University of Akron
Homeostasis of fluid and electrolyte balance is important for the body to be able to function. The nursing student will cover the risk, pathology, and signs and symptoms for both fluid deficit and hypokalemia. The nursing student will also apply these findings to the patient specific information from the clinical day February 8, 2011. This will give her the ability to formulate four different nursing diagnosis and evaluations of interventions and outcomes. Review of the patient’s case
DS was admitted to the hospital for a ventral hernia repair and a small bowel resection on January 30, 2011. During recovery from the surgery, DS acquired Clostridium Difficile. She also has a history of hypertension, chronic obstructive pulmonary disease, and has suffered a myocardial infarction. DS smokes a pack of cigarettes daily and states she is guilty of eating poorly. She said she does not take her “heart pill” routinely and deserves all the health issues she has had. A ventral hernia repair is usually caused by a previous surgical incision where the muscle is weak, but can also be caused by a naturally thin place in the muscle wall. A small portion of the bowels can protrude through this weakness in the muscle wall causing a hernia. In order to correct this issue, a small piece of surgical mesh is surgically inserted to strengthen the muscle wall. The muscle tissue grows into and around the surgical mesh to form a stronger muscle wall. The patient has a Jackson-Pratt drain to draw off excess fluid from the surgery. The nursing student emptied this drain at the end of the clinical day and was able to drain 40 cc. As stated previously, the patient was having some postoperative complications and through a stool sample was able to find out she had Clostridium Difficile. Clostridium Difficile is a gram-positive spore-forming bacillus. This bacillus can be found in the environment and is not always harmful. It is resistant to the acidity of the stomach and grows in the stomach. The colonization of C. Dif causes mucosal damage and inflammation. It is commonly found in people taking antibiotics or who have been in the hospital for an extended stay. It is also common to find C. Dif in patients who have recently had an abdominal surgery like DS. C. Dif also increases capillary permeability and stimulates intestinal peristalsis. This is why a common symptom of C. Dif is watery diarrhea and abdominal pain. C. Dif is known to cause dehydration, lacerations in the large intestine, and kidney failure. In order to find out if the patient has C. Dif a stool sample must be sent down to the lab. Antibiotics are used to treat C. Dif (Patho book 933). DS was prescribed many medications she was not taking because she refused to allow intravenous access. |Medication |Reason Perscribed | |Famotid PO 20 mg daily |To treat and maintain duodenal ulcers | |Gabapentin PO 600 mg every 8 hours |To treat hot flashes or neuropathic pain | |Heparin subcutaneous injections 5,000 units every 8 hours |To prevent deep vein thrombosis, pulmonary embolism, or peripheral | | |embolism | |Metaprolol Tartrate PO 25 mg every 12 hours |To treat hypertension | |Metronidazole PO 500 mg every 8 hours |To prevent postoperative infections | |Nicoderm transdermal patch 14 mg ever 24 hours |To aid the patient in...