lOMoARcPSD|62982272
Part I: Small Bowel Obstruction
NextGen Unfolding Reasoning
Mary O’Reilly, 55 years old
Primary Concept
Elimination
Interrelated Concepts (In order of emphasis)
Patient Education
Clinical judgment
NCLEX Client Need Categories Covered in NCSBN Clinical Covered in
Case Study Judgment Model Case Study
Safe and Effective Care Environment Step 1: Recognize Cues
Management of Care Step 2: Analyze Cues
Safety and Infection Control Step 3: Prioritize Hypotheses
Health Promotion and Maintenance Step 4: Generate Solutions
Psychosocial Integrity Step 5: Take Action
Physiological Integrity Step 6: Evaluate Outcomes
Basic Care and Comfort
Pharmacological and Parenteral
Therapies
Reduction of Risk Potential
Physiological Adaptation
Copyright © 2020 Keith Rischer, d/b/a KeithRN. All Rights reserved.
Downloaded by elizabeth moses ()
, lOMoARcPSD|62982272
Part I: Initial Nursing Assessment
Present Problem:
Mary O’Reilly is a 55-year-old woman with a prior history of partial colectomy w/colostomy and small bowel obstruction
three months ago that resolved with bowel rest and required no surgical intervention. Three days ago Mary developed a
sudden onset of sharp generalized abdominal pain with nausea, vomiting and decreased output from her colostomy bag.
She has had two small glasses of water today. Mary is admitted to the medical/surgical unit and you will be the nurse
caring for her. You receive the following highlights of report from the emergency department (ED) nurse:
CT of her abdomen/pelvis revealed high-grade small bowel obstruction.
Lactate 2.8, WBC 14.7, Sodium 143, Potassium 3.7, Creatinine 1.35
An NG was placed and she is on low intermittent suction. She had NG output of 225 mL of bile green liquid.
Received hydromorphone 0.5 mg IV for pain one hour ago. Abdominal pain decreased from 9/10 to 3/10 and she
is resting more comfortably.
Abd. is firm, slightly distended, with tympanic bowel sounds.
Initial HR/BP was 102 and 92/48.
Most recent vital signs: T: 99.8 (o) P: 78 (reg) R: 18 BP: 108/52 after 1000 mL 0.9% NS bolus 20 g. peripheral IV
in left forearm.
What data from the history are RELEVANT and must be NOTICED as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
parital colectomy w/colostomy, surgery is more than likely required
perforated small bowel three months patient isn't clearing lactate from the blood
ago, 4.9 lactate, 18.9 WBC, 92/48 high WBC is indicative of infection
systolic BP, 65 MAP, administered BP is below normal limits
NS, received antibiotics MAP is trending down and dangerously low
Possible that patient is developing sepsis
NS used as fluid resuscitation for low BP
antibiotics used to treat infection
After receiving report, you quickly review this patient’s past medical
history and home medications in the electronic health record:
1. WHY is your patient receiving these home medications? Draw lines to connect the medication to the problem it
is most likely treating. (NCLEX: Pharmacologic and Parenteral Therapies)
Past Medical History: Home Medications:
COPD Aspirin 81 mg PO daily
Paroxysmal atrial fibrillation Furosemide 20 mg PO daily
Coronary artery disease Lisinopril 5 mg PO daily
Diverticulitis Metoprolol 25 mg PO BID
Small bowel obstruction Simvastatin 20 mg PO daily
Partial colectomy w/colostomy Umeclidinium-vilanterol 62.5/25 mcg inhaler 1 puff daily
Non-dilated cardiomyopathy-EF 25% Albuterol 0.083% neb solution 3 mL every 6 hours PRN
Mary is transferred from the cart to her bed on the medical/surgical unit. You
introduce yourself, and collect the following clinical data:
Copyright © 2020 Keith Rischer, d/b/a KeithRN. All Rights reserved.
Downloaded by elizabeth moses ()
Part I: Small Bowel Obstruction
NextGen Unfolding Reasoning
Mary O’Reilly, 55 years old
Primary Concept
Elimination
Interrelated Concepts (In order of emphasis)
Patient Education
Clinical judgment
NCLEX Client Need Categories Covered in NCSBN Clinical Covered in
Case Study Judgment Model Case Study
Safe and Effective Care Environment Step 1: Recognize Cues
Management of Care Step 2: Analyze Cues
Safety and Infection Control Step 3: Prioritize Hypotheses
Health Promotion and Maintenance Step 4: Generate Solutions
Psychosocial Integrity Step 5: Take Action
Physiological Integrity Step 6: Evaluate Outcomes
Basic Care and Comfort
Pharmacological and Parenteral
Therapies
Reduction of Risk Potential
Physiological Adaptation
Copyright © 2020 Keith Rischer, d/b/a KeithRN. All Rights reserved.
Downloaded by elizabeth moses ()
, lOMoARcPSD|62982272
Part I: Initial Nursing Assessment
Present Problem:
Mary O’Reilly is a 55-year-old woman with a prior history of partial colectomy w/colostomy and small bowel obstruction
three months ago that resolved with bowel rest and required no surgical intervention. Three days ago Mary developed a
sudden onset of sharp generalized abdominal pain with nausea, vomiting and decreased output from her colostomy bag.
She has had two small glasses of water today. Mary is admitted to the medical/surgical unit and you will be the nurse
caring for her. You receive the following highlights of report from the emergency department (ED) nurse:
CT of her abdomen/pelvis revealed high-grade small bowel obstruction.
Lactate 2.8, WBC 14.7, Sodium 143, Potassium 3.7, Creatinine 1.35
An NG was placed and she is on low intermittent suction. She had NG output of 225 mL of bile green liquid.
Received hydromorphone 0.5 mg IV for pain one hour ago. Abdominal pain decreased from 9/10 to 3/10 and she
is resting more comfortably.
Abd. is firm, slightly distended, with tympanic bowel sounds.
Initial HR/BP was 102 and 92/48.
Most recent vital signs: T: 99.8 (o) P: 78 (reg) R: 18 BP: 108/52 after 1000 mL 0.9% NS bolus 20 g. peripheral IV
in left forearm.
What data from the history are RELEVANT and must be NOTICED as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
parital colectomy w/colostomy, surgery is more than likely required
perforated small bowel three months patient isn't clearing lactate from the blood
ago, 4.9 lactate, 18.9 WBC, 92/48 high WBC is indicative of infection
systolic BP, 65 MAP, administered BP is below normal limits
NS, received antibiotics MAP is trending down and dangerously low
Possible that patient is developing sepsis
NS used as fluid resuscitation for low BP
antibiotics used to treat infection
After receiving report, you quickly review this patient’s past medical
history and home medications in the electronic health record:
1. WHY is your patient receiving these home medications? Draw lines to connect the medication to the problem it
is most likely treating. (NCLEX: Pharmacologic and Parenteral Therapies)
Past Medical History: Home Medications:
COPD Aspirin 81 mg PO daily
Paroxysmal atrial fibrillation Furosemide 20 mg PO daily
Coronary artery disease Lisinopril 5 mg PO daily
Diverticulitis Metoprolol 25 mg PO BID
Small bowel obstruction Simvastatin 20 mg PO daily
Partial colectomy w/colostomy Umeclidinium-vilanterol 62.5/25 mcg inhaler 1 puff daily
Non-dilated cardiomyopathy-EF 25% Albuterol 0.083% neb solution 3 mL every 6 hours PRN
Mary is transferred from the cart to her bed on the medical/surgical unit. You
introduce yourself, and collect the following clinical data:
Copyright © 2020 Keith Rischer, d/b/a KeithRN. All Rights reserved.
Downloaded by elizabeth moses ()
