VSIM Stan Checketts NSG270 Page 1 CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Bowel Obstruction: Page 10 Dehydration: Page 11 Serum Potassium Level: Page 12 Serum Chloride Level: Page 13 Nasogastric tube to low intermittent suction: Page 14 DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) Abdominal x-ray to rule out bowel obstruction WBC ABG CT with contrast Colonoscopy/Sigmoidoscopy Barium enema Electrolyte panel PATIENT INFORMATION 52 year old male Distended abdomen C/O abdominal pain with N/V “dizzy and weak” Poor skin turgor Dry mucous membranes No urine output since yesterday Allergy: Demeral Height: 160cm Weight: 76kg ANTICIPATED PHYSICAL FINDINGS Fever >100*F Abdominal pain Hyperactive bowel sounds Vomiting Diarrhea followed by constipation Absence of flatulence Tachycardia Abdominal distention Poor skin turgor Weakness Dry mucous membranes ANTICIPATED NURSING INTERVENTIONS Nutrition monitoring Frequent positioning 30-45 degrees; semi-fowlers position Respiratory monitoring Splinting when coughing Decompression of gastric via Nasogastric Tube with suction Fluid management and maintenance Wound Care/Incision care if surgery is needed Monitor for hypovolemic shock ECG monitoring Continuous pulse oximetry Abdominal x-ray to check placement of nasogastric tube Administration of fluids via IV Administration of medications per physician order Obtain IV access if not available Prepare patient for surgery if needed