GI Escape Room

Care of a Patient with a GI Disorder

SHANEKA DUMAS, BSN, RNADVENTHEALTH UNIVERSITY

Start

MISSION OBJECTIVES

• Recognize/analyze cues in clients with GI dysfunction.
• Prioritize plans for returning a client to homeostasis.
• Generate solutions and take action.
• Evaluate therapeutic response from treatment.

Next

Anthony, a medical surgical nurse, needs to clock in before recieving report from Monica on the patient who just arrived to the observation unit. Help him clock in before the shift huddle.

0645

Pre-Shift Huddle

• What clinical manifestations are expected?
• What are the normal lab values?

• What clinical data is important vs. less important?
• What problem is important to manage first?
• What orders will be anticipated by the nurse?
• What intervention(s) are needed immediately?
• What interventions are needed next?

Start

• J. Cast, 45, room 3
• Follow-up after a routine colonoscopy.
• Reports episodes of constipation and diarrhea, both accompanied by lower abdominal discomfort and excessive flatulence.

• Patient reports episodes usually subside and that he really does not think much of it, “just part of being busy with life and stress.”
• Click on quick tip!

Next

My wife recently died and she did most of the cooking. So, for breakfast I eat a bowl of cornflakes, milk, and coffee. Lately, most of my meals have been from my favorite steakhouse near my house. The baked potato and corn are my favorite sides for my ribeye. I have a 3-4 beers on most days to help me unwind.

I don't like vegetables but I do enjoy a banana or apple every once in a while when I can make it to the local supermarket. I've never been a smoker. Oh, and I haven't noticed any blood in my poop but I do remember that mom used to have this problem before she died. I am trying to find the motivation to work out more but it's so hard without my wife.

Vital Signs

Labs

Nurses' Notes

Orders

H&P

Anthony adds the information from Mr. Cast to his notes. He must now review the patients chart...

access CHART

Vital Signs

Labs

Radiology Res

Orders

H&P

Cast, J., 45 DOB: January 20, 1978 MRN: 1482928 Weight: 5'10" Height: 219 lbs Widow

AlertsAllergies: Bentyl (hives)

Vital Signs

Labs

Radiology Res

Orders

H&P

C/C: Intermittent costipation/diarrhea with lower abdominal pain and excessive flatulence Home meds: Simvastatin 40 mg qDay, Famotidine 20 mg PRN PHM: Hyperlipidemia x 6 years; GERD x 8 yrs FH: Mother deceased: HTN, DM2, hyperlipidemia Father living: GERD, IBS Notes: Patient states he is able to care for daily needs; sedentary lifestyle per patient, recently widowed

Radiology Res

Vital Signs

Labs

Orders

H&P

0718: Blood pressure: 134/87 mm Hg Heart rate: 110 bpm Respiratory rate: 18 brpm Body temperature: 101.6 F Oxygen saturation: 98%

Vital Signs

Labs

Radiology Res

Orders

H&P

Ultrasound

chest xray

Colonoscopy

Vital Signs

Labs

Radiology Res

Orders

H&P

Urinalysis

Colonoscopy

CBC

FECAL CALPROTECTIN

BMP

Stool study

LFTs

urine culture

CRP

urine culture

CEA

Next

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Alright, let's admit Mr. Cast. I will send the orders over now.

"Thanks Dr. Reyes, I'll review the orders now"

Vital Signs

Labs

Nurses' Notes

Drug Guide

Orders

H&P

- Initiate NPO status. - Start IV 0.9% sodium chloride at 125 mL/hr and maintain strict intake and output records. - Administer IV piperacillin/tazobactam 4.5 g q6h and metronidazole 500 mg q8h. - Administer IV morphine sulfate 4 mg q4h PRN for pain relief. - Administer IV acetaminophen 650 mg q6h PRN for fever control. - Administer IV regular insulin 10 units/hour PRN for blood glucose management. - Prepare for emergency exploratory laparotomy w/possible bowel resection and colostomy. - Obtain informed consent for the surgery. - Educate about the diagnosis, treatment plan, potential complications, and postoperative care.

Oh, nurse, I'm so glad you're here. I don't know what's going on. They told me I have diverticulitis and that I need surgery. Can you help me understand the information?

Help Anthony provide the best response

Next

Next

Next

Mr. Cast makes a full recovery with no post-op complications. Six weeks later, Mr. Cast comes back into the clinic for his follow-up. His detailed food diary and absence of abdominal symptoms suggest improvement. The clinic will continue to follow-up with Mr. Johnson. You have successfully completed the following activity: "Caring for a Patient with Digestive Disorders"

exit