University Nursing Care Study: Small Bowel Obstruction Management

This case study focuses on the nursing care of a 34-year-old female patient, Louise Wilson, admitted with a small bowel obstruction (SBO) following a previous surgery. The assignment details the patient's presentation, symptoms, and the underlying condition of SBO. It then provides a comprehensive overview of nursing models, particularly the Roper-Logan-Tierney (RLT) model, and its application in assessing, planning, implementing, and evaluating patient care. The study emphasizes the importance of nurses in identifying patient needs and providing holistic care, including assessment of activities of living, and the use of the nursing process to deliver individualized patient-focused care. It also incorporates discussions on nursing theory, nursing process, and recommendations for nursing practice in managing SBO cases, maintaining professional healthcare standards, and ensuring optimal patient outcomes. The study concludes with insights into effective nursing interventions and patient care strategies for individuals with SBO.

Managing the needs of an individual presenting with small bowel
obstruction: A care study: Maintaining professional healthcare standards
Name of the student:
Name of the university:
Author note:

Introduction
Small bowel obstruction or SBO is a now-a-days the most common problem which
leads to an emergency to do an immediate surgery. This complication has increased to 5% of
frequent admissions to the hospitals (Brown and Dawson, 2009). In this disease urgent
treatment is needed because SBO is basically a lethal and life threatening. It causes difficulty
in bowel movement, perforation, ischemia, peritonitis sepsis and also may lead to death
(Moran, 2007). In fact Moran stated that the risk of complications of SBO in the patients is
high with 30% of patient suffering from bowel strangulation and 15% suffering from bowel
necrosis.
Diagnosis at initial stage and treatment includes situation up where these
complications are clear, and surgery is required. If not then, a non-operative trial of
moderately dealing with the patient's side effects may be suitable to check whether the
blockage is settling by own (Catena et al. 2011).
Since the dangers of complications are high in SBO, it is important that the nurses
precisely distinguish the patient's needs (Barrett, Wilson and Woollands 2012). Particularly
since the nurses have an expert duty of care to give superior requirements of care, and are
responsible for their activities and exclusions (NMC 2008). For this reason, nursing models
are helpful in giving a structure to guide the nurses about the nursing care (Pridmore, Murphy
and William, 2010). These nursing models are utilized in a combined way to execute and
assess patient care. Combination of these nursing processes is used to assess the
complications, planning, implementation and evaluation of patient care. These nursing
models are used to promote a systematic, holistic, comprehensive, and critical thinking
approach for delivering nursing care to individual persons (Matthews et al. 2010).

This task portrays the traditional nursing administration of a person with SBO on
admission to a surgical ward amid a 48 hour time on the basis of an altered type of the Roper-
Logan-Tierney demonstrate. A pseudonym is used through to secure patient classification as
per the Nursing and Midwifery Council, NMC (2008). The article incorporates foundation on
the symptoms, history and SBO itself. It additionally gives a basic review of nursing models
and a discussion of the Roper-Logan-Tierney Model.
A framework of the nursing procedure is then included, in addition to a more point by
point portrayal of the surveying, arranging, actualizing, and assessing steps engaged with
giving patient-focused care to the person. Proposals for nursing practice and a short
conclusion are likewise included.
Patient Presentation
Louise Wilson is a 34 year old single woman who used lives alone and is a business
counsellor. Recently, she experienced an open surgery for a punctured colon because of
Crohn's Colitis. The surgical strategy included a pan-colostomy with the formation of
ileostome and she had recovered well without complications. She is not taking any
medicines. However, Louise was admitted after 3 months to the regional hospital in the
emergency department complaining of a severe onset of stomach pain that happened in
irregular waves. This torment was joined by serious episodes of queasiness, Louise's
ileostomy had stopped to capacity, and she had stomach distension. Louise's stomach size
was measured as 70cm and stomach auscultation by a specialist revealed unusual bowel
sounds. A chest x-beam was unremarkable and a plain stomach radiograph was uncertain. In
this way, in contact with the radiographers, Louise experienced a CT check with differentiate
which appeared two enlarged circles of gut, driving the specialists to determine Louise to

have incomplete mechanical little gut impediment. Louise at that point had a nasogastric tube
embedded to decompress her gut also, was therefore admitted to a surgical ward.
Small Bowel Obstruction
Small bowel obstruction happens when typical peristaltic transport of intestinal
substance and flatus is essentially impeded, blocked, or totally obstructed (Ansari, 2014). The
side effects incorporate colicky stomach torment, queasiness, spewing, stomach distension,
the runs or, on the other hand stoppage and anomalous gut sounds (Kent, 2007; Moran,
2007). These side effects may emerge from one of the wide range of sorts of inside
impediment which are grouped as indicated by their fulfillment, nature, area, seriousness,
etiology and timing (Appendix 1) (Kent, 2007; Di Saverio et al., 2013).
In small bowel obstruction, the food that are eaten are not digested by the digestive
juices hence the food does not dilate (Kent, 2007). The gastrointestinal liquid at that point
ends up plainly hypertonic and draws liquid osmotically from the body into the intestinal
lumen, additionally distending the inside (Monahan, Neighbors and Green, 2011). As the
bowel dilates, it increases the peristaltic movement in an attempt by the body to overcome the
barrier – causing the irregular bowel sounds and cause pain in stomach (Brunicardi et al.,
2010).
Various factors can cause check of the inside lumen, counting affected defecation,
outside bodies, parasites, tumors, gallstones, provocative strictures, bonds, hernias and
volvulus. In any case, intra-stomach grips are the most normal reason for mechanical little
bowel block in the created world (Stephenson and Singh, 2011). Patients who have had past
stomach or gynecological surgery are especially in danger, representing upto 75% of cases
(Diaz et al., 2013). In this way, not just is it vital to stay away from surgical mediations due
to the characteristic dangers they convey, surgery could likewise advance further repeats of

entrail deterrent (Catena et al., 2011; Di Saverio et al., 2013). Therefore, the part of medical
caretakers in giving excellent care amid preservationist administration is fundamental with
the goal that surgery is in this manner kept away from.
Nursing Theory and Models
Nursing is regularly characterized as a teach that includes looking after individuals as
to their wellbeing (Royal College of Nursing (RCN), 2003; International Council of Nurses
(ICN), 2014; World Health Organization (WHO), 2014; American Nurses Association
(ANA), 2014). It includes clinical judgment (RCN, 2003), self-governing and community
oriented care (ICN, 2014; WHO, 2014) and treatment of the human reaction to ailment
(ANA, 2014). While these definitions are valuable, in any case, they neglect to catch the
substance of nursing and what makes this discipline interesting (RCN, 2003).
Over the recent couple of years, to set up nursing as a discipline different from other
health experts has been a vital objective of nursing scholars (Murphy, Williams and
Pridmore, 2010). This has led to a move far from the medicinal model whose system is
esteemed unseemly to control nursing care (McKenna and Slevin, 2011). Subsequently,
different hypotheses and model systems have been produced which consolidate the 4 basic
components used to characterize nursing, known as the 'metaparadigm of nursing', of
individual, condition, wellbeing and nursing (McKenna, Pajnkihar and Murphy, 2014).
Specifically, nursing models are used to inform the nurses what is vital and relevant when
conveying individualized care (Barrett, Wilson and Woollands, 2012) in view of
perspectives, convictions and qualities about these four focal ideas.
Various, US-based, nursing models and hypotheses exist including that of Roy, Orem, Peplau
and Carper (Peate, 2012; McKenna and Slevin, 2011) which all attention on various parts of
nursing. Roy's Adaptation display (RAM) sees wellbeing as the limit of an individual to

adjust to physiological, mental or social stressors (Walsh, 1998) and is generally relevant in
assorted wellbeing circumstances (Fawcett and Desanto-Madeya, 2012). Faultfinders of
RAM, in any case, contend the time has come expending to actualize and expects clients to
get it complex thoughts and broad language (Ingram, L, 1995; Fawcett and Desanto-Madeya,
2012). Interestingly, Peplau's hypothesis concentrates on building up patients' critical
thinking aptitudes through restorative relational connections, basically constraining its
application to emotional health settings (McKenna, Pajnkihar and Murphy, 2014).
In any case, the estimation of this model has been its commitment to understanding
the relational idea of the medical caretaker quiet relationship (Aggleton and Chalmers, 2000).
This basic part of nursing care is moreover consolidated into Carper's thoughts on the 4 sorts
of nursing learning (empirics, feel, morals and individual knowing), which have set a critical
point of reference for creating nursing information (McKenna and Slevin, 2011). Distinctive
again is Orem's self-mind shortage display which depends on the rationality that medical
caretakers help patients and their families to accomplish selfcare (Walsh, 1998). This model
is generally relevant in numerous different medicinal services settings and has advanced the
significance of patients adding to their care (Barrett, Wilson and Woollands, 2012).
In any case, it's pertinence to UK medicinal services is flawed on the grounds that it
was initially created for a USA protection based human services framework that is supported
by an alternate culture, set of qualities and nursing instruction program (McKenna, Pajnkihar,
and Murphy, 2014). Taken together, these cases show that nobody model can fit all nursing
circumstances, in this way nurture must pick a model that fits a patient's needs (McKenna and
Slevin, 2011).
RTL Model of Nursing

The Roper-Logan-Tierney (RLT) display was picked as a system to manage nursing care in
this task since it is the prevalent nursing model utilized as a part of the UK and is, thusly,
recognizable to most medical caretakers (Maxfield and Parker, 2012). This model was first
distributed by Roper, Logan and Tierney in 1980 to enable understudies to build up their
reasoning about nursing (Roper, Logan and Tierney, 2000).
The RLT model shows a movement from a disease based way to deal with mind
towards perceiving the all encompassing needs of an individual since it considers the
independence of a man, their exercises of living, the dependence-independence furthermore,
life expectancy continuums, and other affecting variables (Barrett, Wilson and Woollands,
2012). The last incorporate natural, mental, socio-social, ecological furthermore, politico-
monetary variables (Roper, Logan, Tierney, 2000). A focal concentration of the RLT show is
the part of attendants in helping people to forestall, mitigate, take care of or adapt to issues
identifying with 12 Activities of Living (ALs) (Aggleton and Chalmers, 2000). These ALs
cover an assortment of points that incorporate eating and drinking, right through to resting
and notwithstanding passing on as well (Appendix 2) (Brooker and Waugh, 2013). In
rehearse, attendants work in association with patients to survey every AL so as to
comprehend the patient's individual needs and recognize genuine or potential nursing issues
(Aggleton and Chalmers, 2000). While the advantage of this approach is its
straightforwardness and absence of language (Bellman, 1996), pundits contend it decreases
patients to an insignificant rundown of exercises (Walsh, 1998; McKenna, Pajnkihar and
Murphy, 2014). In any case, Bellman (1996) states that this blame is an outcome of the way
the RLT demonstrate is actualized, be that as it may, as opposed to being a issue with the
model itself (Walsh, 1998). At the point when utilized as a part of blend with the nursing
process, the RLT demonstrate advances the conveyance of precise, all encompassing and
individualized persistent care (Pridmore, Williams and Murphy, 2010).

Nursing process
The nursing procedure was first presented by Yura and Walsh in 1967 (Barrett, Wilson and
Woollands, 2012) which, regardless of introductory feedback, acquainted a precise approach
with nursing care that advanced basic considering and clinical basic leadership (Huckabay,
2009; Castledine, 2011). Yura and Walsh (1967) initially depicted the nursing procedure as a
recurrent, dynamic 4-stage process including Assessment (A), Planning(P), Intervention(I)
and Evaluation(E) (known as 'APIE'). In later years, be that as it may, these means have been
adjusted and extended by a few creators with the goal that now 4, 5 or 6 stage renditions of
the nursing process exist (Barrett, Wilson and Woollands, 2012). Whichever adaptation is
utilized the primary motivation behind the nursing procedure is the same - to deliberately
distinguish a patient's real or potential social insurance needs, design and convey nursing
mediations to meet these distinguished necessities, and after that assess the viability of the
care gave (Kozier et al, 2012). Critically, an indispensable piece of this procedure includes
distinguishing and utilizing proof based rules to support all nursing care (Castledine, 2011).
By and large, the first 4 stage APIE adaptation is all the more generally utilized as a part of
the UK (Matthews, 2010) also, a 5 stage form is prevalently utilized as a part of North
America (Appendix 3) (Brooker and Waugh, 2013). The benefit of the APIE form is that it
has been regularly utilized, is commonplace to most human services experts, and the 4 phases
help distinguish a patient's needs rapidly and productively (Lloyd, 2010). In any case, the 5-
stage rendition incorporates a different nursing analyze venture between the evaluation and
arranging stages, allowing medical caretakers to methodicallly build up a nursing
determination to guarantee nursing issues are not disregarded (Barrett, Wilson and
Woollands, 2012). Despite the fact that determinations has for quite some time been viewed
as a basic stride in the nursing procedure (Hogston, 1997), the NMC don't yet expect medical
caretakers to receive nursing analyze as a center piece of arranging quiet care (NMC, 2010a).

Along these lines, unless the NMC's position changes, the 4-stage variant of the nursing
procedure is probably going to remain the most commonplace to most human services
experts. Therefore, the 4-stage APIE adaptation is utilized as a part of this task.
Evaluating
The initial step of the nursing procedure is understanding evaluation which starts when a
medical caretaker experiences the patient (Castledine and Close, 2009). Medical caretakers
gather subjective and objective information so as to recognize the patient's real and potential
wellbeing needs, and afterward plan nursing analyze (Matthews, 2010). Subsequent to
increasing educated assent (NMC, 2008), a complete evaluation that mulled over her
physical, passionate, social, mental, profound and social needs was embraced with Louise as
per NMC (2010a) prerequisites (Appendix 4). It was basic to attempt the appraisal in
cooperation with Louise in a non-judgemental way so data gathered was exact, finish and
guaranteed that her own inclinations were considered as indicated by the assets accessible
(Matthews, 2010). From this data, the two needs of nursing look after a more point by point
focused on appraisal of Louise's needs were hydration and torment. On meeting Louise not
long after her exchange to the ward, the Airways, Breathing, Circulation, Incapacity and
Exposure (ABCDE) structure was utilized to efficiently evaluate prompt needs of administer
to Louise (Thim et al., 2012).Although the correct points of interest of this system fluctuate
as per the mastery, aptitudes and information of the specialist (Jevon, 2010), medical
attendants ought to be urged to utilize the ABCDE structure as it upgrades conveyance of
high caliber, understanding focused care (Clarke, 2014). Louise was ready and orientated
and, as a need, her imperative signs were checked to get standard perceptions. The National
Institute for Health and, Care Excellence (NICE) (2007) determine that 6 least physiological
perceptions ought to be made in evaluating patients (temperature, beat, systolic pulse,
respiratory rate, oxygen immersion and level of cognizance). Be that as it may, Elliott and

Coventry (2012) propose torment and pee yield ought to likewise be surveyed frequently in
intense care settings to help distinguish clinical decay. On estimation, all Louise's imperative
signs were inside ordinary breaking points as per Dougherty and Lister (2011). Louise
showed at least a bit of kindness rate of 82 beats for every moment, a consistent and solid
heartbeat, a circulatory strain of 101/68 mmHg, a breath rate of 16 breaths every moment,
oxygen immersion of 96% (on room air), and a center temperature of 37.5°C.
Louise had additionally urinated over the most recent 3 hours and her pee yield was typical at
0.6ml/kg/hr (Scott, 2010). On counseling with the surgical recorder, Louise was additionally
encouraged to remain Nil By Mouth (NBM) to elevate her inside to rest (Whiteing and
Hunter, 2008). From perception, Louise displayed non-verbal conduct that demonstrated she
was in torment, counting a strained, squatted body stance, eagerness and facial frowning
(Monahan, Neighbors and Green, 2011). As prescribed by Kozier et al. (2012), the PQRST
memory helper was utilized as guide in evaluating Louise's intense torment (Appendix 5).
While this prompts medical caretakers to think about variables which incorporate the nature
of the torment, its area, its force and length, Briggs (2010) suggests likewise considering
related manifestations and past treatment. In this manner these parts of Louise's torment were
additionally taken into thought. The utilization of open-finished addressing set up that the
idea of Louise's torment was crampy, wavelike, and limited around her stoma in her correct
lower stomach quadrant. The torment likewise transmitted to her peri-umbilical area and
Louise portrayed the torment as 'sharp and blade like'. A torment evaluation apparatus was
then used to survey the power of Louise's torment. There are a few agony evaluation
apparatuses that exist including the visual simple scale (VAS), verbal numerical rating scale,
straight out rating scale, and a few sorts of polls (Brooker and Waugh, 2013). While each of
these instruments has its merits, the numerical rating scale (NRS) was picked in light of the

fact that it is the least demanding to comprehend and is basic to utilize (McLafferty and
Farley, 2008). Louise was asked to verbally rate her torment utilizing the NRS of 0-10, with
10 being the more awful agony she had ever experienced (Castledine and Close, 2009).
Louise detailed a score of 9, giving a target measure of a subjective encounter. Louise at that
point verbalized that the agony was causing a lot of tension and made it troublesome for her
to prepare. She additionally announced feeling consistently sick, and had regurgitated three
times. Looking in Louise's restorative notes demonstrated she had been directed 1g of
intravenous paracetamol and 50mg tramadol in the crisis office, before her exchange to the
ward, yet Louise detailed that this absense of pain had not been completely viable. With little
entrail blockage, patients are in danger of serious parchedness, electrolyte lopsidedness and
hypovolaemic stun because of sickness and spewing, and in addition liquid movements into
the entrail (Hughes, 2005; Harold, 2011; Hinkle and Cheever, 2014). This would incorporate
any gastric liquid uninhibitedly depleting from Louise's nasogastric tube. Along these lines,
Louise's liquid status was next evaluated. Louise's slim refill was over 2 seconds, her lips
were dry and, she announced being parched – all showing that she was dried out (Dougherty
and Lister, 2011). In Louise's therapeutic notes, consequences of a full blood check, serum
electrolytes, urea and creatinine blood tests uncovered a lifted haematocrit level of 65%,
raised urea of 12.1 mmol/l and diminished serum potassium of 3mmol/l, steady with lack of
hydration. All other blood esteems were unremarkable.
Arranging
The arranging stage includes organizing nursing care as indicated by the level of hazard
ascribed to each distinguished patient need (Brooker and Waugh, 2013), and after that
interpreting these necessities into particular, reasonable, recognizable, quantifiable and time-
restricted patient-focused objectives (Lloyd, 2010; Barrett, Wilson and Woollands, 2012).
With intense conditions, for example, little entrail hindrance, here and now objectives are

dominatingly used in light of the fact that medical attendants for the most part concentrate on
the patient's prompt needs (Kozier et al., 2012). In this manner, here and now objectives for
Louise were:
(1) to remedy her drying out and electrolyte unevenness to guarantee Louise accomplishes a
0-500ml positive liquid adjust inside 12 hours, and her and serum potassium levels
standardizes between 3.5-5mmol/l inside 48 hours;
(2) to ease Louise's stomach torment from a score of 10 to <4 inside 1-2 hours and to
determine her agony inside 4-6 hours. Likewise, side effects related with Louise's drying out
and torment will be tended to including Louise's nervousness, queasiness and her dry mouth.
The general objective being to minimalistically deal with Louise's indications with a specific
end goal to enable her inside deterrent to determine itself (Diaz et al., 2013) – accordingly
reestablishing her entrail work and easing her stomach side effects inside 2-3 days.
Executing
The executing phase of the nursing procedure is the place medical attendants take after the
guidelines endorsed in the care design and from different individuals from the
multidisciplinary group to give confirm based care (Barrett, Wilson and Woollands, 2012).
Before attempted each intercession, the points of interest of every strategy were disclosed to
Louise to increase educated assent as per the NMC (2008) and to relieve her nerves. It was a
need to rectify the liquid and electrolyte deficiencies emerging from Louise's gut deterrent
utilizing intravenous (i.v.) liquid treatment, particularly since Louise was NBM (Stephenson
and Singh, 2011). Poor liquid admission, heaving and liquid pooling inside the gut lumen in
little inside block all put patients in danger of creating hypovolaemia, which bargains
haemodynamic status (Harold, 2011). A specialist recommended 3 liters of i.v. liquids with
potassium supplements to rectify Louise's liquid deficiency and hypokalaemia for the initial

24 hours and furthermore started an i.v. liquid administration program as per NICE (2013)
rules. Before directing any intravenous liquids, a fringe cannula as of now embedded into
Louise's cephalic vein on her lower arm was outwardly checked every day for indications of
redness, swelling, agony and contamination (Brooker and Waugh, 2013). The line was
likewise watched that it was in place and patent. Since i.v. liquids are named recommended
drugs, the pack of liquid was checked it was in place, in date, and the arrangement was clear
(Kozier et al, 2012). The 5Rs of pharmaceuticals administration were then clung to (NMC,
2010b; Dougherty and Lister, 2011). Utilizing aseptic procedure, one liter of i.v. Hartmann's
answer with 40mmol/l potassium was at that point gone through an implantation pump and
directed to Louise through her cannula at the recommended rate and span. Hartmann's answer
was dealt with Louise's inside obstacle and gastrointestinal liquid misfortunes as indicated by
Powell-Tuck et al. (2011). Hartmann's is an isotonic electrolyte arrangement with a structure
like human plasma which implies it stays in the vascular liquid compartment to remedy
intravascular liquid deficiencies (Kozier et al., 2012). As indicated by the NMC (2009), great
record-keeping is a vital piece of giving safe, compelling nursing care which advances data
sharing among the between proficient group and coherence of care. Along these lines, all the
i.v. imbuement subtle elements were recorded and marked in Louise's notes as indicated by
Younger and Khan (2008). The hourly volumes of intravenous liquid controlled to Louise
were additionally recorded in a liquid adjust outline, actualized to measure Louise's liquid
information and her yield from pee, emesis, nasogastric seepage and stomal misfortunes.
Consistently, the aggregate yield was subtracted from the aggregate contribution to help
screen general liquid adjust (Dougherty and Lister, 2011) and Louise was likewise measured
day by day (Duffy, 2011). Louise's liquid and electrolyte status was then checked further with
day by day blood tests. Full blood tallies (counting haematocrit to check for drying out),
serum electrolytes, in addition to urea and creatinine levels, were altogether attempted in

contact with the healing center phlebotomists. At long last, Louise was exhorted the specialist
expected her to be kept NBM to rest her entrail, and was kept refreshed when she could
present tastes of liquid. Louise was offered glycerol jam to dampen her lips, customary
mouthwashes to rouse her mouth and nose mind as well as solace measures (Lewis et al.,
2004; Baillie, 2009; Duffy, 2011). To address Louise's stomach torment, prove based
methodologies for intense torment administration included utilizing the WHO 3-stage
Analgesic Ladder backward. This approach begins with a solid opioid like morphine (give or
take non-opioids or adjuvants) to give absense of pain to direct to serious agony, and moves
down the means as the intense torment enhances to non-opioids like paracetamol, ibuprofen
and non-steroidal mitigating drugs (Appendix 6) (Dougherty and Lister, 2011). In contact
with a torment expert medical attendant, and regarding Louise's NBM status, Louise was
initiated on intravenous morphine utilizing patientcontrolled absense of pain (PCA).
Morphine is a solid opioid whose reactions incorporate respiratory misery, hypotension,
bradycardia, sickness and wooziness (British National Model (BNF), 2012). Thusly, it was
essential to gauge Louise's indispensable signs frequently to guarantee Louise remained
haemodynamically steady. Naloxone was additionally recommended by the specialist for
crisis use, in case of respiratory discouragement from the morphine organization (BNF,
2012). Louise was taught about utilizing absense of pain through PCA and her crucial signs
were measured hourly for the initial 24 hours, and afterward 2 hourly from that point, as per
nearby healing facility arrangement. The intravenous morphine was controlled through the
fringe cannula as of now in situ in Louise's lower arm in the wake of checking the line was
patent and in place. At that point, Louise's PCA was affected by the senior charge attendant
and second-checked by a staff nurture in light of the fact that the medicine included a
controlled medication (Tuckey, 2013), guaranteeing the 5Rs of medications administration
and lawful prerequisites for treatment of controlled medications were clung to (Misuse of

Drugs Act, 1971; NMC 2010a; NMC, 2010b; Dougherty and Lister, 2011). The attendants at
that point modified the PCA to give morphine at 1mg for each snap and a 5 minute bolt out
interim. Quiet controlled absense of pain (PCA) is a technique whereby patients self-manage
low measurements of intravenous (IV) sedative absense of pain by means of an electronic
pump, which conveys an endorsed measure of IV absense of pain upon patients enacting a
catch (Tuckey, 2013). Overdose is averted by the machine closing down for a pre-set
"lockout" interim, which likewise enables time for the sedative to work viably (Chumbley
and Mountford, 2010). Dealing with Louise's torment by PCA was advantageous in light of
the fact that it gave her a feeling of control, maintained a strategic distance from delays in
attendants controlling absense of pain, diminished drug blunders, and made a difference
control Louise's agony all the more viably (Tuckey, 2013). To help deal with Louise's
extreme torment successfully, she was likewise controlled 1g of IV paracetamol 3 times day
by day, as a non ('opioid-saving') pain relieving close by the PCA conveyed morphine in
accordance with WHO (1986) proposals. To control Louise's queasiness, 50mg intravenous
cyclizine (a hostile to emetic) was regulated three times, as required. This prescription was
imperative in advancing Louise's solace since sickness is a typical symptom of the morphine
(BNF, 2012), and an indication of her condition. Nonpharmacological comfort measures
including situating, consolation, giving a regurgitation bowl, putting a call ringer inside
achieve, general mouthcare keeping Louise warm and setting her bed inside a peaceful, more
quiet territory of the ward were additionally given as well. All through all methodology, steps
were taken to safeguard Louise's poise and protection as per the NMC (2008). It was likewise
critical to guarantee all nursing care given was tolerant focused.
Assessing
Following 48 hours of executing opportune and proper confirmation based rules, Louise's
imperative signs stayed stable and she never again hinted at any drying out. Louise's lips

were never again dry, she had more facial shading, her slender refill was under 2 seconds,
and, her liquid adjust outline demonstrated that she was +200ml in positive liquid adjust.
Blood tests demonstrated Louise's urea, haematocrit and potassium levels had now
standardized and all her other electrolyte levels had been kept inside ordinary points of
confinement as well. Louise had additionally been allowed by the surgical specialists to begin
ingesting tastes of clear liquids because of a change in her stomach manifestations and Louise
said she was enduring this well. At the point when gotten some information about her
stomach torment, Louise at first revealed a decrease in agony to a verbal rating score of 3
following 1 hour following starting organization of the i.v. morphine utilizing a PCA.
Following 48 hours Louise never again required the i.v. morphine through the PCA gadget,
and her agony score was reliably decreased to zero as per the reported perceptions. Her i.v.
paracetamol necessities had likewise been lessened from 3g to 1g day by day following 48
hours of nursing care. Moreover, Louise's queasiness had died down following 48 hours of
nursing consideration and she revealed feeling less on edge as well. As far as her gut work,
Louise's ileostomy had begun creating flatus and a watery yield, demonstrating that her
entrail work had been reestablished. Along these lines, each of the two Activities of Living
from the RLT show that initially required nursing mind were hinting at positive advance,
showing the nursing care was powerful.
Suggestions for Practice
While this task shows that Louise's agony was overseen effectively utilizing a PCA gadget to
self-direct her absense of pain, Carr et al. (2013) reports that numerous people reliably
encounter imperfect agony administration in healing facility. Since unrelieved agony can
deliver antagonistic physiological and mental impacts (Cox, 2010a), surveying an person's
torment much of the time and treating them immediately and viably is basic (Elliott also,
Coventry, 2012). It is likewise an essential human right and a necessity of the NMC (Human

Rights Act, 1998; NMC, 2008) which can be overseen through pharmacological or
nonpharmacological measures. Attendants ought not sit tight for patients to illuminate them
of their agony, however, ought to be proactive about torment administration and much of the
time screen the patient (Elliott furthermore, Coventry, 2012). For Louise's situation, her
agony was evaluated as a major aspect of her schedule perceptions, yet it was additionally
imperative to assess her torment 5-10 min after intravenous absense of pain was directed
(Briggs, 2010). Despite the fact that Louise could self-regulate her intravenous morphine
through PCA, it was as yet critical to guarantee she was working it appropriately and the
absense of pain was working adequately (Cox, 2010b). Frequently checking on the absense of
pain was additionally essential to guarantee it stayed fitting to Louise's level of torment
(Tuckey, 2013).
Conclusion
This paper portrays the moderate nursing administration of a person with little entrail
hindrance, in light of an adjusted type of the Roper-Logan-Tierney (RLT) show. Nursing
models advise medical attendants what is vital and significant when formulating and
conveying individualized care (Barrett, Wilson and Woollands, 2012). Various models exist,
however no one model fits all circumstances, so nurture must pick a model fitting to their
patient's needs (McKenna and Slevin, 2011). In this task, the RLT demonstrate was picked as
a structure and after that consolidated with the 4-stage variant of the nursing procedure to
convey precise, prove based, individual focused and individualized nursing care. The RLT is
a nursing model in light of 12 Activities of Living (ALs) which guides nurture in arranging
understanding consideration. Commentators attest that the RLT nursing model diminishes
patients to a negligible rundown of exercises (Walsh, 1998; McKenna, Pajnkihar, and
Murphy, 2014). In any case, this paper makes a difference show how the RLT model can be
utilized successfully to convey comprehensive, individualized nursing care by review ALs in

light of the physical, mental, social and otherworldly parts of a person. The accomplishment
of this strategy is apparent by the way that following 48 hours of all encompassing
confirmation based and individualized nursing care, Louise's condition had verifiably
enhanced with mitigation of her side effects and reclamation of her entrail work. Critically,
the RLT nursing model served to precisely distinguish and organize treating Louise's dire
clinical needs – which included hydration and viable torment administration. Evaluating and
overseeing torment adequately is an essential part of all encompassing nursing mind (Brooker
and Nicol, 2011). It is imperative attendants take care to as often as possible screen, audit
also, check a person's torment is by and large enough and fittingly controlled.

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Appendix1. Classification of small bowel obstruction (SBO)
Classification Type
Completeness Partial or complete
Timing Acute or insidious
Nature Mechanical or non-mechanical (functional)
Aetiology Adhesional or non-adhesional
Appendix2. Roper-Logan-Tierney’s 12 Activities of Living (ALs)
Activity of Living (AL)
1. Maintaining a safe environment
2. Communicating
3. Breathing

4. Eating and drinking
5. Elimination
6. Washing and dressing
7. Controlling temperature
8. Mobilisation
9. Working and playing
10. Expressing sexuality
11. Sleeping
12. Dying
Taken from: Holland et al.
Appendix3. Common versions of the nursing process
(a) The 4-step nursing process, originally published by Yura and Walsh (1967).
(b) The 5-step nursing process with a separate nursing diagnoses step (Barrett et al., 2012).
 Assessment (nursing)
 Diagnoses
 Planning
 Implementation
 Evaluation
 Assessment

 Implementation Planning
 Evaluation
Appendix4. Comprehensive nursing assessment, based on RLT Model – part I
Activity of Living Assessing Planning Implementing Evaluating Maintaining a Safe
Environment
 Vital signs within normal limits, but at risk of hypovolaemia due to dehydration
and NBM status.
 Patient has severe, colicky abdominal pain, occurring in intermittent waves. Pain
score of 9/10
 Louise distressed and anxious about her pain and her prognosis
 Louise has nasogastric tube in situ but still experiencing some nausea, but has not
vomited yet. She is worried about vomiting though.
 To ensure Louise maintains a stable haemodynamic status, as evidenced by vital
signs that remain within normal limits.
 To reduce Louise’s pain score to <4 within 1 hour and to 0 within 4-6 hours
 To alleviate Louise’s anxiety and minimise her distress.
 Monitored vital signs hourly for first 24hrs, and then 2-hourly thereafter
 Consulted specialist pain nurse, and then administered intravenous (i.v.) morphine
via PCA for Louise based on their advice (1mg bolus, 5 minute lockout interval).
Also administered 1g i.v. paracetamol TDS, as required. Asked the doctor to
prescribe an antiemetic, and then administered 50mg Cyclizine, TDS when Louise
felt she needed it.
 Educated Louise about using PCA to ensure she obtained effective pain control.

 Kept Louise informed of her plan of care to allay her fears and anxieties.
 Involved Louise in all decision making
 Used comfort measures to relax– eg. placed bed in quiet area of ward, placed a
vomit bowl and a call bell within reach.
 Louise’s vital signs remained within normal limits throughout the 48 hour period.
 After 1hour of starting PCA, Louise’s pain had reduced from a pain score of 10 to
4. After 4 hours, Louise’s pain was reduced further to a pain score of 0. After 48
hours, Louise’s condition had improved and her PCA discontinued. Her analgesia
had been reduced to 1g Paracetamol daily.
 Louise’s nausea subsided and she no longer required anti-emetics after 48 hours.
Her nasogastric tube was removed.
 Louise was visibly happier and less anxious after talking through her nursing care
and keeping her updated.
 Louise gave feedback that the comfort measures made her feel well cared for and
lessened her anxiety too.
Communicating - No problems reported. No action required. n/a n/a
Eliminating - Usually self-caring for her ileostomy. Usually empties stoma appliance, 5-6
times daily. Estimated 200ml stoma output each time.
 Currently no stoma output due to small bowel obstruction.
 Urine output is currently normal at 0.6ml/kg/hr, but Louise reports it is darker, more
concentrated due to dehydration, but unable to drink due to NBM status
 To keep Louise in a positive fluid balance, as evidenced from monitoring fluid intake
and output.

 Overall, to promote restoration of bowel function as evidenced by a return in stoma
output and signs of flatus
 To monitor restoration of bowel function by asking Louise if she could collect stoma
output in a receptacle for measuring. To document output on the fluid balance chart.
 See notes above in ‘eating and drinking’ on implementing fluid balance chart.
 See mobilising section, below.
 After 48hours, Louise’s bowel function had been restored. She had flatus and a
watery stoma output.
 Louise’s urine output is now pale and straw-coloured urine.
Appendix4. Comprehensive nursing assessment, based on RLT Model – part II
Activity of Living Assessing Planning Implementing Evaluating
Eating and drinking - Currently Nil By Mouth (NBM) to promote bowel rest.
Currently dehydrated - Louise has dry mucous membranes, is thirsty and has a capillary
refill of <2 seconds.
At risk of hypovolaemic shock due to signs and
symptoms of small bowel obstruction, plus NBM
status.
Louise scored 0 with the Malnutrition and Universal
Screening Tool (MUST) (BAPEN, 2011), which places
her in the low risk category.
To ensure Louise is aware of her

NBM status and understands the
reason for it.
To keep Louise’s mouth moist
due to her dehydration and NBM
status.
To ensure Louise maintains a
stable haemodynamic status, as
above.
Advise Louise of NBM status,
explaining why it is necessary.
Provide comfort measures
(petroleum jelly to ease dry lips)
Monitor vital signs regularly
(as above – see maintaining a
safe environment section)
Implement fluid balance chart,
documenting intake and output
hourly. Subtract total output
from total input every hour.

Advise Louise to leave urine
samples for collection and
measurement, to ensure accurate
output calculation.
Document intravenous fluid
therapy input and output from
nasogastric tube drainage, urine
output, any emesis, any stoma
output and insensible losses.
Liase with Phlebotomists and
order full blood count (including
haematocrit to check for
dehydration), urea, creatinine
and serum electrolytes.
After 48 hours, the surgeons
advised that Louise could drink
sips of clear fluid. She was
tolerating this well, so Louise will
be able to introduce a soft diet.

Louise’s fluid balance was kept in
positive balance of +250ml after
48 hours i.v.fluid therapy.
After 48 hours, Louise’s lips were
no longer dry, she had good skin
turgor and her capillary refill was
<2-3 seconds. She was also not
feeling thirsty anymore.
After 48 hours, Louise’s serum
potassium levels normalised, all
other electrolytes and full blood
counts, urea and creatinine results
were kept within normal limits.
Washing and Dressing Usually independent, self-caring.
Currently may need assistance to mobilise to bathroom as
Louise feels weak and nauseous on mobilising.
See ‘mobilising’ AL section,
below.
See mobilising section, below. See mobilising section, below.

Breathing No problems reported. No action required. n/a n/a
Mobilising Usually independent.
Currently may need some assistance to bathroom for
hygiene and toileting needs as Louise feels weak and
nauseous on mobilising.
Ensure Louise is able to get to the
bathroom safely for her hygiene
and toileting needs.
Encourage Louise to move
independently as her condition
improves.
Ask Louise if she feels she needs
any assistance mobilising safely
for hygiene and toileting needs
while she feels unwell. Then
encourage her to mobilise
independently as she feels able to.
Louise needed minimal assistance to
walk to the bathroom for hygiene and

toileting needs for the first 24 hours.
After 48 hours, Louise was
independent with mobilising.
25 | P a g e
Appendix 4. Comprehensive nursing assessment, based on RLT Model – part III
Activity of Living Assessing Planning Implementing Evaluating
Controlling Body
Temperature
Usually normothermic.
Currently apyrexial.
No specific action required. Keep monitoring the
temperature with vital signs and
ensuring Louise remains
apyrexial.
Louise remained apyrexial throughout
the 48 hours.
Working and Playing Works as a Sales Adviser.
Enjoys sewing, reading and running as leisurely
activities/ hobbies.

She lives alone, so her friends are important to her and
she enjoys socialising with them.
Currently unable to work or socialise due to abdominal
symptoms.
To facilitate Louise’s friends
coming to visit her, as evidenced
by her friends coming to visit her.
Conservatively manage her signs
and symptoms in order to restore
her to good health.
Assist Louise with accessing a
phone if she needs to. Tell Louise
the ward telephone number and
visiting hours, so her friends are
able to contact her and come and
visit.
Louise used the phone to contact her
friends and has had many visitors in
the last 48 hours. Louise said this has

made her happier about her hospital
stay.
Expressing Sexuality Not in a relationship
No problems reported.
No action required. n/a n/a
Sleeping Usually has uninterrupted sleep for 6-8 hours a night.
Louise reports not sleeping well in hospitals because it is
too noisy and she finds hospitals intimidating.
To lessen Louise’s anxieties and
reduce her pain, as above, so that
it helps Louise to relax and
minimises sleep disturbance.
See pain management in
‘maintaining a safe environment’
section.
Louise’s pain was managed well and
she did not report any problems
sleeping in the last 48 hours.
Death and Dying Self-reports being a ‘Christian with a strong faith’, so

requests that if her condition deteriorated the Christian
Chaplain be called to pray for her.
Louise does not wish to have a Chaplain to visit her
otherwise.
No immediate action required.
n/a n/a
26 | P a g e
Appendix 5. PQRST mneumonic to aid pain assessment.
P Provoking factors
Q Quality of pain
R Region and
radiation
S Severity
T Timing and
duration.
Taken from: Kozier et al., 2012.
Appendix 6. WHO 3-step analgesic ladder.
(WHO 3-step Analgesia Ladder , n.d.)