vSim Stan Checketts
Case Scenario/Description
Location: Emergency DepartmentTime: 04:00Situation:Stan Checketts, a
52-year-old widower, arrived in the Emergency Department 30 minutes ago with
severe abdominal pain. A small bowel obstruction is suspected.Background:He
has experienced worsening abdominal pain, nausea, and vomiting for 1-2 days
with inability to eat or drink much over the last few days. His past surgical history
includes a cholecystectomy, appendectomy, and right inguinal hernia repair, all
more than 5 years ago.Assessment:Mr. Checketts is awake and states he has
felt 'dizzy' and 'weak' all evening. His vital signs upon arrival were: BP: 108/73;
temperature: 100.9 °F (38.3 °C); pulse: 110; respiratory rate: 22, and SpO2: 95%
on room air. He has poor skin turgor, dry mucous membranes, and has not
urinated since yesterday. His abdomen is distended. He signed an informed
consent for treatment. A right forearm saline lock was placed, and labs, a CBC,
and BMP were drawn.Recommendation:You will need to check the provider's
orders just written and see if the lab results are back.
The nurse is admitting Stan Checketts with complaints of severe abdominal pain
with N & V. The nurse suspects an obstruction. What assessment findings
support the nurse's suspicions?
-Abdomen soft, non-tender
-P 88 bpm
-Dizziness
-Poor skin turgor
-BP 90/58
-RR 18
-Urine dark yellow color
, -dizziness
-poor skin turgor
-BP 90/58
-urine dark yellow color
...The clinical manifestations assoc. w/ intestinal obstructions include dizziness,
hypotension, poor skin turgor, and concentrated urine assoc. w/ dehydration from
poor oral intake. A client with an intestinal obstruction will often also have a
distended abdomen from the obstruction and inability of fluid to advance. The
finding of a soft abdomen, pulse of 88, and RR of 18 reflect expected findings in
a healthy adult.
Based on the client's objective and subjective findings, the nurse suspects that
Mr. Checketts' medical diagnoses are hypovolemia and bowel obstruction. the
nurse will anticipate the provider's order to include _____________ to treat
hypovolemia and insertion of a _______ as the primary intervention to prevent
the complications of a small bowel obstruction.
infusion of NS
NG tube
...The dx of hypovolemia and small bowel obstruction mandate the infusion of
fluids to reestablish fluid balance. Isotonic solutions such as normal saline are
used to replace GI fluid loss. The other fluid solutions are contraindicated and are
used to treat other conditions. A NG tube is inserted to decompress the stomach
and alleviate NV. Rectal tube insertion and insertion of a chest tube do not
address the immediate concerns of a small bowel obstruction. Although insertion
of an indwelling catheter is an appropriate intervention in the case, it will not
prevent the priority complications of a small bowel obstructions, which are due to
increasing distention and pressure within the intestinal lumen. This can cause
Case Scenario/Description
Location: Emergency DepartmentTime: 04:00Situation:Stan Checketts, a
52-year-old widower, arrived in the Emergency Department 30 minutes ago with
severe abdominal pain. A small bowel obstruction is suspected.Background:He
has experienced worsening abdominal pain, nausea, and vomiting for 1-2 days
with inability to eat or drink much over the last few days. His past surgical history
includes a cholecystectomy, appendectomy, and right inguinal hernia repair, all
more than 5 years ago.Assessment:Mr. Checketts is awake and states he has
felt 'dizzy' and 'weak' all evening. His vital signs upon arrival were: BP: 108/73;
temperature: 100.9 °F (38.3 °C); pulse: 110; respiratory rate: 22, and SpO2: 95%
on room air. He has poor skin turgor, dry mucous membranes, and has not
urinated since yesterday. His abdomen is distended. He signed an informed
consent for treatment. A right forearm saline lock was placed, and labs, a CBC,
and BMP were drawn.Recommendation:You will need to check the provider's
orders just written and see if the lab results are back.
The nurse is admitting Stan Checketts with complaints of severe abdominal pain
with N & V. The nurse suspects an obstruction. What assessment findings
support the nurse's suspicions?
-Abdomen soft, non-tender
-P 88 bpm
-Dizziness
-Poor skin turgor
-BP 90/58
-RR 18
-Urine dark yellow color
, -dizziness
-poor skin turgor
-BP 90/58
-urine dark yellow color
...The clinical manifestations assoc. w/ intestinal obstructions include dizziness,
hypotension, poor skin turgor, and concentrated urine assoc. w/ dehydration from
poor oral intake. A client with an intestinal obstruction will often also have a
distended abdomen from the obstruction and inability of fluid to advance. The
finding of a soft abdomen, pulse of 88, and RR of 18 reflect expected findings in
a healthy adult.
Based on the client's objective and subjective findings, the nurse suspects that
Mr. Checketts' medical diagnoses are hypovolemia and bowel obstruction. the
nurse will anticipate the provider's order to include _____________ to treat
hypovolemia and insertion of a _______ as the primary intervention to prevent
the complications of a small bowel obstruction.
infusion of NS
NG tube
...The dx of hypovolemia and small bowel obstruction mandate the infusion of
fluids to reestablish fluid balance. Isotonic solutions such as normal saline are
used to replace GI fluid loss. The other fluid solutions are contraindicated and are
used to treat other conditions. A NG tube is inserted to decompress the stomach
and alleviate NV. Rectal tube insertion and insertion of a chest tube do not
address the immediate concerns of a small bowel obstruction. Although insertion
of an indwelling catheter is an appropriate intervention in the case, it will not
prevent the priority complications of a small bowel obstructions, which are due to
increasing distention and pressure within the intestinal lumen. This can cause
