Small bowel obstruction

Pathophysiology of a small bowel obstruction… include everything from causes, signs&symptoms, what occurs in the body? diagnosting, diagnositic procedures, lab values to take into consideration, surgery, recovery, …. etc

I also have to incorporate my patients info in the paper and discuss similarities and discrepencies in the usual signs, symptoms ,lab values ect. Patient info is below…

Client’s Initials M.M. Age 89 Sex F Date of Admission 03/26/14

Allergies Codeine DNR No Renewal Date N/A

Advanced Directive: Yes-03/26/14 Expected LOS: Unknown

Medical Diagnosis and Reason for Admission:

Primary Diagnosis: Small bowel obstruction

Co-morbidities: Intestinal disorder, Hyperlipidemia, Hypertension, CAD, Arthritis

Reason for Admission: Nausea/Vomiting

Surgery/Date: N/A

Pathophysiology of Primary Medical Diagnosis:

A small bowel obstruction occurs when intestinal contents cannot pass through GI tract. This occurs in the small intestine and can be partial or complete,simple or strangulated. Pattient M.M. Had a complete small bowel obstruction from strangulation, which leads to insufficient blood supply. The causes of intestinal obstruction are classified as mechanical or non mechanical. In this case the cause was mechanical obstruction, which meant there was an occlusion of the intestinal lumen. Surgical adhesion is the most common reason for small bowel
obstructions.

Date
Lab
Normal Value
Patients Value
Clinical Significance
04/05/14
WBC
4.0-11.0 thou/mcl
10.6
WNL

RBC
4.2-5.4 mill/mcl
3.51

Low; possibly from hemorrage due to previous strangulation of bowel; hemolysis or destruction of RBC’s; nutritional deficiencies (Iron).

Hgb
14-18 g/dl
9.1
Low; indicitive of bleeding from strangulation of bowel.

Hct
45-54%
28.1
Low; indicitive of bleeding from strangulation of bowel.

MCV
80-100 fL
80
WNL

MCH
27-34 pg
27
WNL

MCHC
32-37%
32.4
WNL

RDW
11.5-14.5%
24.8
High; possibly from too little vitamin B12 or folic acid.

Platelet
150-400
261
WNL

MPV
7.4-10.4 fL
9.4
WNL

Neut auto
50-70%
66.1
WNL:

Lymph auto
20-40%
20.3
WNL

Mono auto
4-8%
8
WNL

INR
0.9-1.2
1.1
WNL

PT
9.2-12.2
10
WNL

Mag
0.75-1.25 mmol/L
0.9
WNL

Glucose
74-100 mg/dL
83
WNL

BUN
8-23 mg/dL
2
6
High; due to gastrointestinal bleeding; dehydration

Creatinine
0.8-1.3 mg/dL
0.9
WNL

eGFR-AA
>60
>60
WNL

eGFR-NAA
>60
>60
WNL

Sodium
136-145 meq/L
142
WNL

Potassium
3.5-5.1 meq/L
5.8
High; possibly due to prescribed potassium supplements

Chloride
98-107 meq/L
113
High; most likely from dehydration

CO2
23-29 meq/L
23
WNL

AGAP
3.0-7.0
6
WNL

Calcium
8.6-10.2 mg/dL
8.7
WNL

ALT
10-40 U/L
20
WNL

AST
8-48 U/L
40
WNL

Alk Phos
38-126 U/L
120
WNL

Total Protein
6-8.3 mg/dL
8.1
WNL

Albumin Lvl
3.5-5.0
4.2
WNL

Glob
2-3.5 g/dL
3
WNL

A/G Ratio
1.0-2.0
1
WNL

Bili Total
0.2-1.2 mg/dL
0.5
WNL

Drug
Dose
Route
Frequency
Reason
amlodipine
(Norvasc)
10 mg
PO
QD @1000
HTN
amlodapine
(Norvasc)
5 mg
PO
QD @1000
HTN
metoprolol
(Lopressor)
50 mg
PO
BID @1000,2200
HTN
heparin flush
50 units
IV
PRN

heparin flush
50 units
IV
q12h

heparin
5,000 units
SQ
q8h

saline flush
10 mL
IV
PRN

saline flush
10 mL
IV
q12h

clonidine patch
(Catapres-TTS-2)
0.2 mg
Transdermal
q7days

clonidine
(Catapres)
0.1 mg
PO
BID
@1000

gabapentin soln
(Neurontin)
400 mg
PO
TID
@1000,1800
Pain
gabapentin
(Neurontin)
300 mg
PO
BID
Pain
magnesium sulfate
2 gm
IV Piggyback
PRN

potassium chloride Soln
40 mEQ
PO
PRN

potassium chloride ER tabs
40 mEQ
PO
PRN

potassium chloride
20 mEQ
IV Piggyback
PRN

potassium chloride
ER tabs
10 mEQ
PO
QD
@1000

acetaminophen
(Ofirmev)
1,000 mg
IV
q8hr PRN
Pain
levothyroxine
(Synthroid)
25 mcg
IV
QD

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levothyroxine
(Synthroid)
50 mcg
PO
QAM

epoetin alfa
(Procrit)
As Directed

Iron
1 injection

As Directed
Iron deficiency
pantoprazole
(Protonix)
40 mg
IV Piggyback
q24hr

furosemide
(Lasix)
20 mg
PO
QOD-alternate btwn 40 mg

furosemide
(Lasix)
40 mg
PO
QOD-alternate btwn 20 mg

diphenhydrAMINE
(Benadryl)
25 mg
PO
QHS
Sleep
Stool softener
1 cap
PO
QD
Soften stool
tramadol
50 mg
PO
B ID
Pain
Escitalopram
(Lexapro)
5 mg
PO
QD

Ondansetron
(Zofran)
4 mg
IV
Q6h PRN
N/V
omeprazole
20 mg
PO
BID

AtorvaSTATin
(Lipitor)
40 mg
PO
QPM

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