Caring for Clients with common Digestive/ Gastrointestinal Health Challenges.
Select any three (3) questions from Case Study # 1 or from Case Study # 2, and discuss the rationale by posting/ responding in the online learning activity/ discussion forum. Please identify the case study selected and copy the three questions chosen directly into the post. Include and properly reference information taken from the course readings to support your ideas.
CASE STUDY #2
(must be 3 pages with at least 5 references no older than 5 years)
Joshua Phelps, 37, arrives at the ED complaining of right lower quadrant abdominal pain. You obtain his vital signs and find out that he has no known allergies and takes no medications. His BP is 156/ 94; pulse, 100 and regular; respirations, 20; and temperature, 99.6 F (37.6 C).
What is the next step in investigating his problem?
Mr. Phelps’ pain began last evening and is associated with nausea, but he hasn’t vomited. Eating doesn’t seem to affect the pain, and he hasn’t had any bowel or bladder changes.
In assessing Mr. Phelps’s pain, what information should you obtain?
Mr. Phelps describes his pain as constant, deep and achy, and worse with movement. On a pain scale of 0- to 10, with 10 being the worst pain he has ever experienced, he rates the pain at a 7. He doesn’t want to lie supine and is guarding his right lower quadrant.
When assessing Mr. Phelps’ abdomen, describe the order and specifics associated with the assessment?
Abdominal assessment shows a normal inspection, normoactive bowel sounds, and no masses, enlargement, or tenderness of the liver or spleen. However, Mr. Phelps did display rebound tenderness and positive obturator and iliopsoas signs. Based on his history and physical assessment, the healthcare provider orders a complete blood cell count and urinalysis. The results indicate a total white blood cell (WBC) count elevation with 96% neutrophils. The urinalysis is normal.
Mr. Phelps’ signs and symptoms, history, physical assessment, and lab findings suggest which diagnosis? Explain your rationale.
Abdominal aortic dissection.
Acute appendicitis.
Renal calculi.
Acute Cholecystitis.
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What is my knowledge concerning providing care for and with clients experiencing digestive and gastrointestinal challenges? (i am a community rpn)
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Case Study #2
1) In assessing Mr. Phelps’s pain, what information should you obtain?The information that should be obtained about Mr. Phelps’s pain include:
Character of the pain: deep and achy
Duration: States it’s constant
Frequency
What makes the pain worse or better: movement makes it worse, lying supine
Location: right lower quadrant
Distribution of referred pain
Time pain started: last evening
2) When assessing Mr. Phelps’ abdomen, describe the order and specifics associated with the assessment?
Start with inspecting the abdomen noting colour, contour, symmetry, the umbilicus is midline etc.
Next we would auscultate because “percussion and palpation can increase peristalsis which would give a false interpretation of bowel sounds” (Jarvis, 2014). During auscultation we listen for bowel sounds(character and frequency) and vascular sounds.
Percussion comes next “to assess the relative density of abdominal contents, to locate organs, and to screen for abdominal fluid or masses”(Jarvis, 2014).
Palpation is last. You note whether their is tenderness, masses, involuntary rigidity, guarding etc.
3) Mr. Phelps’ signs and symptoms, history, physical assessment, and lab findings suggest which diagnosis? Explain your rationale.
Mr. Phelps’s assessments suggest acute appendicitis based on the following findings:positive obturator and iliopsoas sign, pain in RLQ. “when the iliopsoas muscle is inflamed (which occurs with an inflamed or perforated appendix) pain is felt in the RLQ” (Jarvis, 2014)
Rebound tenderness
Pain aggravated by movement
Nausea
Fever
Total white blood cell count elevation with 96% neutrophils
References
Jarvis, C. (2014). The Abdomen, Physical Examination and Health Assessment (2nd CanadIan ed., pp 557-569). Toronto, ON: Elsevier Canada.
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