Your intestines are about 25 feet long, which means it takes a while for any meals we ingest to travel before they get digested and excreted. This is done by your intestines in a wave like motion, known as peristalsis. However when peristalsis is interrupted by a problem with the muscles in the intestines, paralytic ileus may occur. A paralytic ileus is impairment of intestinal motility (it persists for more than 2 to 3 days) postoperatively.Patients who are affected by a gastro-intestinal obstruction display a number of symptoms such as abdominal distention, the absence of bowel sounds and nausea/vomiting. There are various causes of paralytic ileus which are classified into two different groups, mechanical obstruction and a malfunction in the gastro-intestinal excretion process, some causes of paralytic ileus include, an abdominal surgical operation, the use of pharmacological agents either pre-operatively (anticholinergic drugs i.e. Diphenhydramine or calcium channel blockers), or post-operatively (opioids used during or after surgery i.e. hydromorphone, morphine and oxycodone), and chemical, electrolyte or mineral imbalances (i.e. hypokalemia or hypocalcemia).2. Identify in priority order three assessments that are required. Please provide a brief rationale for each.1. Circulatory assessment. Due to the factors affecting the patient such as not being able ambulate due to dizziness and also the patient’s hemoglobin being low at an 85 when normal ranges for a female are between 115-165. Hemoglobin is what transports oxygen from our lungs to the cells of our body. If the patient has too low of hemoglobin. This could lead to anemia, and if further untreated could lead to fatigue, heart complications, and possibly even life-threatening complications. The findings from the patient could also be a result of bleeding which may be of the result the distended stomach, lack of blood flow to systems (such as the digestive system) causing them to slow down, the dizziness when ambulating, and the low hemoglobin levels. Vital signs and proper circulatory assessments could result in findings of bleeding.2. abdominal and bowel assessment. Due to the patient being distended with no bowel sounds audible, the nurse should routinely check on the patient and also call the doctor since a paralytic ileus is a major concern for the patient considering they also just had an abdominal surgery which can increase the chances. As the nurse you want to make sure they are passing flatus, bowel sounds present and they have bowel movements every 2-3 days with no trouble.3. pain assessment. Since the patient is post-op day 2, with a distended bowel and low hemoglobin, the patient is expected to feel pain, and nausea. The patient’s pain should be maintained and controlled so that wound healing can be encouraged and so that she is able to tolerate and be able to be comfortable.Based on evidence informed practice, some nursing interventions that will be implemented in caring for this patient are, to inspect the abdomen for distention, measure abdominal girth and auscultate bowel sounds for any changes, this is important because it will help to assess for the return of peristalsis and the ability to pass flatus. Another important intervention that should be implemented would be to place the patient in a semi-fowler’s positions to help promote breathing and relieve abdominal distention caused by the paralytic ileus. The third nursing intervention would be to administer a laxative intravenously to help stimulate the bowel movements, administering these medications intravenously is important because the patient should be on an NPO diet to prevent a risk of aspiration and to rest the bowels. 4. What three members of the interprofessional health care team would the nurse collaborate with in the care of this client? Please provide a brief explanation of the reasoning behind each of your choices.The nurse would collaborate with the physician or surgeon of the patient. You would want to work closely to the surgeon because they know the procedure that was done, and they know the possible complications that could arise with that procedure. Since they performed the surgery they would have more in-depth knowledge as what the complication would be.Another person of the health care team that you could collaborate with would be the Nurse practitioner. Since they work under the supervision of the physician, they could assess the patient alongside you and they can more often be available when the physician or surgeon is not. Nurse practitioners can also diagnose and prescribe medications.A third healthcare team member that the nurse could benefit from working alongside for this patient would be the pharmacist. Since they know all about the medications and their effects, they can find and recommend what would be best for this patient. They can also give a more detailed MAR if the patients medications are more complex.6. What classification of medication would be used to treat this client? What is the rationale for using this classification with this client? Identify three priority nursing implications for administering medications within this classification.If the patient has paralytic ileus then medications that would help treat this client would be laxative or stimulants for the digestive system or gastric secretion. Other medications that could be used are non-opioid pain medication and also medication or iv therapy to help with the patient’s hemoglobin. The reason for this client using these classifications of drugs would be to help prevent worsening or help the situation of the paralytic ileus. As part of the healthcare team we would like the patient to typically have a bowel movement every 2-3 days with no trouble. After surgery this can result due to the medication and slowing of the bowel movements. Non-opioid pain medication would also be beneficial to this patient since opioids often times slow down bowel movements which is not what we would like. IV therapy would help the patient receive nutrients, medications and fluids that could help stabilize the patient’s hemoglobin. Three priority nursing implications for these medications would be to often check up on the patient and asking questions due to their bowel movements. As the nurse questions like “are you passing gas” or “when was your last bowel movement” are important questions that should be asked with the abdominal assessment. Pain interventions should also be taken into place since we would like the patient to be comfortable so that wound healing can be promoted. Checking on the patient routinely can help prevent patient pain. Finally, checking patient’s bloodwork results are key. This will update the healthcare team on how the patient is doing and can be helpful especial if medications are changed.
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