What are the fundamental differences in the underlying pathophysiology of the various gastrointestinal problems
2. To apply principles related to nutritional disruptions when caring for indi- viduals with gastrointestinal problems
3. To prepare patients for gastrointestinal procedures, treatments, and surgery
4. To plan care for the postoperative patient with gastrointestinal disease
vegetables from her diet. However, when her stomach emptied a short time later, the same dull, gnawing pains returned. Her husband gave her antacids to extend the relief from pain.
The antacids were effective for some time, but Mrs. Holland noticed that when she took milk of magnesia she developed diarrhea, and when she took amphogel she developed constipa- tion. In any case, the relief was short lived and she needed to find a way to treat her symp- toms with more long-lasting effect.
Preparation for Class: Nursing Care of a Person with Ulcer Disease
P r e p a r a t i o n f o r C l a s s G u i d e l i n e s
1. Literature Review
2. Facts
Underline the facts in the situation
3. Nursing Care Issues and Concerns (include those related to aging)
4. Assessment and Tentative Nursing Diagnoses a. Functional health patterns
144 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
1. Health perception–health management
2. Nutritional-metabolic function
3. Elimination
4. Activity-exercise
5. Sleep-rest
6. Cognitive-perceptual function
7. Self-perception–self-control
8. Role-relationship
9. Sexuality-reproductive function
10. Coping–stress tolerance
11. Value-belief
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 145
b. Cultural aspects
c. Missing information
d. Tentative nursing diagnoses
146 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing Tentative Nursing
Diagnoses Etiology Defining
Characteristics Method of Validation
5. Clinical Data a. Lab values
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 147
Lab Values Given Expected/Normal Values
b. Medications
148 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
Medications Given Expected
c. Nutrition
d. Environment
e. Discussion of logical fit between subjective and objective information
6. Decision Making
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 149 Nursing Diagnosis
(List All Tentative)
Level of Priority (Provide Rationale)
Retain or Eliminate
(Provide Rationale) Expected Outcome
7. Nursing Interventions
150 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
Nursing Diagnosis (Retained) Nursing Interventions
8. Evaluation of Outcomes
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 151
Nursing Diagnosis (Retained) Outcome of Care
9. Healthcare Professionals and Medical Care Needed
10. Additional Questions about This Patient’s Nursing Care
Class Activity: Nursing Care of Individuals with Ulcer Disease Directions: Respond to each of the following.
1. Compare risk factors for peptic, gastric, and stress ulcers.
2. Identify patient teaching in relation to prevention of peptic, gastric, and stress ulcers.
152 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
5. What are the clinical symptoms of peptic, gastric, and stress ulcers?
6. Identify the medical management and surgical procedures related to the treatment of peptic, gastric, and stress ulcers.
Medical Nursing Care: Practice in Critical Thinking Chronic Care Situations
Case Study: Irritable Bowel Disease (Crohn’s Disease)
Kevin Lacey, a 20-year-old junior in a liberal arts college, began having abdominal pain from cramps and diarrhea that were not relieved by a bowel movement. Because eating and drink- ing seemed to stimulate his intestinal activity, he began reducing his food intake, which did not relieve the cramps and diarrhea. His nutritional status began to deteriorate. Mr. Lacey was surprised at the amount of weight he had lost and the fatigue he experienced, which was caused by the development of an underlying anemia. His abdomen was distended, he had cramps, and he noted blood in his stool. Mr. Lacey felt miserable and was confused about why this was happening to him. He explained his feeling of not having any control over his ill- ness to the nurse in the college’s health clinic. An appointment was made for him to be seen by a gastroenterologist, who admitted him to the hospital for testing and evaluation.
A barium enema showed the characteristic “string sign,” which indicated constriction of the intestine, and a computed tomography (CT) scan showed that the wall of his bowel had thickened, but there was no evidence of adhesions or fistulas anywhere in the small or large intestine. Mr. Lacey was given intravenous fluids and began steroid therapy.
Preparation for Class: Nursing Care of a Person with Irritable Bowel Disease (Crohn’s Disease)
P r e p a r a t i o n f o r C l a s s G u i d e l i n e s
1. Literature Review
2. Facts
Underline the facts in the situation
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 153
3. Nursing Care Issues and Concerns (include those related to aging)
4. Assessment and Tentative Nursing Diagnoses a. Functional health patterns
1. Health perception–health management
2. Nutritional-metabolic function
3. Elimination
4. Activity-exercise
5. Sleep-rest
6. Cognitive-perceptual function
154 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
7. Self-perception–self-control
8. Role-relationship
9. Sexuality-reproductive function
10. Coping–stress tolerance
11. Value-belief
b. Cultural aspects
c. Missing information
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 155
d. Tentative nursing diagnoses
156 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing Tentative Nursing
Diagnoses Etiology Defining
Characteristics Method of Validation
5. Clinical Data a. Lab values
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 157
Lab Values Given Expected/Normal Values
b. Medications
158 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
Medications Given Expected
c. Nutrition
d. Environment
e. Discussion of logical fit between subjective and objective information
6. Decision Making
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 159 Nursing Diagnosis
(List All Tentative)
Level of Priority (Provide Rationale)
Retain or Eliminate
(Provide Rationale) Expected Outcome
7. Nursing Interventions
160 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
Nursing Diagnosis (Retained) Nursing Interventions
8. Evaluation of Outcomes
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 161
Nursing Diagnosis (Retained) Outcome of Care
9. Healthcare Professionals and Medical Care Needed
10. Additional Questions about This Patient’s Nursing Care
Class Activity: Follow-up Care of an Individual with Irritable Bowel Disease (Crohn’s Disease) Directions: To complete this section, read the situation and answer the questions that follow.
Mr. Lacey was discharged, with follow-up care to continue in his home. He had to take a leave of absence from school until he was strong enough to return.
162 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
2. What expected outcomes of nursing care can be anticipated?
3. Identify specific ways in which nurses can intervene in his care.
Surgical Nursing Care: Practice in Critical Thinking Acute Care Situations
Case Study: Cancer of the Bowel
Richard McKinsey, 55 years of age, wanted to practice illness prevention and health promotion activities. He had no family history of colon cancer, but when he learned of the high incidence of colon cancer in adults over 55 years of age, he underwent a routine colonoscopy. He be- lieved that he had no symptoms of disease, so he was stunned when the colonoscopy showed a lesion in his ascending colon. The physician removed tissue for a biopsy and reported that
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 163
the tumor was an adenocarcinoma, originating in the epithelial lining of the intestine. In retro- spect, Mr. McKinsey was able to identify symptoms that he had mistaken for normal patterns.
He recalled complaining of dull abdominal pain and occasional black tarry stools. Because of the location of the lesion, he was prepared for abdominoperineal resection with a permanent sigmoid colostomy. His surgery was scheduled immediately.
As you plan his nursing care, limit your preparation for class to his preoperative care and the first 48 hours of his postoperative care.
Preparation for Class: Nursing Care of a Person with Cancer of the Bowel
P r e p a r a t i o n f o r C l a s s G u i d e l i n e s
1. Literature Review
2. Facts
Underline the facts in the situation
3. Nursing Care Issues and Concerns (include those related to aging)
4. Assessment and Tentative Nursing Diagnoses a. Functional health patterns
1. Health perception–health management
164 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
2. Nutritional-metabolic function
3. Elimination
4. Activity-exercise
5. Sleep-rest
6. Cognitive-perceptual function
7. Self-perception–self-control
8. Role-relationship
9. Sexuality-reproductive function
10. Coping–stress tolerance
11. Value-belief
b. Cultural aspects
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 165
c. Missing information
d. Tentative nursing diagnoses
166 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing Tentative Nursing
Diagnoses Etiology Defining
Characteristics Method of Validation
5. Clinical Data a. Lab values
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 167
Lab Values Given Expected/Normal Values
b. Medications
168 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
Medications Given Expected
c. Nutrition
d. Environment
e. Discussion of logical fit between subjective and objective information
6. Decision Making
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 169 Nursing Diagnosis
(List All Tentative)
Level of Priority (Provide Rationale)
Retain or Eliminate
(Provide Rationale) Expected Outcome
7. Nursing Interventions
170 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
Nursing Diagnosis (Retained) Nursing Interventions
8. Evaluation of Outcomes
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 171
Nursing Diagnosis (Retained) Outcome of Care
9. Healthcare Professionals and Medical Care Needed
10. Additional Questions about This Patient’s Nursing Care
172 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
Postoperatively, Mr. McKinsey progressed as expected. His abdominal wound was clean and intact and his perineal wound had a drain in place that was to be removed gradually. The slight swelling of his stoma was receding and the small amount of normal oozing after sur- gery had resolved.
Questions
1. When planning care for Mr. McKinsey identify the problems that focus attention on the following physical aspects of recovery: respiratory, circulatory, nutritional, and integumentary.
2. Write expected outcomes for the emotional/psychological issues in Mr. McKinsey’s care.
3. Plan a patient education program that will have as its goal to enhance Mr. McKinsey’s self-care abilities.
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 173
Surgical Nursing Care: Practice in Critical Thinking Chronic Care Situations
Case Study: Ulcerative Colitis
Martha Douglas was 28 years of age when she was diagnosed with ulcerative colitis. She was in the midst of a budding career in advertising. By her 40th birthday, she was established in the industry, although she had endured many years of symptoms from exacerbations of the disease. During one week she had had as many as 20 bloody stools a day and she complained to her partner of abdominal cramps and of feeling weak and dizzy. She is 5 ft 5 in tall and weighs 102 lb. Ms. Douglas was hospitalized for evaluation with the strong possibility that she would undergo surgery to create an ileoanal anastomosis. Her partner was very supportive of her decision to have the surgery and recognized that she was in a great deal of pain and that her symptoms interfered with the lifestyle she had chosen.
As planned, a temporary, diverting-loop ileostomy was created to allow the ileoanal anas- tomosis to heal. Ms. Douglas tolerated the procedure very well.
As you plan her nursing care, your preparation for class should include preoperative as well as postoperative care.
Preparation for Class: Nursing Care of a Person with Ulcerative Colitis Requiring an Ileostomy
P r e p a r a t i o n f o r C l a s s G u i d e l i n e s
1. Literature Review
2. Facts
Underline the facts in the situation
3. Nursing Care Issues and Concerns (include those related to aging)
174 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing
4. Assessment and Tentative Nursing Diagnoses a. Functional health patterns
1. Health perception–health management
2. Nutritional-metabolic function
3. Elimination
4. Activity-exercise
5. Sleep-rest
6. Cognitive-perceptual function
7. Self-perception–self-control
8. Role-relationship
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 175
9. Sexuality-reproductive function
10. Coping–stress tolerance
11. Value-belief
b. Cultural aspects
c. Missing information
d. Tentative nursing diagnoses
176 Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing Tentative Nursing
Diagnoses Etiology Defining
Characteristics Method of Validation