Small Bowel Obstruction NextGen Unfolding Reasoning (Part I) Mary O’Reilly, 55 years old

Primary Concept Elimination Interrelated Concepts (In order of emphasis)  Patient Education  Clinical judgment NCLEX Client Need Categories Safe and Effective Care Environment  Management of Care  Safety and Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity  Basic Care and Comfort  Pharmacological and Parenteral Therapies Covered in Case Study    NCSBN Clinical Judgment Model Step 1: Recognize Cues Step 2: Analyze Cues Step 3: Prioritize Hypotheses Step 4: Generate Solutions Step 5: Take Action Step 6: Evaluate Outcomes Covered in Case Study         Reduction of Risk Potential Physiological Adaptation   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: