Nursing Priorities for Eleanor Wilson's Care

Question 1
Eleanor Wilson is a 58year old woman. Social history shows that she is married and has two kids
and has been working in administration for 20 hours in a week, and she is smoking 20 cigarettes
and drinks 2 units of alcohol every day. She has never been involved in a nation bowel screening
program or colonoscopy. She has been admitted to hospital due to her recent reports on the
change of bowel habits and her GP has made possible for blood testing and colonoscopy. On her
past medical history, she has had hypercholesterolemia, lap cholecystectomy, asthma, and
myocardial infarction with left coronary artery. Eleanor has a family history of cancer, the father
had bowel cancer while the mother also died of pancreatic cancer. On her current illness, she has
been feeling very tired and she presented to her GP history of constipation, blood in her stools
and general malaise which has occurred for the past three months. She is currently under the
following drugs: Simvastatin 40mg, captopril 50mg, ranitidine 150mg, and Aspirin 75mg mane.
On laboratory test her carcinogen antigen has increased, hematocrit decreased and her
hemoglobin level is low compared to normal range and her gender, her heart rate is high and also
BMI of 28.4 which indicate pre-obesity.
Hypovolemia is a condition which causes the body to have decreased blood volume especially
blood plasma (Goswami, et al, 2018). It has the following symptom: sodium depletion, excessive
loss of body water and dehydration. Trauma is one cause among the many causes of
hypovolemia as it may cause excessive blood loss which eventually causes dehydration
(Pachtinger, 2014). In this case, Eleanor underwent acute surgery for resection of tumor which
led to decreased amount of blood circulating which in turn lowered cardiac refill and venous
return hence causing hypotension in the arteries. Reduced circulating volume leads to decrease
tissue perfusion which can result to excess oxygen demand which leads to myocardial infarction.
Reduced tissue perfusion also cause an anaerobic embolism, this is metabolism in the absence of
oxygen resulting in acidosis, it can cause multi-organ failure. At some point during
intraoperative management fluid volume can be managed inappropriately by estimating it
incorrectly and this leads to poor management of patient's fluid volume which contributes to
hypovolemia. Eleanor has a blood pressure of systolic 90 and diastolic of 54, this is lower than
the normal range of 100-120 for systolic and diastolic pressure (Ferreira et.al, 2015) respectively
this is a clear sign of hypovolemia indicated by hypotension. The patient has a Hematocrit level

of 0.36 compared to the normal range of 0.37-0.47. She has tachycardia with an increased heart
to 106 compared to the normal heart rate of 60-100 beats per minute. She has a low urine output
of 15-20mls/hour which is lower than normal of more than 30mls/hour. This objectively obtained
data clearly shows signs of hypovolemia in our patients which is a danger sign as it needs proper
management of signs and symptoms.
Eleanor's body will be able to compensate for reduced circulating blood in many ways, the
following are ways in which the body can compensate physiologically: Baroreceptor reflexes
sense fall in central venous blood pressure through arterial and cardiopulmonary baroreceptors
(Wehrwein, & Joyner, 2013), chemoreceptor reflexes which increases sympathetic activity
which stimulates heart and its vessels to increase arterial pressure, vasoconstriction of vessels,
renal angiotensin aldosterone system in the kidney which enables reabsorption of water and
sodium, causes vasoconstriction and enhanced sympathetic activity , activation of thirst
mechanism in the brain and reabsorption of tissue fluids. If bleeding is stopped, arterial pressure
goes back to normal and heart rate is decreased and long term compensatory mechanisms are
activated which restores back the normal arterial pressure and blood volume back to normal.
During bleed, the kidneys compensate by increasing Renin which causes vasoconstriction
(Gomez et., 2018) The aim of this compensatory mechanism is to increase cardiac output and
arterial pressure. Some neurotransmitters such as catecholamine and specifically epinephrine,
dopamine, and norepinephrine activate sympathetic adrenergic system which helps in regulating
physiological functions leading to heart stimulations thus increasing heart rate and contractility
force. Vasoconstriction of vessels increases systemic vascular resistance. Cardiac output is, in
turn, redistributed from less important organs to organs which are critical for survival such as the
brain. The body causes reduced capillary pressure which leads to reduced fluids leaving the
capillaries and when excessive hemorrhage occurs and it falls, reabsorption of fluid can later
occur from tissue interstitial back to blood plasma increasing blood volume.
Question 2
The various data that have been obtained in the assessment of Eleanor Wilson can be used to
identify the nursing priorities for her care. These findings include; the respiratory rate of 12
breaths per min, blood pressure of 90/54 mm Hg, pulse of 106 beats per min, the temperature of

36.9 C and a sedation score of 1. She also has hourly urine of 15 – 20 ml/hr. Eleanor is⁰
experiencing post-operative hypovolemia and there his care should be prioritized towards
handling this condition. The aim of the nursing care has to be aimed at addressing the cause of
shock and also making sure that the intravascular volume has been reduced. Following the
assessment data in the case study, four nursing priorities of care that are identified include;
deficient fluid volume, decreased cardiac output, ineffective tissue perfusion and risk for
infection.
Deficient fluid volume is related to active fluid volume loss as evidenced by increased heart rate
(tachycardia) and low urine output (15-20 ml/hr). There is a decrease in the patient’s body fluid
which is because of the fluid loss experienced during the resection of the tumor. The patient also
lost blood following right hemicolectomy. It is therefore important to restore the patient fluid
volume to prevent hypovolemic shock (Chatrath, Khetarpal, & Ahuja, 2015).
Decreased cardiac output related fluid volume loss as evidenced by decreased blood pressure,
decreased urinary output and tachycardia. This is another nursing problem that has to be
prioritized because the decrease in cardiac output may result in decreased tissue perfusion which
further leads to an increase in myocardial oxygen demand that can cause myocardial infarction.
She has a urine output of 15-20mls per hour which is less than the normal range of ≥30mls per
hour.
The third nursing problem identified for Eleanor case is ineffective tissue perfusion related to
severe blood loss and diminished venous return as evidenced shallow respirations. This the
`reduce in oxygen supply in the body such that it is inadequate to nourish the tissues at the
capillary level.
The fourth nursing problem is the increased risk of infection. Eleanor has undergone surgery and
therefore has a wound which is at risk of getting infected if not well cared for, especially due to
the exposure to the hospital environment which has a lot of pathogens. Moreover, she has an
indwelling catheter which can be another source of infection if proper catheter care is not
provided.
Question 3