Situation
A 63-year-old man, accompanied by his wife, goes to the emergency room of a small rural hospital in a Canadian province because of a dull to sharp pain in the region of the epigastrium that crosses to the back. The pain lasts for several days and is accompanied by nausea and vomiting. It becomes more and more intense, frequent and acute.
The nurse on call in the emergency room installs the patient on a stretcher in the treatment room. She collects data, performs a physical assessment from head to toe, and proceeds with sanctioned prescriptions according to abdominal complaint protocols. She takes the necessary blood for the tests, then prepares the patient for an intravenous tube.
Relevant data from the patient’s history
1) Recent laparoscopic cholecystectomy (5 days) performed in a hospital 300 km. The surgeon indicates to have made a small «gash» to the pancreas. According to the wife, a purulent discharge came from the site when the nurse removed the drain before dischare.
2) Presence of Guilbert’s disease since the patient’s adolescence.
3) Regular alcohol consumption (makes own wine).
On physical examination, the nurse finds:
• T = 38.6 C (oral) P = 113 bpm R = 24 TA = 98/52 Sa02 = 91% room air.
• Decreased bowel sounds, tympanism and abdominal pain with defensive reaction to palpation.
• Some crackling at the base of the lungs.
• Moist, pale skin.
• Slight confusion, lethargy and drowsiness.
Answer the following questions
1. What should the critical care nurse do if she is to act without the direct supervision of the physician?
2. Describe the blood tests to include in the patient profile for clinical investigation, especially the most important.
3. Identify three intravenous solutions that can be infused without compromising patient health.
4. What is likely the cause of the patient’s condition?
5. What are the next steps?
6. Which of Watson’s (1988) carat factors would be a priority in this case? Select a single carat factor. Justi fi ez the care to be provided according to the theory of Watson (1988).
***Add at leats one scientific reference for each question and respect APA 7th edition. ***
