Patient Introduction Mr. Watkins is a 69-year-old male who presented to the Emer
ID: 248174 • Letter: P
Question
Patient Introduction
Mr. Watkins is a 69-year-old male who presented to the Emergency Department 4 days ago with complaints of nausea, vomiting, and severe abdominal pain and was admitted for emergent surgery for bowel perforation. He underwent a hemicolectomy. He has a midline abdominal incision without redness, swelling, or drainage. He is tolerating a soft diet without nausea or vomiting. Bowel sounds are present in all four abdominal quadrants. He had a bowel movement yesterday. Last urinary output was 400 ml at 6 a.m. He is reluctant to use the incentive spirometer, but his wife encourages him to do his deep breathing. Abdominal pain has been controlled with morphine. He has refused to ambulate this morning because of fatigue and a sore leg. He is ringing the call light requesting to see his nurse.
Guided Reflection Questions
1. How did the scenario make you feel?
2. Discuss your use of adjunct oxygen therapy for this patient, including why you chose a particular oxygen device, rate, and flow.
3. Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused this result.
4. Discuss the use of a heparin nomogram (guideline for heparin titration) and safety related to this intervention.
5. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.
6. Discuss why Vernon Watkins may be at risk for right ventricular failure as a complication of his pulmonary embolism (PE).
7. Discuss how you would communicate with the patient in acute respiratory distress in this emergency situation and what effective communication techniques you would use.
8. Consider what would have happened if Vernon Watkins’ family members had been present at the bedside, and describe how you would have supported them during this acute episode.
9. What would you do differently if you were to repeat this scenario? How would your patient care change?
Explanation / Answer
1)The case of Mr.Watkins makes a medical professional to be aware of getting complications out of surgery due to avoidance of doing certain activities.Helps a trainee or students to get ample of nursing management to be done for this patient
2)As this patient avoids using a Spirometry there are high chances of getting pneumonia due to mobilisation post surgery.So an adjunct oxygen therapy of O2 via nasal prongs at 2 litre can help him
3)The ABG level could tentatively change because of low oxygen level after abdominal surgery like increased CO2 leve causing respiratory acidosis.
4) Heparin nomogram is used for this patient to provide the right dose of medication so that the patient will not get any pulmonary embolism, simultaneously it is very important that the patient may bleed if overdose occurs.