2. 2
Session objectives
At the end of this session the learner will be able to:
Explain surgical case diagnosis, investigation, nursing
intervention and management with their ctisisim
Identify the cases diagnosis in appropriate way
List all acute surgical cases with their evaluation.
3. 3
1. SBO
Diagnosed By:
C/C- Abdominal pain/ 2wks duration
Lab Investigation and Diagnostic procedure they use
• History and P/E- to the point
• Radiology/ Ultrasound- detected obstructed bowel
• Hematology/ CBC- ed WBCs and ed hemoglobin or
hematocrit
• Chest X-ray
5. 5
Criticism on Dx and Investigation
• BUN and Creatinine is not seen but its indicator of SBO
• Serum electrolyte not done
Rectal tube is not done ( Fanos Surgery, 2019, JU)
To decompress an area that is lower in the bowel
6. 6
Medication for Management of SBO
• Maintenance Fluid
• Vancomycin 500mg po/day
• Ceftazidine 1gm iv
• Metrondazole 500mg iv tid
• Morphine
• Surgical Intervention and colostomy is done for the patient.
(Fanos Surgery, 2019, JU
7. 7
Criticism on Medication
They don use Prokinetics to promote gastric motility
(octreotide [Sandostatin]) in paralytic ileus or partial
obstruction.
IV therapy to replace the depleted water, potassium
(electrolytes) is not added to the medication. (Fanos
surgery 2019, JU)
8. 8
Nursing Management and intervention for pts
• NCP
• Daily wound care
• Fluid Maintenance admistering
• Following V/S
• Changing colostomy for her at least BID
• Preventing Infection by Nurses and other health
professions
9. 9
Criticism on Nursing Mgt & Rx
Those intervention is not well done for the patient.
Assessing for fluid and electrolyte imbalance
• Providing emotional support and comfort
• Monitoring nutritional status
• Monitor intake and output, worsening of pain or abdominal
distention
• Maintaining the function of the nasogastric tube, assessing
and measuring the nasogastric output
10. 10
2. Blunt Chest Trauma
Diagnosed by:
c/c….Chest Injury of 2 days duration
Lab + Diagnostic procedure: (Fanos surgery 2019, JU)
History and P/E
CBC- Low Hgb due to excessive bleeding
CXR- Accumulation of blood to lower part of the lung
ECG- for the purpose of heart rhythm and rate
11. 11
Criticize on BCT Lab and Investigation
Ultrasonography not done ( RN Adult nursing 9th edition)
E-FAST: extended focused assessment for the sonographic
evaluation of the trauma patient.
Echocardiograph not done
CT Angiography not done
12. 12
Management
Post op Management:
The patient is on maintenance fluid/ NS
Antibiotics is given for infection
He is on Oxygen Supplement b/c of low oxygen saturation
Chest tube is inserted for removal of Blood/ fluind
(hemothorax)
Following V/S.
13. 13
Criticize on Mgt
MF not calculated to administer the fluid.
Chest tube drainage is not well monitored.
Pain is not well relieved. The patient complains pain.
14. 14
Nursing Care Plan/ Nursing Intervention
• They follow Vital sign
• They follow chest tube on place and assess OP
• They assessing color of Out put fluid
• Assess patients respiration
• They administering fluid for replacement
• They Administer antibiotics for the patient
15. 15
Criticism on Nsg Intervention
• They done well, But
• NCP Is not well done
• Wound care is not appropriately clean at injured site.
16. 16
3. Acute Appendicitis
Diagnosed By:
c/c ... Acute Abdomen /2 days duration
Lab + P/E at OPD:
All P/E For the appendicitis patient is identified at OPD and
link to SRC for OR Purpose (sign of appendicitis).
CBC—ed WBCs (neutrophils >75%)
Abdominal x-ray films, ultrasound studies, and CT scans
17. 17
On Diagnosis
They are well diagnosed!
But,
• Serum C-reactive protein (CRP)
• Ultrasound
• MRI……………not done
19. 19
Management
Post op mgt
Maintenance fluid
Antibiotics and intravenous fluids
Analgesics after diagnosis
Appendectomy (surgical removal of the appendix)
Done with a low abdominal incision (laparotomy) or by
laparoscopy.
20. 20
Based on Mgt
• Available evidence on duration of treatment is limited and
mainly focused on children.
• However, there is no firm evidence on the duration (3, 5, 7,
10 days) and route of administration (usually intravenous
administration for 48 h, then oral administration)
21. 21
Nsg Intervention they do
They follow V/S
Placing the patient in a semi-Fowler position
Opioid, usually morphine sulfate
Oral fluids as tolerated as prescribed.
Food is provided as desired and tolerated on the day of
surgery
Ambulation begins the day of surgery or the first
postoperative day
22. 22
Criticize on Nsg Intervention
• NCP of the patient is not well done
• Others are done by the ward nurses.
• No documentation on NCP about pt status
23. 23
Reference
1. RN Adult Medical Surgical Nursing 9.0 th Edition.
2. Medical-Surgical-Nursing-Demystified
3. Fanos surgery 2019, JU
