However, the result of the biopsy has not
been seen. She also had a colostomy to
eliminate waste products until such time the
colon heals.

The study focuses on the nature and
possible causes which may lead people to
experience this obstruction. The patient is in
her older age and same with other elders
who have the same case as Nanay Ganda,
it is difficult in their part to deal with the
disorder. Since they are older, they need
more attention and care from the medical
team, and particularly, from their significant
others.

It is for this reason why the student
nurses decided to have the case. To
give awareness and knowledge of
what is the disorder all about and how
can somebody be of help to manage
patients with this case especially the
older ones.
This will be a big implication in the medical
and nursing care since it is a challenge to
diagnose a bowel obstruction. The keys to
successful management are to identify
signs and symptoms that may present very
subtly at first, followed by a commitment to
help the patient before the condition
becomes aggravated. Whatever the
treatment, participation in management and
postoperative care is vital. Staying current
with new findings and methods is the best
course.

General Objectives:
Comprehend and recognize salient
points that are important to remember when
dealing with patients who manifested
intestinal obstruction; its nature, causes,
clinical manifestations, management, and
prognosis This is to enhance the students
and other health care providers awareness,
knowledge, and understanding of it in order
to promote health, prevent the disease and
help manage patients with this kind of
disorder to recover.

Specific Objectives:

Present the introduction of the studied
disease;
State the purpose of the study;
Present the obtained initial database of
the patient;
Present the nursing history including
the past and present illness of the
patient, as well as his activities of daily
living;

Present the patients cephalocaudal
assessment;
Identify the anatomy and physiology of
the system involved (Gastrointestinal
System);
Trace the pathophysiology of the disorder
process through an illustration and
explanation;
Compare the clinical manifestations of
the disorder based on the theories and
actual observations;
Explain the assessment and diagnostic
findings;

Interpret the laboratory results and the
nursing responsibilities;
Discuss the medical and nursing
management for the said condition.
Outline the drug study from the patients
medication;
State the discharge planning of the
patient;

List the health teachings given to the
patient;

State the prognosis of the disease;

Enumerate the problem list;

Present the Gordons Functional Pattern
of the patient; and

Present the nursing care plan made for
the patient.

Name: Nanay Ganda
Age: 84 years old
Sex: Female
Address: Block 17 Lot 14
Gensanville Subd.,
Bula, GSC
Religion: Roman Catholic

Civil Status: Married
Birthdate: September 12, 1926
Birthplace: Bajada, Davao City
Room: 242 A and 242 B
Date of Admission: December 8, 2010
Attending Physician: Dr. Albano

Chief Complaints: Generalized Abdominal
Pain; Inability to defecate;
Abdominal distention

Admitting Diagnosis: T/C Ileus Partial
Obstruction; Fecal Stasis

Occupation/Source of Income : Housewife

A. History of Present Illness

4 days before the admission, Nanay
Ganda experienced inability of defecating.
She also recalled and claimed that its
approximately a year that she has been
suffering from intermittent pain in the
abdominal area. She cited that pain starts at
the right upper quadrant and radiates all
throughout the abdomen.

Nanay Ganda and her children then
decided to let her be seen by a physician.
They scheduled the check-up last
December 8, 2010. According to them,
the physician advised Nanay Ganda to be
admitted on that same day, after doing
assessment and series of laboratory tests
such as complete blood count and fluid
serum. After 5 days being at the hospital,
she had episodes of vomiting.
The impression to the result of the ultrasound
of her whole abdomen is to consider ileus;
partial obstruction and fecal stasis. Dr. Albano
believed that the symptoms being manifested
were results of a disorder she has in a long
time. Since they werent able to have that
checked and it wasnt figured out earlier, the
signs become more evident now. Its also
because these manifestations develop and
progresses relatively slowly.
It was then that the physician decided to let
the patient undergo exploratory lap to detect
what really had cause the obstruction. It was
December 13, 2010 when the surgeon
discovered a tumor at the site of the
obstruction particularly at the descending
colon and immediately removed it. The found
tumor was then subjected for biopsy.

B. Past Medical History

Immunization and Childhood Illness
The patient can only recall being
immunized with BCG and OPV. She had a
history of having chicken pox infection when
she was on her 1
st
year high school. She also
experienced cough and colds, fever, diarrhea,
constipation, sore throat, rashes, and nausea
and vomiting.

Compliance to Health Management

Nanay Ganda rarely visits a doctor to
have a check-up. However, she is using
herbal medicines since her childhood days
depending on what condition she has such
as oregano, guava, bitter gourd, and ginger.
She also takes over the counter drugs
and what she mentioned were Solmux,
Neozep, Biogesic, Mefenamic acid, Bentyl,
and Loperamide. She said that when she
was still on her 30s to 40s, she is taking
multivitamins which is Enervon and later on,
she stopped taking it.

Menarche
Her menarche started when she
was in her 6
th
grade. She was 11 years
old back then on the year 1938.

C. Family History
There is no known inherited
condition present in her both paternal and
maternal family. Shes the first in their
family to be experience intestinal
obstruction.

D. Activities of Daily Living

Personal Hygiene
The patient is able to bathe herself.
She takes a bath everyday. According to
her, before and after eating her meals, she
only washes her hands with the use of
water though sometimes, she can be able
to use soap.

Nutrition

Since she believes that eating fruits
and vegetables is good for her and will be
able to maintain her health, she doesnt
seek for medical assistance that much.
She eats her meals three times a
day with snacks in between. She admitted
that she only drinks 4-5 glasses of water a
day which approximately is equal to 1.5L.
She drinks coffee in the morning and
afternoon. She claimed that she has
allergies on food particularly shrimps.

Elimination

She voids 4-5 times a day. Her
urine color is yellow which is dark most
of the times. There is no burning
sensation/ pain felt during urination.
She usually moves her bowel every
morning with brown and formed stools.
But recently, she is having difficulty in
defecating.

Rest and Sleep

She can sleep for 7-9 hours per
night. Her earliest time in going to
sleep is at 9:30 PM while the latest
time in waking up is at 6:30 AM. She
sometimes takes a nap at noon for
about 1-3 hours. She said that she
doesnt experience any difficulties in
going to sleep and doesnt take any
sedatives.

Exercise

The patient ambulates within the
house and does household chores. She
also takes a walk at their subdivision in
visiting their neighbors or buying at the
store. She does simple exercises on the
upper and lower extremities by means of
shaking and stretching.

Religion

She is a Roman Catholic who has a
strong faith in God. She goes to the
church with her youngest child and her
grandchildren to attend the mass every
Sunday. She always brings with her the
rosary and always prays at night.

Sexuality

The patient is married and has 4
children. She has no history of Sexually
Transmitted Disease or any disease
affecting her sexual organ. Her menarche
was on the year 1938 when she was still
11 years old and she is now on her
menopausal stage.

E. Hospitalization

This was her first hospitalization.
She never experienced being
hospitalized before because her
parents would just bring her to
manghihilot in their place.

Date Conducted: December 13 14, 2010

a. General Appearance

Pre-operative Phase

IVF of D
5
NM 1L x 16
0
hooked at her left cephalic
vein

Vital Signs
12-13-10

8 AM 12PM Normal
T 36
0
C 36
0
C 36.5-37.5
0
C
PR 93 bpm 94 bpm 60-100 bpm
RR 30 cpm 24 cpm 12-20 cpm
BP 110/80mmHg 110/80mmHg 90/60-120/90 mmHg
Thin
Clean and well-groomed
Conscious and coherent
Tries to be calm and relaxed
Facial grimacing at times
Oriented to people, time, and place
Frequent sighing

Post-operative Phase

IVF of PLR 1L x 8 hours as main line
hooked at her left cephalic vein with a
side drip of PNSS 500mL + 2 ampules
Voltaren at 20cc/hr and an IVF of PNSS
1L x KVO hooked at her right cephalic
vein with a side drip of 2units PRBC

Vital Signs
12-14-10

8 AM 12PM Normal
T 36
0
C 36.5
0
C 36.5-37.5
0
C
PR 70 bpm 84 bpm 60-100 bpm
RR 18 cpm 18 cpm 12-20 cpm
BP 120/70 mmHg 100/60mmHg 90/60-120/90 mmHg

Uses oxygen via face mask at 3 LPM
She has a nasogastric tube attached to a
drainage bottle
Calm but shows evidence of weakness
A colostomy is being attached to
colostomy bag at the left upper quadrant
of her abdomen
A vertical surgical incision is present on
the abdomen with clean and intact
dressing
Foley catheter is attached to uro bag
draining well with dark yellow urine

Skin, Hair, Nails

Light brown in color same all
throughout the body
Senile skin turgor
Wrinkles present on the face and
neck
Dry and flaky prominent over the
extremities
Brown-colored macules on the face
and upper extremities
No edema

Unblemished skin
No masses noted
No lesions found
Warm to touch
Evenly distributed short, thin, white
hair
Short and thick fingernails and
toenails

Head

Normocephalic
Oblong-shaped
Symmetric facial features
Symmetric facial movements
Without lesions, lumps, or masses
noted

Eyes

Eyebrows are unevenly distributed and
aligned
Eyelashes are short and curl outwards
Sunken eyeballs
White sclera
Pale conjunctiva
Pupils appear smaller in size and both
react to light and accommodation
Bilateral blinking

Ears

Color is same as facial skin
Symmetrical
Mobile and firm pinna that recoils
after it is fold
Pinna aligned with the outer canthus
of the eye
No unnecessary foul discharges
Can hear sounds in both ears

Nose

Color is same as facial skin
Symmetric
Greenish discharges present after
operation
No lesions

Mouth

Symmetric
Dark colored dry lips
Able to purse lips
No lesions noted
Dark colored gums
No swelling
Uses dentures
Tongue is moist and pink in color which is in
central position
Tongue moves freely


Neck

Color is same with the head
Wrinkles present
Not enlarged
Head centered
Coordinated movement
Spine and Back

Spinal curvature is accentuated
Before operation, patient can turn to
sides with slight discomfort
After operation, patient is flat on
bed

Thorax and Lungs

Decrease in depth of respiration during
inspiration
Use of accessory organs during expiration
Before operation, respiration rate is 24 cpm
After operation, respiration rate is 18 cpm
Vibrations present and can be felt on the
chest
Clear breath sounds

Breast

Color is same all throughout the abdomen
Slightly unequal in size
Generally symmetric
Appears flaccid
Lacks firmness
No masses and lesions found
Areola and nipples are darker in
pigmentation
No discharges noted

Heart

Present and audible heartbeats
Beats with regular rhythm
Before operation, cardiac rate is 90
bpm
After operation, cardiac rate is 73
bpm

Abdomen
Pre-operative Phase

Uniform color
Unblemished skin
Round with asymmetric contour
Rises with inspiration and falls with
expirations
Umbilicus centrally positioned
Hypoactive bowel sounds auscultated

Abdominal distention

Claimed that pain starts at the right
upper quadrant and radiates all
throughout the abdomen

The impression to the result of the
ultrasound of her whole abdomen is
to consider ileus; partial obstruction
and fecal stasis

Post-operative Phase

Symmetric contour
A colostomy is being attached to
colostomy bag at the left upper quadrant
of her abdomen
A vertical surgical incision is present on
the abdomen with clean and intact
dressing
No tenderness

Upper Extremities

Both arms are in the same size and length
Movement is limited
No lesions noted
No masses noted
No rashes found
Dry and flaky skin
Brown-colored macules noted
Senile skin turgor

Lower Extremities

Both legs are in the same size and
length
No lesions and masses noted
Dry and flaky skin
Fissures noted
With lesser hair distributed in the
legs

Musculoskeletal

Muscles are equal in size on both
sides of the body
Flaccid muscles
No tremors found and no presence
of tenderness or swelling
Limited range of motion; decreased
strength; becomes weak in
prolonged activities

Neurologic

Has poor posture but is able to walk
and maintain balance; but aided
during ambulation
Reaction to stimuli are slower
Has reduced speed of movement

Genitourinary

On menopausal stage
No history of disease affecting
genitals
After operation, a foley catheter is
attached to uro bag draining well with
dark yellow urine; no pain during
urination

Abdominal CT scan - combines special x-
ray equipment with sophisticated computers
to produce multiple images or pictures of
the inside of the body. These cross-
sectional images of the area being studied
can then be examined on a computer
monitor, printed or transferred to a CD.

Abdominal X-Ray - An abdominal X-ray is
a picture of structures and organs in the
belly (abdomen). This includes the
stomach, liver, spleen, large and small
intestines, and the diaphragm, which is the
muscle that separates the chest and belly
areas. Often two X-rays will be taken from
different positions. An abdominal X-ray
may be one of the first tests done to find a
cause of belly pain, swelling, nausea, or
vomiting.

Abdominal Ultrasonography - An
ideal clinical tool for determining the
source of abdominal pain. It can
simplify the differential diagnosis of
abdominal pain, especially when pain
and tenderness are present over the
site of disease.
Barium Enema - X-
ray examination of the large
intestine (colon and rectum). The test
is used to help diagnose diseases and
other problems that affect the large
intestine. To make the intestine visible
on an X-ray picture, the colon is filled
with a contrast material containing
barium. This is done by pouring the
contrast material through a tube
inserted into the anus.
Laboratory studies (e.g.,
electrolyte studies and a
complete blood cell count)
reveal a picture of dehydration,
loss of plasma volume, and
possible infection.
Decompression of the bowel through a
nasogastric or small bowel tube is
successful in most cases. When the
bowel is completely obstructed, the
possibility of strangulation warrants
surgical intervention.
Before surgery, intravenous therapy is
necessary to replace the depleted
water, sodium, chloride, and potassium.
The surgical treatment of intestinal
obstruction depends largely on the cause
of the obstruction. In the most common
causes of obstruction, such as hernia and
adhesions, the surgical procedure
involves repairing the hernia or dividing
the adhesion to which the intestine is
attached. In some instances, the portion
of affected bowel may be removed and an
anastomosis performed. The complexity
of the surgical procedure for intestinal
obstruction depends on the duration of
the obstruction and the condition of the
intestine.
A colonoscopy may be performed to
untwist and decompress the bowel. A
cecostomy, in which a surgical
opening is made into the cecum, may
be performed for patients who are
poor surgical risks and urgently need
relief from the obstruction. The
procedure provides an outlet for
releasing gas and a small amount of
drainage.
A rectal tube may be used to
decompress an area that is lower in
the bowel. The usual treatment,
however, is surgical resection to
remove the obstructing lesion.
A temporary or permanent colostomy
may be necessary. An ileoanal
anastomosis may be performed if it is
necessary to remove the entire large
colon.
Nursing management of the nonsurgical
patient with a small bowel obstruction
includes maintaining the function of the
nasogastric tube, assessing and measuring
the nasogastric output, assessing for fluid
and electrolyte imbalance, monitoring
nutritional status, and assessing
improvement (eg, return of normal bowel
sounds, decreased abdominal distention,
subjective improvement in abdominal pain
and tenderness, passage of flatus or stool).
The nurse reports discrepancies in
intake and output, worsening of pain or
abdominal distention, and increased
nasogastric output. If the patients
condition does not improve, the nurse
prepares him or her for surgery. The
exact nature of the surgery depends on
the cause of the obstruction. Nursing
care of the patient after surgical repair
of a small bowel obstruction is similar to
that for other abdominal surgeries
Fluid Serum
December 8, 2010
Electrolytes exist in the blood as acids, bases,
and salts (such
as sodium, calcium, potassium,
chloride, magnesium, and bicarbonate). They
control such things as cardiac function
and muscle contraction and are routinely
measured by laboratory studies of the serum.
Fluid Serum is the cell-free fluid of the
bloodstream. It appears in a test tube after the
blood clots and is often used in expressions
relating to the levels of certain compounds in
the blood stream.
A Blood chemistry test is a procedure to
examine the general health of a patient
especially to assess the functioning of certain
organs.
Test Result Reference
value
Interpretation
Creatinine 0.8 mg/dl 0.7-1.2 Normal
Sodium 137 mmol/L 137-145 Normal
Potassium 3.4 mmol/L 3.5-5.0 Low
Amylase 37 u/L 30-110 Normal
Interpretation:
The table shows that Potassium is slightly
decreased. This decrease in potassium may
be due to patients vomiting, deficient
potassium intake, or dehydration.

Nursing Responsibilities:

define and explain the test
state the specific purpose of the test
explain the procedure
discuss test preparation, procedure,
and posttest care
some blood chemistry tests will have
specific requirements such as dietary
restrictions or medication restrictions.
Complete Blood Count
December 8, 2010

The complete blood count (CBC) is one of the
most commonly ordered blood tests. The complete
blood count is the calculation of the cellular
(formed elements) of blood. These calculations are
generally determined by special machines that
analyze the different components of blood in less
than a minute.
This test may be a part of a routine check-up or
screening, or as a follow-up test to monitor certain
treatments. It can also be done as a part of an
evaluation based on a patient's symptoms.
Interpretation:
CBC is a combination report of a series of test of the
peripheral blood. White blood cells (leukocytes) are
bodys defense against infective organisms and foreign
substances. The table shows that there is elevated
number of WBC which indicates that there is possible
infection or immunosuppression happening inside.

Test Results Reference
Value
Interpretation
WBC 12.1 5-10 x 10
^
9/L High
Segmenters 0.76 0.55-0.65 High
Lymphocyte 0.15 0.25-0.35 Low
Monocyte 0.08 0.03-0.06 High
Eosinophil 0.01 0.02-0.04 Low
Hemoglobin 96 140-170 9/L Low
Hematocrit 0.29 0.40-0.50
volume
Low
Platelet 291 150-350x10
^
9/L Normal
Segmenters are above the
normal range which indicates
infection.
Low Lymphocyte, Eosinophil
and Monocyte count indicates
that the body's resistance to fight
infection has been substantially
lost and one may become more
susceptible to certain types of
infection, namely cancer and
tumor. As lymphocyte cells make
up fifteen to forty percent of the
total white blood cells that
circulate in the bloodstream, a low
count can cause damage to
organs.
Hemoglobin is the oxygen carrying
protein within the RBCs. The table
shows that there is decreased
hemoglobin concentration in the
blood, which indicates that there is
less oxygen being transported
throughout the body, because of the
less oxygen being transported. With
this, the patient is likely experiencing
difficulty of breathing that leads
patient to have impaired gas
exchange.
Hematocrit is the percentage of RBC
mass to original blood volume. The
table shows that hematocrit volume is
decreased which indicates that there
is over expansion of extra cellular
fluid volume, since the patient has a
decreased RBC she also have a
decreased hematocrit level..
Nursing Responsibilities:

Explain that the tests are done to
detect any hematologic disorders as
well as infection and inflammation.
Tell the patient that a blood sample
will be taken and that she may feel
slight discomfort from the tourniquet
and needle puncture.
Use gloves when collecting and
handling all specimens.
Transport the specimen to the
laboratory as soon as possible after
the collection.
Do not allow the blood sample to clot,
of the results will be invalid. Place the
specimen in a biohazard bag.
Abdomen Supine and Upright
December 8, 2010

Abdominal x-rays may be performed to
diagnose causes of abdominal pain, such as
masses, perforations, or obstruction.
Abdominal x-rays may be performed prior to
other procedures that evaluate the
gastrointestinal (GI) tract or urinary tract,
such as an abdominal CT scan and renal
procedures.
Result:
Lung bases are clear. Free subphrenic
air is noted. There are gas containing
loops of small and large bowel in all
quadrants with no definite pattern. An
ovoid soft tissue density is seen in the
right lower quadrant area overlying
pattern of the right superior iliac crest.
This is seen in the supine view only
and may be in the soft tissues.
Reacted gas is present. There are
advance degenerative changes in
lumbar spine characterized by
osteophytes/ spurs formation.
Asymmetrical narrowing of L4-L5
intervertebral joint space, left is seen
with linear lucencies within. Mild
levoseoliosis is noted.
Impression:
Essentially (-) study of the abdomen
save for degenerative changed of the
lumbar spine.
Abdomen Supine and Upright
December 8, 2010

Abdominal x-rays may be performed to
diagnose causes of abdominal pain, such as
masses, perforations, or obstruction.
Abdominal x-rays may be performed prior to
other procedures that evaluate the
gastrointestinal (GI) tract or urinary tract,
such as an abdominal CT scan and renal
procedures.
Abdomen Supine and upright
December 9, 2010

Re-examination no longer shows the
ovoid soft tissue density in the right lower
quadrant area or seen in the abdominal
supine view. Gas containing loops of
predominantly small bowel segments are
still seen in all quadrants with no definite
pattern. Rectal gas is present. Pro-
peritoneal flank stripes are intact,
abdomen are not displaced laterally.
Nursing Responsibilities:

Remove any clothing, jewelry, or
other objects that might interfere with
the procedure.
Given a gown to wear.
Position in a manner that carefully
places the part of the abdomen that is
to be observed. The patient may be
asked to stand erect, to lie flat on a
table, or to lie on the side on a table,
depending on the x-ray view the
physician has requested.
Body parts not being imaged may be
covered with a lead apron (shield) to
avoid exposure to the x-rays.
Nursing Responsibilities:

Once positioned, ask the patient to
hold still for a few moments while the
x-ray exposure is made. Also, ask the
patient to hold his/her breath at
various times during the procedure.
It is extremely important to remain
completely still while the exposure is
made, as any movement may distort
the image and even require another x-
ray to be done to obtain a clear image
of the body part in question.
The x-ray beam is then focused on
the area to be photographed.
Urinalysis
December 9, 2010

Routine urinalysis is performed for
general health screening to detect
renal and metabolic diseases; to
diagnose diseases or disorders of the
kidneys or urinary tract. In addition, it
is performed to help diagnose specific
disorders such as endocrine diseases.
Interpretation:
The physical and chemical properties of the
patients urine show normal results. Normally, blood must
be absent in the urine. Presence of blood may indicate
acute kidney infections, chronic infections, and stone
formation in the kidneys.
Color Reaction Transparency Specific gravity
Light yellow 6.0 Clear 1.003
Sugar Albumin
Negative Negative
Pus cell RBC
0.1/ HPF 0.1/ HPF
Nursing Responsibilities:

Explain how to collect a clean catch
specimen of at least 15 mL.
Explain that there is no food or fluids
restriction.
Obtain a first voided morning specimen if
possible.
Medications may be restricted for it may
affect laboratory results.
Fecalysis
December 9, 2010

It refers to a series of laboratory tests
done on fecal samples to analyze the
condition of a person's digestive tract
in general. Among other things, a
fecalysis is performed to check for the
presence of any reducing substances
such as white blood cells (WBCs),
sugars, or bile and signs of poor
absorption as well as screen for colon
cancer.


Interpretation:
Black stool may be a result of possible
internal bleeding, particularly somewhere in the
digestive tract.
Color Chemical and
occult blood
Result
Black Positive No intestinal
parasite seen
Nursing Responsibilities:

Discourage patient from taking
aspirin, alcohol, vitamin C, ibuprofen,
and certain types of food if fecal
sample will be checked for any sign of
blood.
The patient must urinate first to
prevent any urine from mixing with
feces.
The patient must wear gloves when
it's time to handle stool and transfer it
to a safer container. This will prevent
any possibilities of being contaminated
or infected by bacteria found within the
stool.
Solid and liquid fecal samples are
both acceptable as long as they do not
have urine or other foreign substances
like soap, water, and toilet paper
mixed in them.
Nursing Responsibilities:

If the patient is suffering from
diarrhea, placing a plastic wrap and
securing it under the toilet seat
could facilitate the collection
process.
Collected samples must be
brought to the doctor's office or
laboratory as soon as possible.
Delays could compromise the
quality of the sample.
Volume or amount is also
important so the patient must be
sure he has collected an adequate
amount of stool.
Potassium Test
December 10, 2010

This test measures the amount of
potassium in the blood. Potassium (K+)
helps nerves and muscles communicate. It
also helps move nutrients into cells and
waste products out of cells.
Test Result Reference
value
Interpretation
Potassium 4.1 3.6-5.0 mmol/L Normal
Interpretation:
The potassium level of the patient is normal.
Ultrasound in the Whole Abdomen
December 10, 2010

It is an ideal clinical tool for
determining the source of abdominal
pain. It can simplify the differential
diagnosis of abdominal pain,
especially when pain and tenderness
are present over the site of disease.
Result:

Liver is normal in size and contour. It
shows normal homogenous echo
pattern. No mass lesion is noted.
Intrahepatic bile ducts and CBD are
not dilated. Hepatic vessels are
unremarkable. Gallbladder is
physiologically distended. It shows
normal wall thickness. No internal
echoes are noted. No pevicholecystic
fluid collection is seen.
Pancreas and spleen are normal. Right
kidney measures 9.6 x 4.2 cm with
cortical thickness of 1.2 cm. Left kidney
measures 9.5 x 4.0 cm with cortical
thickness of 1.5 cm. Both are normal in
size showing homogenous
corticomedullary parenchymal
echogenecity. No echogenic focus or
mass lesion is noted. There is no
separation of the central echo complexes.
Proximal uterus is not dilated. Uterus is
atrophic and is compatible with the age of
the patient. No abnormal masses are
seen in both advexac.
Moderately dilated, fecal-filled segment of
large bowel are noted in both paracolic
gutters, iliac regions and pelvis. No
evident mass lesion is appreciated.

Impression:
Considers ileus; Partial obstruction
Fecal stasis
Nursing Responsibilities:

Before procedure, instruct patient to be
on NPO 8-12 hrs since air or gas car
reduce quality of image
Assess abdominal distention because it
may affect quality of image
During procedure, keep the patient in a
supine position
Doctors Order
An exploratory laparotomy is done
especially when a person
complains of abdominal pain. The
operation allowed the surgeon to
examine the internal organs.
Disease or damage can be
uncovered. In some cases, the
problem can be corrected during
the surgery.
A colostomy is when the colon is cut in half and
the end leading to the stomach is brought
through the wall of the abdomen and attached
to the skin. The end of the colon that leads to
the rectum is closed off and becomes dormant.
Usually a colostomy is performed for infection,
blockage, or in rare instances, severe trauma of
the colon. This is not an operation to be taken
lightly. It is truly quite serious and demands the
close attention of both patient and doctor. A
colostomy is often performed so that an
infection can be stopped and/or the affected
colon tissues can heal.
Assess and measure the nasogastric output
Assess fluid and electrolyte balance and
administer IV as prescribed
Monitor nutritional status
Assess improvement such as return of normal
bowel sounds, decreased abdominal distention,
abdominal pain and tenderness, passage of
flatus or stool
Prepare patient for surgery which includes
preoperative teaching
After surgery, provide wound care and
post-operative nursing care
Place ice chips on the same day of
surgery to ease the patients thirst. By the
next day, the patient may be allowed to
drink clear liquids.
Slowly add thicker fluids and then soft
foods as the bowels begin to work again.
Patient may eat normally within 2 days
after the surgery.
The colostomy drains stool
(feces) from the colon into the
colostomy bag. Most colostomy
stool is softer and more liquid than
stool that is passed normally. The
texture of stool depends on the
location of the segment of
intestine used to form the
colostomy.
Drug Study
Prognosis
When client is to be discharged from
the hospital, nursing care is still
continued. With sufficient support at
home, most client recover gradually.
During home visits, the clients physical
status and progress towards recovery is
assessed. The clients understanding of
therapeutic regimen is also assessed,
and previous teaching is reinforced.
Method

Instruct the significant others to take the
following home medication as ordered by
the physician.
Explain to the significant others the drug
names as well as the right route and
dosage.
Inform the significant others about the side
effects that may occur brought by the
medication.
Encourage the significant others to comply
and follow religiously the right timing in
taking the medication.
Confer with the patients family the need
take precautions regarding medication
therapy, activity, and dietary restriction.
Discuss with the patients family ways to
cope with stressful situations in positive
manner.
Method

Instruct patients family to report for
immediate occurrence of signs and
symptoms to a health care professional.
Reinforce and supplement patients family
knowledge about diagnosis, prognosis, and
expected level of function.
Provide patients family with specific
directions about when to call the physician
and what complications require prompt
attention.
Peer support and psychological counseling
may be helpful for some families.
Exercise/ Environment

Once at home, patient may resume
much of the normal activity short of
aggressive physical exercise.
Walk short distances everyday and
gradually increase activity.
No lifting of a weight greater than 20
lbs (9kg) for 6 weeks. Exercise
should be started cautiously.
Encourage to practice deep
breathing exercise and range of
motion exercises up to the level of
capability.
Exercise/ Environment

Explain the need for rest periods
both before and after certain
activities.
Teach client the importance of
stress management through
relaxation technique,
Help improve patients self-concept
by providing positive feedback,
emphasizing strengths and
encouraging social interaction and
pursuit of interests.
Treatment

Explain to the significant others the
need to continue drug therapy
Provide patients family with a list of
medications, with information on
action, purpose and possible side
effects.
Advise significant others to always
comply with the medications. Call the
physician if there is a problem taking
them.
Hygiene

Keep proper hygiene. Teach clients
family the importance of hygiene like
daily oral care, bathing and changing
clothes.
Proper Wound care must be
observed.
Outpatient

Advise to visit or have her follow up
check-up with her attending physician.
Advise to call and notify the attending
physician for any unusualities that may
occur
Routinely, follow up check up with
patients within two weeks. If there are
staples that require removal,
postoperative problems, or wound
issues, a follow-up appointment will be
scheduled sooner.
Diet

Emphasize to the clients family the
importance of proper nutrition, its need for
early recovery. This can aid in restoring
body functioning.
Provide dietary instructions to help
patients family identify and eliminate foods
that is needed by the patient.
Soft or low residue diet upon discharge;
this should be continued at home for
approximately 2 weeks (this includes
breads, cereals, chicken, fish, and soup).
Avoid large quantities of raw fruits and
vegetables.
After 2 weeks, gradually reintroduce your
regular diet.
Encourage to drink plenty of fluids.
Take nutrition supplements