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Bowel Elimination Unfolding Case Study An 81-year-old patient is being seen by the nurse in an extended care living facility. The patient is stating they are having abdominal pain and describes the pain as sharp, 8/10 and in the hypogastric region. The patient stated that the pain has been off and, on all night, and does not radiate. Denies any vomiting, diarrhea or nausea during the night. LBM was yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has contractures. The patient states they have pain to left leg where lower leg used to be and describes that pain as a 4/10. The patient can transfer from bed to wheelchair with assistance pivoting on their unaffected right leg. The patient has a past medical history of a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO q HS, aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID, methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily. Highlight the assessment findings in the above scenario that require immediate follow-up by the nurse. (5-points) Use an X to indicate which assessment finding is associated with each of the listed patient’s health problems. All assessment findings should be used and can be used only once. (7-points) Assessment Finding Bowel elimination Mobility Abdominal pain in hypogastric region Left arm contracture Unaffected right leg Denies vomiting, diarrhea or nausea History of rheumatoid arthritis Methotrexate 6 mg one PO daily Left below the knee amputation (BKA) The patient’s breakfast tray is served. The patient calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to hypogastric area. The patient’s breath has a foul odor, and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H. pylori lab test. AM VS 100/70, P 100, R 18, T 98.4 F, O2 94%. Based on the patient’s condition, the patient’s priority need will be to prevent_______1_______ In addition, he will need interventions to prevent life-threatening complications of bowel elimination, especially ___________2____________ and ___________2______________. (3-points) Options for 1 Options for 2 Gastric Ulcer Ruptured appendix Appendicitis GI bleeding Ascites Gall stones Cholecystitis GI perforation The patient’s breakfast tray is served. The patient calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabbing pain to hypogastric area. The patient’s breath has a foul odor, and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H. pylori lab test. AM VS 100/70, P 100, R 18, T 98.4 F, O2 94%. Use an X for the nursing actions listed below that are Indicated (appropriate or necessary, Contraindicated (could be harmful) or Non-Essential (makes no difference or not necessary) for the patient’s care at this time. Only one selection can be made for each nursing action. (6-points) Nursing Action Indicated Contraindicated Non-Essential Give AM meds as prescribed Perform a test for rebound tenderness Give Toradol IM for phantom limb pain Place NGT to decompress Call lab results to HCP Perform a through abdominal assessment The patient’s breakfast tray is served. The patient calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabling pain to hypogastric area. The patient’s breath has a foul odor, and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H. pylori lab test. AM VS 100/70, P 100, R 18, T 98.4 F, O2 94%.The patient is given pantoprazole and ondansetron. The patient has a large black tarry stool. The patient states their nausea is relieved, but their pain is still unchanged. Use an X to indicate which actions listed in the left column would be implemented. (6-points) Actions Implemented Call the HCP about stool Send stool for stool culture Hold ASA and clopidogrel Place warm KPad to abdomen Perform FOBT on stool Order a high fiber diet The patient’s breakfast tray is served. The patient calls the nurse to the room because after eating sausage served on their tray, they state the pain to their abdomen is now a 9/10. They describe the pain as a burning, stabling pain to hypogastric area. The patient’s breath has a foul odor, and they state they are nauseated. The nurse calls the HCP. New orders received include lansoprazole 15 mg one PO daily, ondansetron 4 mg ODT q 4 H, CBC and H. pylori lab test. AM VS 100/70, P 100, R 18, T 98.4 F, O2 94%.The patient is given pantoprazole and ondansetron. The patient has a large black tarry stool. The patient states their nausea is relieved, but their pain is still unchanged. 6. The nurse evaluates the effectiveness of actions. Which of the following findings indicate effectiveness? Select all that apply. (6-points) Able to tolerate a bland diet. Vomits once blood tinged material 3. H. pylori test is negative Verbalizes pain to abdomen of 8/10 BP 90/40, P 114, R 26, O2 sat 94% Bowel sounds are hyperactive In all 4 quads Pain stated as 2/10 to L BKA Bowel_Elimination_Unfolding_Case_Study.docx

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