The subject of my case study is an alert and oriented Native American male between the age of 60-65, who was admitted to the hospital for abdominal pain with a medical diagnosis of a possible postoperative small bowel obstruction or an ileus. 21 days prior to being admitted, the patient was travelling for work in Mexico when he underwent an emergency open cholecystectomy versus laparoscopic due to formed adhesions from 3 previous colon resection surgical procedures. Patient was placed on Total Parenteral Nutrition (TPN) for 2 days and then discharged to resume work. Patient was readmitted to the hospital in Mexico for abdominal pain and diagnosed with an ischemic bowel in which an exploratory laparotomy was performed removing 50 cm of the small bowel 10 days later. He was placed on a clears diet, but due to poor tolerance resumed TPN for six days. Due to the complexity of his status, the patient requested being transferred to a facility in his native country, U.S.A. The patient was transferred to the current site, admitted with abdominal pain and diagnosed with possible bowel obstruction. Due to complications in translating the medical records from Mexico, TPN was not ordered for the patient until his fifth day of care. The patient is a full code with allergies to Morphine, Penicillins and shellfish. Background Information
The patient belongs to the San Carlos Apache Reservation, and practices Native American beliefs. He has been married to his wife for 39 years and conceived 3 children who are now of adult age. He is college educated, middle socioeconomic status and is employed as a Regional Sales Manager for an Agriculture company. He is family and career focused, and prides himself on being a “damn good father, grandfather, husband, son, healer and provider.” Based on this information, he is categorized well in Erikson’s psychosocial development of Generativity versus Stagnation. (Wilkinson & Treas, 2011) Patient is adaptive to all medical staff and compliant in fulfilling tasks and verbalizing acknowledgment of procedures to ensure the maximal efficacy in treatment for his diagnosis. Affected Systems and Physiology
The Digestive system is the primary organ system involved. It is composed of the gastrointestinal tract (GI) and accessory digestive organs. Normal gut motility depends on the integration of smooth muscle activity within the gut wall through both sympathetic (inhibitory) and parasympathetic (excitatory) neural input along with a variety of hormonal interactions. This excitatory activity is usually interrupted by surgery but returns, in stages, to the small intestines within 24 hours after surgery followed by the stomach within 24 to 48 hours, and finally to the colon after 2 to 3 days. However, coordinated propulsive activity may not recover appropriately. (Phipps et al., 2011, p. 164) Due to the condition of this patient, other affected systems related to his condition include integumentary system and the immune system. The integumentary system plays a role in homeostasis of our body and the barrier that serves as protection of our internal organs, and the immune system protects our body against disease. (Tortora & Derrickson, 2009) Pathophysiology
The pathophysiological processes involved in the complications of this case study are due to diverticulitis; an inflammation in the wall of the colon, cholecystitis; an inflammation of the gallbladder often related to cholelithiasis; gallstones made up of cholesterol or biliary sludge that causes an obstruction in the cystic duct or common bile duct. (Huether, 2010) There is a cultural correlation for the incidence of these conditions being greater in Native Americans. These conditions resulted in the surgical history of three colon resections due to a perforated diverticulum in which he developed peritonitis 14 years ago in addition to his recent emergency open cholecystectomy and exploratory laparotomy....