Nursing

Case 1:
The patient`s symptoms (nausea & vomiting, abdominal distension, absent bowel sounds and anuria) are suggestive of intestinal obstruction CITATION Cha03 \l 1033 (Kahi & Rex, 2003). The increase in weight is due to third space fluid shift occurring secondary to inflammation due to intestinal obstruction CITATION Red01 \l 1033 (Redden & Wotton, 2001) and the abdominal distension could be either due to intestinal obstruction or secondary to bladder distension due to urinary retention (UR). UR occurred as a side effect of one of her medications. Anticholinergic agents such as Oxybutynin (Ditropan) have an established role in the etiology of UR as they reduce the contractility of the bladder detrusor muscles and Metoclopramide (maxalon) has also been found to cause UR CITATION Dra98 \l 1033 \m Bri08(Drake, Nixon, & Crew, 1998; Selius & Subedi, 2008). The patient is in a decompensated state as reflected by fever, hypotension and tachycardia and thus, the initiation of infusion of Hartmann`s solution is an appropriate step, since it is isotonic and would help to restore the electrolyte levels (particularly sodium, chloride and potassium) which would have been altered due to vomiting and fluid shift CITATION Sah05 \l 1033 (Rassam & Counsell, 2005) but the rate of 84 ml/hr is not an adequate amount for an adult patient and rates upto 500 ml/hr are recommended CITATION Max07 \l 1033 (Weil, 2007). Moreover, the suggested plan of action, i.e. insertion of IDC (which is the most important step in the management of UR for bladder decompression CITATION Joh06 \l 1033 (M.Fitzpatrick & Kirby, 2006)), collection of blood samples and antipyretic administration is also appropriate. However, an important missing intervention is placement of a nasogastric tube to help prevent further bowel distention CITATION Cha03 \l 1033 (Kahi & Rex, 2003). Moreover, Maxolon should not be administered to the patient since it can potentially cause urinary retention and might aggravate the patient`s condition CITATION Dra98 \l 1033 (Drake, Nixon, & Crew, 1998) and thyroxine should be discontinued temporarily as it can aggravate tachycardia. In addition, thyroxine levels should be checked and proper treatment should be initiated if the patient is found to be hypothyroid.
Case 2:
CVC`s are used for the administration of IVF, drugs, blood products and parenteral nutrition CITATION KHP02 \l 1033 (Polderman & Girbes, 2002) and also to monitor the hemodynamic status of patients , such as measurement of CVP, as in this case CITATION Nic06 \l 1033 (Gilboy & Tanabe, 2006). The blood culture sample collection technique to draw a discard sample before the actual sample is correct, although it is recommended that it should be collected via a peripheral source to avoid catheter lumen colonization CITATION CHR09 \l 1033 (CHRISP, 2009). The minimum recommended discard volume is 1.5 times the internal volume of the catheter CITATION Den...