NURS3001 Assignment 4: Critical Analysis of Mrs. Cherry's Case

This case study focuses on Mrs. Cherry, a 72-year-old woman admitted after a surgical procedure for a small bowel obstruction. The assignment requires a critical analysis of her condition, including concerns related to her age, bowel movement issues, low blood pressure, wound drainage, and an indwelling catheter. The student provides a rationale for each concern, explaining the potential risks and complications. The core of the assignment involves listing and prioritizing appropriate nursing interventions, such as pain management, catheter care, and monitoring vital signs, and then providing detailed rationales for these interventions, supported by relevant literature. The case study emphasizes the importance of geriatric nursing, post-operative care, and evidence-based practice in addressing Mrs. Cherry's complex needs. The student addresses the management of nausea, vomiting, and hypotension, along with appropriate wound care protocols to prevent infection. The assignment highlights the critical thinking skills needed to provide comprehensive and effective care for elderly patients with post-operative complications.

Running Head: CASE STUDY
CASE STUDY
Name of the Student
Name of the University
Author’s Note

1CASE STUDY
Bullet point list your main concerns for this patient
 Mrs Cherry is a 72 year old woman who has currently gone through surgical procedure
for her small bowel obstruction. The concern here is that she is an old lady, which can be
a reason for delayed treatment and limitations in medical interventions.
 She has issues with her bowel movement, which is evident from her symptoms of nausea,
vomiting and abdominal pain. It is a major concern as she is in her old age and it can
increase her dependency on others.
 Her vital signs indicated that she has low blood pressure of 100/75 mmHg. This is not
preferable for her health condition as low blood pressure can lead to severe issues.
 She has a wound drain and it might contaminate if it is not handled properly.
 She has IDC in situ that means indwelling catheter, which is a catheter used for urination.
It is used to remove urine from the bladder as the bag collects. This can be complicated
for Mrs. Cherry as she is in her old age and it can lead to pain and further infection if the
catheter is not sanitized properly.
Provide a rationale/reason for this concern
 People in their old age are vulnerable to more number of diseases and complications
especially when they are going through any surgical procedures. Mrs. Cherry is in a post-
operative stage as she was operated for her small bowel obstruction. Anaesthesia is a
common sedation that is used during surgery as it helps in the prevention of pain and
losing consciousness. She is conscious and alert after her operation but she is vulnerable
to post-operative complications such as postpartum cognitive dysfunction. It is a matter

2CASE STUDY
of concern as she is an old lady and she is already suffering from small bowel
obstruction, which was diagnosed when she got admitted.
 She was diagnosed with small bowel obstruction (SBO) and later she was gone through a
surgical procedure that relieved her from her obstruction. SBO is the blockage in the
small intestine that is caused due to several reasons such as cancer, hernia or scar tissue.
She was admitted for nausea and vomiting, which is a matter of concern for older people
as they are weak and they need to be assisted and guided during these time (Loftus et al.,
2015). People with small bowel obstruction especially older people have a high morbidity
and mortality rate. Their quality of life and functioning is affected by the complications
due to bowel obstruction. They need acute and emergency medical care due to the
increasing issues in their bodily functions and daily tasks. Small bowel obstruction is the
reason for 51% of emergency laparotomies. There is an 80% of morbidity rate in people
with small bowel resection that includes death related to emergency surgery (Paulson &
Thompson, 2015). Some of the methods of diagnosis for small bowel obstruction is
abdominal X-ray, computerized tomography (CT), standard X-rays, ultrasound and air or
barium enema. These diagnosis methods are used when the patient starts showing
symptoms such as cramp including abdominal pain, constipation, vomiting, and inability
to pass gas or bowel movement or swelling of the abdomen (Catena et al., 2016).
 Low blood pressure could be a life threatening medical condition because it indicates that
the blood is not able to travel to all parts of the body such as heart and the brain. People
in old age are more susceptible to low blood pressure as they are weak and are sometimes
deprived of nutrition. If the blood pressure is lower than 90/60 mmHg then it is diagnosed
as hypotension, which means that Mrs. Cherry needs to keep a check on her blood

3CASE STUDY
pressure because it can later turn into hypotension (Elgendy et al., 2015). She has just
been operated for her small bowel obstruction, which makes it more dangerous for
someone with hypotension. She was admitted for her tendencies that suggested that she
had obstructions in her bowel movement or the small intestine. Having a low blood
pressure can limit her medications and further surgical interventions, which is not safe for
her health. A low blood pressure could be signs of cardiovascular disease, which shows
signs of future complications.
 The concerns related to indwelling catheter is several in old age because the material used
for catheter could cause irritation and allergic reactions. When an IDC treatment is done
for a long time then it can cause kidney damage as well including injury to urethra
causing blood in urine. It can also lead to urinary tract infection, kidney or blood
infection if the catheter is not cleaned properly (Nicolle, 2014). Patients with long term
catheters have a tendency of suffering from hematuria, which is a symptom of kidney
stones or cancer in the bladder. Bladder spasm is also a common complication found in
patients who use indwelling catheter.
 Surgical draining is done in wounds to reduce the infection by removing the fluid in the
wounds. These are implants that help in the removal of fluid or gas from the wound or
any body cavity. It also helps in increasing the rate of the healing process that is
necessary for patients with surgical wounds. It reduces inflammation, foreign material,
bacteria and necrotic tissue from the wounds. The issue with wound drainage is the fact
that it becomes contaminated if the management is not handled properly. There are
certain measure that needs to be followed before handling a wound drainage such as
sanitizing the hand before using any instrument, checking room for additional

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precautions, using non sterile gloves, alcohol swab and waterproof pad. If it is not used
with sterilized equipment then it can get contaminated leading to sepsis, which is not
preferable for someone with that age. The plug should be pointing away from the face so
that the person does not get contaminated due to the fluid. The rationale for concern
regarding wound drainage is the issue of cross contamination and wound infection,
specifically for someone with a wound in the small intestine, which is more susceptible
because of its location (Larsson, 2016). Wound drainage is a necessary protocol after a
surgery, which is required for Mrs. Cherry.
List all the appropriate interventions in order of priority (be specific).
 Proper management and care is necessary for someone who has a small bowel
obstruction surgery because their digestive system is still not healed due to the process.
They are not permitted to eat just after the operation so the nurses should make sure that
she is monitored. Her intervals between every gas being passed should be kept in check
so that she could be allowed to eat and drink. The surgery can leave sensations of pain
after the patient has turned conscious so the nurses should ask about her pain at every
interval so that she is comforted and given optimum care (Scrima et al., 2017). The
nurses should give medications for pain such as fentanyl, methadone or Panadol if there
is a sensation of pain or discomfort. This intervention will help in reducing the
complication of post-operative small bowel obstruction because the recovery for this
requires a longer period of time. An estimated time is 6-7 days in bed rest depending on
the procedure and the health of the person. As Mrs. Cherry is 72 years old she should be
more careful and given better interventions for her condition.

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 Indwelling catheters should be handled carefully because they can increase infections
inside the urinary bladder. Interventions have to be taken for proper handling by using
reusable catheters that needs to be washed after every use with disinfectant liquids
including the area of the body that has the catheter (Colli et al., 2015). When using one
time use catheters then only the body part needs to be cleaned so that the sterilized
catheter can be inserted. The urine bag should be emptied every 8 hours after it is filled
with urine. The urine bag should be cleaned with a mixture of vinegar and bleach with
water to eradicate the infectious microorganism from the bag. It is ideal to use a catheter
for a weeks as it can stay in place from 2 to 12 weeks if the reusable catheter is being
used (Ho et al., 2015).
 Symptoms of nausea and vomiting due to her complication of bowel movement
obstruction needs a care intervention of its own. Geriatric nursing requires more effort as
people with old age are not easy to care for because of their increasing complications
both physically and mentally (Möhler & Meyer, 2014). In the same way older people
with bowel movement issues need to monitored and kept under surveillance so that
nurses can make a care plan for them. Mrs. Cherry complained of nausea and vomiting,
which should be stopped with the help of medications and dietary restrictions. The bowel
is a significant organ for the function of excretion and if any complication is found in the
intestines that helps in the smooth passing of faeces then it should be immediately
treated. People in old age should be more careful about their diet and physical activity
because any issues can obstruct their bowel movement.
 Hypotension in old age is another issue that needs to be noticed so that it does not
increase to severe cardiovascular disease. Interventions should be taken so that her blood

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pressure is in a normal range. It is necessary to make them drink more water and increase
salt in their diet so there is not issue of low heart rate or blood pressure. Medications such
as non-steroidal anti-inflammatory drugs (NSAIDs), midodrine, fludrocortisone,
erythropoietin and caffeine should be given to patient if no change is seen. Mrs. Cherry is
not suffering from hypotension but due to her low reading in the vital stats it is necessary
to take action and implementation for the wellbeing because it can elevate and turn into a
disease (Zia, Kamaruzzaman & Tan, 2015).
 Wound drainage is done after a surgery so it is important that it should be done in a
proper manner so that there is no cross contamination or infection in the wound. The
nurses should take all safety measures before they start preparing for the gauges because
any unsterile equipment during the wound management can increase the infection, which
is not preferable for a patient who has just been out of an operation (Benbow, 2016). The
use of correct catheter should be utilized so that infection is prevented and it is done
efficiently for the betterment of the patient.
Provide a rationale/reason for these interventions in order of priority
 Care after surgical procedures of small bowel obstruction should be implemented because
it is related to the small intestine, which is an important organ for digestion and excretion.
The limitation of food after surgery and the monitoring of passing of gas should be done
so that further complications do not arise (Partridge et al., 2014). An obstruction in the
bowel is extremely painful because it blocks the way for excretion and undigested food,
which is not preferable for the health. It can cause permanent damage to the intestines,
bleeding or leaking, electrolyte disturbances and fluid loss. If it remains untreated then it
can cause low blood pressure that results to cardiac failures or death in critical situations.

7CASE STUDY
 The interventions taken for indwelling catheter should be taken seriously because Mrs.
Cherry has already gone through a surgery and she needs to be stay in a disinfectant
environment so that her wound does not get infected. She is also having a wound
draining, which should be considered when an indwelling catheter is being used for her
(Feneley, Hopley & Wells, 2015).
 Her symptoms of nausea and vomiting should be controlled so she does not become
weaker due to ill dietary patterns and restricted bowel movement.
 It is important to control her blood pressure and make it come back to the normal range
because low blood can cause vertigo, cardiac issues and fatality if not treated in time.
Even if it does not cause cardiac arrest, it can cause low supply of blood between the
heart and brain, which will cause damage to the organs.
 Proper wound management is a necessity for people after surgery because inefficient
practice can lead to cross contamination or even sepsis in severe stages (Lipsky et al.,
2017).

8CASE STUDY
References
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Catena, F., Di Saverio, S., Coccolini, F., Ansaloni, L., De Simone, B., Sartelli, M., & Van Goor,
H. (2016). Adhesive small bowel adhesions obstruction: Evolutions in diagnosis,
management and prevention. World journal of gastrointestinal surgery, 8(3), 222, doi:
10.4240/wjgs.v8.i3.222
Colli, J., Tojuola, B., Patterson, A. L., Ledbetter, C., & Wake, R. W. (2014). National trends in
hospitalization from indwelling urinary catheter complications, 2001–2010. International
urology and nephrology, 46(2), 303-308, doi: 10.1007/s11255-013-0524-x
Elgendy, I. Y., Huo, T., Chik, V., Pepine, C. J., & Bavry, A. A. (2015). Efficacy and safety of
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trials. American journal of hypertension, 28(5), 576-585, doi: 10.1093/ajh/hpu209
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status,
adverse events and research agenda. Journal of medical engineering & technology, 39(8),
459-470, doi: 10.3109/03091902.2015.1085600
Ho, C. H., Sung, K. C., Lim, S. W., Liao, C. H., Liang, F. W., Wang, J. J., & Wu, C. C. (2015).
Chronic indwelling urinary catheter increase the risk of bladder cancer, even in patients
without spinal cord injury. Medicine, 94(43), doi: 10.1097/MD.0000000000001736
Larsson, M. (2016). U.S. Patent No. 9,408,755. Washington, DC: U.S. Patent and Trademark
Office.

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Liu, X., Yu, Y., & Zhu, S. (2018). Inflammatory markers in postoperative delirium (POD) and
cognitive dysfunction (POCD): a meta-analysis of observational studies. PloS one, 13(4),
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