Kindly help me this for nursing care plan ACUTE ON

For each of the following CASES, identify one or two likely conditions based on the data. Most importantly, include your rationales as to why you chose that disorder. Lastly, discuss any additional interventions needed to confirm the diagnosis. Case #1: T.H., a 57-year-old stockbroker, has come to the gastroenterologist for treatment of recurrent mild to severe cramping in his abdomen and blood-streaked stool. You are the registered nurse doing his initial workup. Your findings include a mildly obese man who demonstrates moderate guarding of his abdomen with both direct and rebound tenderness, especially in the left lower quadrant (LLQ). His vital signs are BP 168/98, HR 110, RR 24, Temp 100.4° F (38° C), and he is slightly diaphoretic. T.H. reports that he has periodic constipation. He has had previous episodes of abdominal cramping, but this time the pain is getting worse. Past medical history reveals that T.H. has a “sedentary job with lots of emotional moments,” he has smoked a pack of cigarettes a day for 30 years, and he has had “2 or 3 mixed drinks in the evening” until 2 months ago. He states, “I haven’t had anything to drink in two months.” He denies having regular exercise: “just no time.” His diet consists mostly of “white bread, meat, potatoes, and ice cream with fruit and nuts over it.” He denies having a history of cardiac or pulmonary problems and no personal history of cancer, although his father and older brother died of colon cancer. He takes no medications and denies the use of any other drugs or herbal products. Case #2: T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp, boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips at a fast-food restaurant earlier today. He is not happy to be in the hospital and is grumpy that his daughter insisted on taking him to the ED for evaluation. After orienting him to the room, you perform your physical assessment. The findings are as follows: He is awake, alert, and oriented × 3, and he moves all extremities well. He is restless, is constantly shifting his position, and complains of fatigue. Breath sounds are clear to auscultation. Heart sounds are clear and crisp, with no murmur or rub noted and with a regular rate and rhythm. Abdomen is flat, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. He reports having light-colored stools for 1 week. The patient voids dark amber urine but denies dysuria. Skin and sclera are jaundiced. Admission vital signs are BP 164/100, pulse of 132 beats/min, respiration 26 breaths/min, temperature of 100° F (37.8° C), SpO2 96% on 2 L of oxygen by nasal cannula. Case #3: M.R. is a 56-year-old general contractor who is admitted to your telemetry unit directly from his internist’s office with a diagnosis of chest pain. On report, you are informed that he has an intermittent 2-month history of chest tightness with substernal burning that radiates through to the mid-back intermittently, in a stabbing fashion. Symptoms occur after a large meal; with heavy lifting at the construction site; and in the middle of the night when he awakens from sleep with coughing, shortness of breath, and a foul, bitter taste in his mouth. Recently, he has developed nausea, without emesis, that is worse in the morning or after skipping meals. He complains of “heartburn” three or four times a day. When this happens, he takes a couple of Rolaids or Tums. He keeps a bottle at home, at the office, and in his truck. Vital signs (VS) at his physician’s office were 130/80 lying, 120/72 standing, 100, 20, 98.6° F (37° C), SpO2 94% on room air. A 12-lead ECG showed normal sinus rhythm. Breathing is unlabored. M.R. has smoked one pack of cigarettes a day for the past 35 years, drinks two or three beers on most nights, and has noticed a 20-pound weight gain over the past 10 years. He feels “so tired and old now.” M.R. has dark circles under his eyes and complains of constant daytime fatigue. His wife is even sleeping in another bedroom because he is snoring so loudly. He also reinjured his lower back a month ago at work, lifting a pile of boards, so his physician prescribed ibuprofen (Motrin) 800 mg TID for 4 weeks. M.R. begins to complain of nausea; as you hand him the emesis basin, he promptly vomits coffee-ground emesis with specks of bright red blood. Case #4: A.G. is an 87-year-old woman with a 1-day history of abdominal pain and nausea and vomiting. A.G. speaks very little English. All information is obtained through her grandson. Past medical history includes colectomy for colon cancer 6 years ago and ventral hernia repair 2 years ago. She has no history of coronary artery disease, diabetes mellitus, or pulmonary disease. She takes only ibuprofen (Motrin) occasionally for mild arthritis. Allergies include sulfa drugs and meperidine. Her vital signs (VS) are stable, she has an IV of D5½NS with 20 mEq KCl infusing at 100 mL/hr, and 3 L oxygen by nasal cannula (O2/NC). Physical examination reveals upper abdominal distention with hyperactive bowel sounds and visible peristaltic waves.

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