Small bowel obstruction

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    Pathophysiology of a small bowel obstruction… include everything from causes, signs&symptoms, what occurs in the body? diagnosting, diagnositic procedures, lab values to take into consideration, surgery, recovery, …. etc

    I also have to incorporate my patients info in the paper and discuss similarities and discrepencies in the usual signs, symptoms ,lab values ect. Patient info is below…

    Client’s Initials M.M. Age 89 Sex F Date of Admission 03/26/14

    Allergies Codeine DNR No Renewal Date N/A

    Advanced Directive: Yes-03/26/14 Expected LOS: Unknown

    Medical Diagnosis and Reason for Admission:

    Primary Diagnosis: Small bowel obstruction

    Co-morbidities: Intestinal disorder, Hyperlipidemia, Hypertension, CAD, Arthritis

    Reason for Admission: Nausea/Vomiting

    Surgery/Date: N/A

    Pathophysiology of Primary Medical Diagnosis:

    A small bowel obstruction occurs when intestinal contents cannot pass through GI tract. This occurs in the small intestine and can be partial or complete,simple or strangulated. Pattient M.M. Had a complete small bowel obstruction from strangulation, which leads to insufficient blood supply. The causes of intestinal obstruction are classified as mechanical or non mechanical. In this case the cause was mechanical obstruction, which meant there was an occlusion of the intestinal lumen. Surgical adhesion is the most common reason for small bowel
    obstructions.

    Date
    Lab
    Normal Value
    Patients Value
    Clinical Significance
    04/05/14
    WBC
    4.0-11.0 thou/mcl
    10.6
    WNL

    RBC
    4.2-5.4 mill/mcl
    3.51

    Low; possibly from hemorrage due to previous strangulation of bowel; hemolysis or destruction of RBC’s; nutritional deficiencies (Iron).

    Hgb
    14-18 g/dl
    9.1
    Low; indicitive of bleeding from strangulation of bowel.

    Hct
    45-54%
    28.1
    Low; indicitive of bleeding from strangulation of bowel.

    MCV
    80-100 fL
    80
    WNL

    MCH
    27-34 pg
    27
    WNL

    MCHC
    32-37%
    32.4
    WNL

    RDW
    11.5-14.5%
    24.8
    High; possibly from too little vitamin B12 or folic acid.

    Platelet
    150-400
    261
    WNL

    MPV
    7.4-10.4 fL
    9.4
    WNL

    Neut auto
    50-70%
    66.1
    WNL:

    Lymph auto
    20-40%
    20.3
    WNL

    Mono auto
    4-8%
    8
    WNL

    INR
    0.9-1.2
    1.1
    WNL

    PT
    9.2-12.2
    10
    WNL

    Mag
    0.75-1.25 mmol/L
    0.9
    WNL

    Glucose
    74-100 mg/dL
    83
    WNL

    BUN
    8-23 mg/dL
    2
    6
    High; due to gastrointestinal bleeding; dehydration

    Creatinine
    0.8-1.3 mg/dL
    0.9
    WNL

    eGFR-AA
    >60
    >60
    WNL

    eGFR-NAA
    >60
    >60
    WNL

    Sodium
    136-145 meq/L
    142
    WNL

    Potassium
    3.5-5.1 meq/L
    5.8
    High; possibly due to prescribed potassium supplements

    Chloride
    98-107 meq/L
    113
    High; most likely from dehydration

    CO2
    23-29 meq/L
    23
    WNL

    AGAP
    3.0-7.0
    6
    WNL

    Calcium
    8.6-10.2 mg/dL
    8.7
    WNL

    ALT
    10-40 U/L
    20
    WNL

    AST
    8-48 U/L
    40
    WNL

    Alk Phos
    38-126 U/L
    120
    WNL

    Total Protein
    6-8.3 mg/dL
    8.1
    WNL

    Albumin Lvl
    3.5-5.0
    4.2
    WNL

    Glob
    2-3.5 g/dL
    3
    WNL

    A/G Ratio
    1.0-2.0
    1
    WNL

    Bili Total
    0.2-1.2 mg/dL
    0.5
    WNL

    Drug
    Dose
    Route
    Frequency
    Reason
    amlodipine
    (Norvasc)
    10 mg
    PO
    QD @1000
    HTN
    amlodapine
    (Norvasc)
    5 mg
    PO
    QD @1000
    HTN
    metoprolol
    (Lopressor)
    50 mg
    PO
    BID @1000,2200
    HTN
    heparin flush
    50 units
    IV
    PRN

    heparin flush
    50 units
    IV
    q12h

    heparin
    5,000 units
    SQ
    q8h

    saline flush
    10 mL
    IV
    PRN

    saline flush
    10 mL
    IV
    q12h

    clonidine patch
    (Catapres-TTS-2)
    0.2 mg
    Transdermal
    q7days

    clonidine
    (Catapres)
    0.1 mg
    PO
    BID
    @1000

    gabapentin soln
    (Neurontin)
    400 mg
    PO
    TID
    @1000,1800
    Pain
    gabapentin
    (Neurontin)
    300 mg
    PO
    BID
    Pain
    magnesium sulfate
    2 gm
    IV Piggyback
    PRN

    potassium chloride Soln
    40 mEQ
    PO
    PRN

    potassium chloride ER tabs
    40 mEQ
    PO
    PRN

    potassium chloride
    20 mEQ
    IV Piggyback
    PRN

    potassium chloride
    ER tabs
    10 mEQ
    PO
    QD
    @1000

    acetaminophen
    (Ofirmev)
    1,000 mg
    IV
    q8hr PRN
    Pain
    levothyroxine
    (Synthroid)
    25 mcg
    IV
    QD

    levothyroxine
    (Synthroid)
    50 mcg
    PO
    QAM

    epoetin alfa
    (Procrit)
    As Directed

    Iron
    1 injection

    As Directed
    Iron deficiency
    pantoprazole
    (Protonix)
    40 mg
    IV Piggyback
    q24hr

    furosemide
    (Lasix)
    20 mg
    PO
    QOD-alternate btwn 40 mg

    furosemide
    (Lasix)
    40 mg
    PO
    QOD-alternate btwn 20 mg

    diphenhydrAMINE
    (Benadryl)
    25 mg
    PO
    QHS
    Sleep
    Stool softener
    1 cap
    PO
    QD
    Soften stool
    tramadol
    50 mg
    PO
    B ID
    Pain
    Escitalopram
    (Lexapro)
    5 mg
    PO
    QD

    Ondansetron
    (Zofran)
    4 mg
    IV
    Q6h PRN
    N/V
    omeprazole
    20 mg
    PO
    BID

    AtorvaSTATin
    (Lipitor)
    40 mg
    PO
    QPM

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