Chronic illnesses such as hypertension

Running head: NRSG 258: PRICIPLES OF NURSING 1
Nsrg258: Principles of Nursing
Name:
Institution of Affiliation:
Question 1

NRSG 258: Principles of Nursing 2
Mr. Ted is an is an 82-year-old patient who underwent a bowel resection surgery after
admission to the hospital. This was after he was diagnosed with dangerous mass in his bowel
following a medical examination conducted on him. He lost his wife three years who
succumbed to pneumonia and he is living solely in his retirement home since his two grown
up children are married and they live far away. He has been in the hospital for four days now
after surgery and for the first two days post-surgery he was nil by mouth. He started taking
his first meal after three days and these comprised of light and fluid diet.
He must have been struggling with loneliness and a feeling of social isolation. It is
evident that he has chronic illnesses such as hypertension, type two diabetes mellitus and
gout, and is on medication for the same. He uses these medicines on a daily basis.
Considering his old age, Mr. Ted must be having someone to help him remember to take his
drugs. The process of senescence has been shown to be accompanied with organ function loss
and cognitive decline (He, Zeng, Huang, & Shi, 2019). Therefore, he might have forgotten to
take his drugs, hence the effect on his health. Mr. Ted must have been affected by the culture
around him. His children left him alone and so he must be stressed. The mass in his colon
was detected a bit late. The operation that is scheduled for him also has effects to him and his
family.
Question 2
The patient has several clinical symptoms recorded after bowel the resection surgery.
After four days post-surgery he was reported to feeling nauseated which made him vomit
twice. He also recorded a higher than normal respiratory rate and this is normal with patients
who have a history of hypertension and diabetes mellitus also this could indicate an infection

NRSG 258: Principles of Nursing 3
caused by the surgery. His blood pressure was high which is normal for patients with past
medical report of cardiac arrest and diabetes however the oxygen saturation in blood was in
normal range (Jamerson & Byrd, 2017).
The patient also had inspiratory crackles because he was having difficulties in
breathing. He was also put on an insitu morphine to act as a pain killer but still complained of
severe abdominal pain. He also has no output since his surgery and this could be as a result of
bowel blockage. Bowel blockage is known to cause abdominal distension and distension
which were seen in the patient. The bowel noises and vomiting could also be as result of this
blockage. Blockage in the bowel occurred as result of accumulation of the food and fluids he
had taken. During bowel blockage the body stimulates disorientation of peristalsis and the
accumulated intestinal contents are continuously pushed up the alimentary canal. This
pressure then leads to severe abdominal pain and distension that was seen in the patient
(Jeppesen, Tolstrup & Gögenur, 2016).
The resultant pressure then leads to collapse of the intestines below the obstruction
and the contents are forced out through vomiting. The swelling of the stoma seen in the
patient was also due to the pressure inside as a s result of bowel obstruction. Additionally,
morphine inhibits or slows down the motility of intestinal contents in the bowel leading to
bowel obstruction. This is the reason as to why the patient was undergoing severe abdominal
pain even after administration of morphine insitu to act as a pain killer hypertension
(LoBiondo-Wood & Haber, 2014). The nurse should stop administering any food or fluids to
him because the patient is vomiting and has no output since surgery. The nurses also need to
consider the type of diet the patient has been taking before surgery this will ensure that they
can know where the problem lies.

NRSG 258: Principles of Nursing 4
The pouch in the swollen stoma should be taken out and another with a bigger
opening should be installed. The patient has several medical conditions in the past which the
nurses should put into consideration when administering any king of treatment. His blood
pressure needs to be closely monitored since surgery causes loss of a lot of blood. He has
minimal oozing from his incision which is normal after surgery, excess would have indicated
errors made during surgery and this calls for immediate treatment. The patient also
complained of having a headache this could be because his electrolytes were not evaluated
and loss of water in the body due to vomiting. Loss of water and electrolyte imbalance causes
headache.
The patient’s urine output was also lower than the normal range because of vomiting
which causes dehydration as a result of loss of water in the body (Du, Li, Qu, Li & Bao,
2019). The nurses need to assess his past medical history carefully such as inquiring if he has
had any surgery in the past and the kind of complications that were observed this will help in
providing treatment and care to suit his current medical conditions. His family medical
history should also be assessed to give a clear plan on how to handle the case since some
information about the children’s medical history is missing. Furthermore, the metformin pills
administered to him as sugar pills should be regular to keep his blood sugar in control and
also prevent further complications such as neuropathies and kidney disease (Shoqirat,
Mahasneh, Dardas, Singh & Khresheh, 2019).
Question 3
The patient is currently undergoing problems with bowel obstruction and inspiratory
coarse crackles. This should be the basis of the goals the nurse should set up and improve his
condition. The first goal will be to manage the conditions that are brought about by bowel
obstruction such as pain, electrolyte imbalance, dehydration and poor nutritional status of the