Bowel Resection Patho

Bowel Resection Running head: SMALL BOWEL RESECTION

Small Bowel Resection Elisabeth Fandrich Montana Tech Nursing Department NURS 1566 Core Concepts of Adult Nursing

March 31, 2008 Noel Mathis RN, BSN, MSN Small Bowel Resection A resection of the small bowel is a surgical procedure in which a section of the intestine is removed. Common reasons that necessitate this surgery are Crohn’s disease, ulcers, cancer,

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intestinal obstruction, injury, and precancerous polyps. Patient 3501, C, T was brought to the emergency room on March 30, 2008 by her family complaining of severe abdominal pain, constipation lasting more than five days and a large bulge of the left groin. It was determined that the patient had developed a left inguinal hernia with possible bowel obstruction. Surgery was indicated. As with any type of surgery, a signed consent form is required. The procedure, what can be expected, risks, and goals are discussed with the patient. The patient must take no food or fluids after midnight the night before the surgery. Blood and urine labs will be collected as well as imaging tests. It is standard practice to administer prophylactic antibiotics, insert a nasogastric tube and foley catheter. After 3501,C,T was admitted to the emergency department, routine hematology and chemistry labs were drawn. When it was determined that she would require surgery, labs were drawn for coagulation and blood bank tests. The initial blood work showed an elevated WBC of 18.70 indicating acute infection, elevated platelet count of 448 (normal 140400), elevated % neuts, absolute neuts and % lymphs. Sodium, potassium, chloride, and total CO2, were low indicating dehydration and electrolyte imbalance. Serum glucose was slightly elevated at 127 (normal range 65-110) may be attributed to the stressful situation, but will most likely be monitored to rule out diabetes mellitus. BUN was elevated at 40 (normal range 7-23) due to dehydration. Calcium was slightly elevated at 10.8 which may be related to the patient’s history of osteoperosis. Serum protein was slightly elevated at 8.2 (normal range 6.2-8.1) which may be attributed to dehydration. A/G ratio was slightly low perhaps because of vitamin C supplementation or malnutrition. The ALT was also low at 18 (normal level 20-55) which might be attributed to stress. The small bowel resection is routinely done by placing the patient under general anesthesia, making a midline incision, removing the diseased or damaged bowel then suturing or stapling the remaining sections together. Upon entering 3501,C,T’s abdominal cavity, the surgeon found a

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large amount of dilated bowel. The surgeon followed this down to the hernia and found that a section of the bowel and some of the omentum was reduced and strangulated. The surgeon determined that the creation of a stoma was not necessary. The incision is then closed. The removed sections of 3501,C,T’s intestine and omentum were sent for pathologic diagnosis. The final pathologic diagnosis showed that there was an area of ulceration of the mucosa. The wall of this area was very thing and had focal necrosis of the mucosa. The findings were consistent with ischemic necrosis. The patient developed a hernia into which an area of intestine slipped and became strangulated causing necrosis of the tissue and obstruction of the bowel. The surgery performed on 3501,C,T was completed without complication and she was admitted to the surgical floor after being monitored in the post anesthesia care unit. Mild pain at the incision site is expected after a bowel resection surgery. This pain was experienced by 3501,C,T and treated with patient controlled analgesia (PCA) effectively. The patient was instructed on the use of splinting when coughing and deep breathing and the importance of incentive spirometry. The patient has a history of COPD so O2 at a flow rate of 3-4L was administered. The nasogastric tube and foley catheter were left in place. The NPO status was maintained but the patient was allowed to relieve dry mouth with ice chips. The surgeon ordered TED hose and sequential compression devices to help prevent the formation of DVT. Bed rest is normally enforced for the first few days post-surgery. The length of time required for recovery from a small bowel resection surgery depends on many variables (i.e. overall pre-operative heath status, age, amount of intestine removed, the condition which led to the need for bowel resection). 3501,C,T is an 81 year old female with a history of COPD and osteoporosis. The patient lives independently and has an extensive social and family support system. No complications are anticipated for this patient’s recovery, but some potential complications are infection, injury related to falling, impaired skin integrity, ineffective pain

Bowel Resection management, development of thrombus or embolism, nutrition imbalance, and development of drug allergies.

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Bowel Resection References

Small Bowel Resection. (2007). Small Bowel Resection. In Encyclopedia of Surgery: A Guide for Patients and Caregivers [Web]. Advameg Inc.. Retrieved March 31, 2008, from http://www.surgeryencyclopedia.com/Pa-St/Small-Bowel-Resection.html Lee, MD, J.A. (2006). Small Bowel Resection. In Medline Plus [Web]. Bethesda: A.D.A.M. Retrieved March 31, 2008, from http://www.nlm.nih.gov/medlineplus/ency/article/002943.htm

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