Medications: Nursing Interventions:

Cefepime  1g -IV push Q6H (730)(1454) INFECTION PREVENTION/CONTROL 

-dilute in 10ml of NS---flush with 10 ml NS- administer IVpush slowly over 3-5 min.--flush again with 10ml NS
Chronic thrombocytopenia and anemia--- explains
1st PRIORITY: Assess level of pain frequently and administer prescribed opioid medication.
fatigue and overall weakness as well. Also effect of Chlorhexidine Gluconate (Topical)-1 ea/day topical INFECTION PREVENTION
chemotherapy
Dextrose 5% in 0.9% Sodium Chloride (D5 NS) 1000 ml IV- 75ml/hr (1600)
Lab Work Values -monitor vitals closely for changes and adverse effects.
Enoxaparin- 40 mg SQ once, daily (08) PREVENT DVT POST-OP
RBC 3.19(low)
Famotidine- 20 mg IV push daily (935) 
HgB 8.7 (low)
Hct 27.1 (low) Morphine Sulfate- 10 mg IV push Every 4 hrs, PRN PAIN MANAGEMENT
Goals/Outcomes: -always have reversal on hand in case of emergency.
MCH 27.3 Nicotine Transdermal- 14 mg transdermal daily(1130)
Platelets 122,000 (low)
Oxycodone- 5-10 mg PO Q4H PRN PAIN MANAGEMENT
RDW 19.6-large - Emphasize patient’s that it is their responsibility for reporting pain/ relief of pain.
BUN 15 Sennoside/Docusate sodium- 17 gm in 8 oz water- oral daily(730) 
Creatine 0.2 Vancomycin Hydrochloride IVPB- 540 ml IVPB Q6H(1008) INFECTION PREVENTION/CONTROL 
Glucose 104 (random)
---monitor labs---hard on renal system---nephrotoxicity. -Assess for pain, distention, and auscultate bowel sounds.
Calcium 7.9 (low) The patient will verbalize optimal relief of pain with
prescribed opioids within 30 minutes of administration.

-Assess pain goals and the expectations for relief.

Objective (Signs) The patient will notify nurse when pain medication is
Vitals: (07:45)- Temp: 37 C temporal; Pulse: 80bpm; Respiration’s: 15; Blood pressure: needed.
105/67 sitting; Pulse ox: 98 room air -Encourage ambulation; Administer pain medications as prescribed prior to ambulation
Alert awake oriented
Other tests: Cardio: no cardiologic problems noted
The patient will remain free from infection and
Abdomen: round, distended and firm. bowel sounds normoactive x4 on auscultation. -Educate patient on safety measures with ambulating due to effects of pain medication.
CT scan of abdomen with 80cc of contrast: complications related to infection.
---Yesterday he was hypoactive in all 4, so this is an improvement!
-possible atelectasis in lung bases- small L pleural effusion --Abdominal Incision: staples intact, no drainage noted, edges are healing well in approximation.
-Liver-several hypodense lesions- largest 3.2cm Extremities: Moves all, no edema
-free fluid in abdomen or pelvis Musculoskeletal: normal inspection, ambulatory-on standby due to narcotic effects The patient will tolerate antibiotics and remain free
-sigmoid colinic stent-- showed edema and wall thickening skin: dry, intact, warm, color within normal limits. from superinfections.
proximally  Ostomy: Pink and moist, no swelling or drainage noted. Patient has not had ostomy output
-small intestine dilation without wall thickening--may in almost 24 hours. 2nd PRIORITY: Assess and monitor patient for signs and symptoms of infection.
reflect small bowel obstruction or illeus ---PATIENT EXPERIENCED OUTPUT IN OSTOMY BAG AT 1430 The patient will tolerate ambulation.
Jackson Pratt drain- L abdomen: scant serous drainage in ostomy bag.
---Drain was used post OP- had excessive amounts of drainage. Once the drainage slowed down, physician placed
removed the drain and placed an ostomy bag over the area to allow the rest of the drainage to drain. The patient will tolerate clear liquid diet.
Subjective (symptoms)

Abdominal pain-throbbing and

intermittent cramping (7/10) 2 Nursing Diagnoses/Prioritize:
ASSESSMENT:

Abdominal tenderness with palpitation

Chills
Acute pain related to small bowel obstruction as
evidence by patient verbally rating pain: 7/10 on scale.
Fatigue

Patient Story; Medical Diagnosis & Past

Medical History:

07/29/20 Conclusion/reflection:

Pathophysiology: -Four other interventions that I completed on my shift:

Patient is a 48 year old male who was admitted to the medical oncology unit at -Drew up and administered opioid analgesics IV push.
-Prepared PO medications from pixis and administered to patient.
Small bowel obstruction is blockage that occurs in the small intestine, causing fluid, on 07/27/20 for severe abdominal pain, fever and absence of contents in -Assisted patient ambulating to restroom.
-Auscultated lungs, heart and bowels and assessed pain.
air, or gas to accumulate near the site of obstruction. Peristalsis increases for a ostomy. Patient has stage IV colon cancer that has metastasized into the liver -Two interdisciplinary team members I worked with:
short period, in an effort to break through the area of blockage. Intestinal lining is and was discharged two days ago (7/26/20) from the oncology unit after having -I collaborated a lot with one of my classmates, on both interventions and assessment findings.
-I collaborated with the CNA a lot as well, for I helped her fulfill patient needs and gather equipment as well as take
injured, distention occurs at and above obstruction site. The stomach and small a diverting transverse colostomy for a perforated bowel on 07/18/20. Patient vital for some patients.
-Something I will take away:
intestine closest to the blockage dilate; the bowel distal to the blockage has experienced post-OP complications with fever and excessive output from JP -Everyday in the hospital is a new and different day—no two days are the same! (and I love that).
decompresses. Water, sodium, and potassium are secreted by the bowel into the
drain.
fluid pooled in the lumen causing this swelling and distention (Lippincott Advisor,
2020). Colorectal cancer pathophysiology is complex and has an unspecified
mechanism which frequently involves genetic alterations and familiar patterns.
Tumors that arise in the sigmoid and descending colon tend grow circumferentially, History of chronic thrombocytopenia, PortA-cath procedure, recent
leading to constriction of the intestinal lumen, often leading to bowel obstruction. chemotherapy, sigmoid colinic stent placement in January for obstruction.
Both parents had colon cancer and colon cancer is
When colorectal cancer metastasizes, it commonly invades the liver. Metastatic known to have a strong genetic link.
lesions begin to form on the liver, often leading to liver failure (Lippincott, 2020).
"Intestinal Obstruction” (2020). In Lippincott advisor. Retrieved https://advisor-
Evaluation:
edu.lww.com/lna/document.do?did=840038 -Patient tolerated ambulation well; after ambulation we noticed output in patients ostomy bag.

“Colorectal Cancer” (2020). In Lippincott advisor. Retrieved from https://advisor- -The patient verbalizes optimal relief of pain with prescribed opioids within 30 minutes of administration.
edu.lww.com/lna/document.do?bid=4&did=815424&searchTerm=colorectal
%20cancer&hits=colorectal,cancers,cancer -Patient notifies nurse when pain medication is needed.

-Patient remains free from infection and complications related to infection; patient tolerates antibiotics.

Patient correctly demonstrates the use of incentive spirometry, and completes x10/hr.

Patient understands teaching of wound care and properly returns demonstration.