Indrani Singh is a 52 yo woman who has been admitted to the emergency department. For the last couple of days, she has been vomiting small amounts, and has had abdominal pain that has become more severe in the last 8 hours. She expresses surprise at her vomiting because she has eaten and drunk very little. She has not had a bowel movement in 2 days. Her medical history shows abdominal surgery for a hysterectomy twelve months ago, on a background of severe endometriosis. Collect cues Vital signs: RR: 14 bpm SpO2: 99% BP: 110/60 mmHg (MAP 77 mmHg) HR: 118 bpm Temp: 37 oC Pain assessment: P = upon movement and at rest Q = aching with occasional stabbing pain R = peri umbilical (central abdomen) S=8/10 T = Constant for last 48 hours Abdominal assessment: Inspection – distension, midline scar Auscultation – absent bowel sounds Palpation – general tenderness and guarding Percussion – gas-induced tympany Fluid status assessment: Weak pulses Pale and cool to the touch Cap refill > 3secs Reduced skin turgor – tongue furrowed Dry mucous membranes Last voided – last night Take action Interventions for Indrani include: 4 hourly vital signs and pain assessment Fluid balance monitoring and hydration status assessment Nil by mouth Nasogastric tube (Salem sump tube) on free drainage and 4 hourly gentle aspirations Intravenous fluids Refer to anatomical structures, and use physiological and pathophysiological mechanisms to explain, step-by step, the development of these cues of Indrani’s presentation.
Indrani Singh is a 52 yo woman who has been admitted to the emergency department. For the last couple of days, she has been vomiting small amounts, and has had abdominal pain that has become more severe in the last 8 hours. She expresses surprise at her vomiting because she has eaten and drunk very little. She has not had a bowel movement in 2 days. Her medical history shows abdominal surgery for a hysterectomy twelve months ago, on a background of severe endometriosis.
Collect cues
Vital signs:
-
RR: 14 bpm
-
SpO2: 99%
-
BP: 110/60 mmHg (MAP 77 mmHg)
-
HR: 118 bpm
-
Temp: 37 oC
Pain assessment:
-
P = upon movement and at rest
-
Q = aching with occasional stabbing pain
-
R = peri umbilical (central abdomen)
-
S=8/10
-
T = Constant for last 48 hours
Abdominal assessment:
-
Inspection – distension, midline scar
-
Auscultation – absent bowel sounds
-
Palpation – general tenderness and guarding
-
Percussion – gas-induced tympany
Fluid status assessment:
-
Weak pulses
-
Pale and cool to the touch
-
Cap refill > 3secs
-
Reduced skin turgor – tongue furrowed
-
Dry mucous membranes
-
Last voided – last night
Take action
Interventions for Indrani include:
4 hourly vital signs and pain assessment
Fluid balance monitoring and hydration status assessment
Nil by mouth
Nasogastric tube (Salem sump tube) on free drainage and 4 hourly gentle aspirations Intravenous fluids
Refer to anatomical structures, and use physiological and pathophysiological mechanisms to explain, step-by step, the development of these cues of Indrani’s presentation.
Step by step
Solved in 3 steps
