Question Answers on Complex Patient Case Study

Running Head: QUESTION ANSWERS ON COMPLEX PATIENT CASE STUDY
QUESTION ANSWERS ON COMPLEX PATIENT CASE STUDY
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QUESTION ANSWERS ON COMPLEX PATIENT CASE STUDY1
1. Explain why a paralytic ileus requires an NGT insertion as part of its management?
Ans. In the cases of bowel obstruction or paralytic ileus, the insertion of Nasogastric tube
(NGT) is done in order to prevent the aspiration of vomit, which is a very common case
scenario in the patients.
2. You have been asked to insert a nasogastric tube (NGT). Is this contraindicated for
this patient? If so, explain the reason?
Ans. As the patient have a traumatic closed head injury, it is risky to try to insert a NGT,
and thus it is contraindicated.
3. Why might a loop ileostomy be performed instead of a regular ileostomy?
Ans. Loop ileostomy is a temporary condition and patient was in need of an ileostomy
since the accident resulted in a perforated bowel in the patient, even though there was not
any other complication in regards to the bowel actions. Thus there was no need of regular
ileostomy.
4. D Select two indications from the list below and provide an appropriate rationale
for the insertion of the NGT in each case.
 Stroke,
 Fractured Hip,
 AMI,
 Anorexia,
 COPD
Ans.
Stroke: Difficulty in moving food around the mouth and shallowing it is called dysphagia
and this can result in difficulty in eating and drinking, since the food and drink might

QUESTION ANSWERS ON COMPLEX PATIENT CASE STUDY2
reach the lungs while going down the wrong way. Dysphagia can be resulting from
stroke.
Anorexia: When the treatment of anorexia nervosa involves NG tube feeding, it has many
beneficial conditions. During the initiation of the treatment, this method is used
additionally with the oral feeding as it facilitates the weight gain to provide some medical
stability and to improve the cognitive skills of a patient for the promotion of readiness
and the engagement in treatment which leads to the psychological recovery.
5. The Doctor has decided to go ahead with the NGT insertion. Whilst you are
inserting the NGT, Jessica shows signs of respiratory distress. What could be the
cause of this?
Ans. Aspiration might be resulting from the incorrect placement of the NGT due to
intubation down the trachea or leading to respiratory tree. If the accidental placement of
the NGT involves bronchopulmonary system intubation, it may result into hemothorax,
pneumothorax or death.
6. What would be your priority nursing action/s when Jessica shows signs of
respiratory distress during the NGT insertion?
Ans. While observing for the respiratory distress, a checking should be done considering
the possibility of the tube being curled up at the back of the mouth of the patient, since
the tube is supposed to be advancing into the respiratory tree.
In conditions like that the tube must be withdrawn at once and the patient must be
comforted and reassured. Keeping some intervals in time another attempt of reinsertion
must be made. In case of failure, the complications and the reasons must be documented
and the situation must be consulted with MO

QUESTION ANSWERS ON COMPLEX PATIENT CASE STUDY3
7. Several days later, after bowel sounds are present, the doctor asks for the NGT to be
removed. Outline three (3) prioritized steps to ensure the safe removal of the NGT?
Ans. The first step involves verifying the order for removing the NGT from the medical
team assigned for the care of the patient. The second step involves washing hands prior to
the preparation of the equipment required, as advised by the local infection control
policy. The third step is to remove the Naso-Fix dressing or the adhesive strips. The
instruction to the patient should involve to take a deep breath and hold the breath, so the
glottis can be closed off and the risk of aspiration during the tube removal in minimised.
The tube must be taken out without ceasing movement.
8. Jessica has gone into urinary retention, possibly due to bladder irritation from the
surgery. The doctor has ordered an IDC to be inserted to drain the urine. Identify
three (3) other indications (reasons) for insertion of an IDC?
Ans.
a. To provide assistance with the incontinence resulting from the neurological
disorders.
b. To start the instillation of fluids or in order to administer antibiotic into the
bladder.
c. To provide temporary relief from the bladder outlet obstruction.
9. You have just finished inserting Jessica’s IDC and have taped the catheter securely
to the leg for comfort and safety.
Identify three (3) other specific nursing interventions that are relevant to the care of
Jessica’s IDC. Give a rationale for each nursing care action?
Ans.