Nursing Process Paper: Bilious Emesis, Increased Fussiness

Nursing Process Paper
Your Name
Your Institution of Affiliation
September 25, 2017
Case Presentation
Chief complaint
The patient, Tegun is a 2-month old male born at 36-week gestational age who presented with multiple episodes of bilious emesis, increased fussiness, decreased PO intake. His mother noted that he has jaundice and abdomen distention.
Lab Reports
Because of this she immediately brought him to CNMC ED while the nurses administered an AXR and UGI revealed an intestinal malrotation and volvulus, which is characterized by a “270º counterclockwise rotation around the superior mesenteric vessels” CITATION Ben17 \l 1033 (Bensard, 2017). In the OR, the noted that there was a purulent, bilious material seen upon entering the abdomen, which is suggestive of a perforation, even if the perforation site was not seen.
Because of this he was taken to the OR on September 14, 2017 for an ex lap. Tegun then underwent a resection of four necrotic segments (24cm in total), which are then left in discontinuity. His bowel was left open while a gauze as well as a Tegaderm was used to cover it until the 16th of September, 16, 2017. As the doctors finished the Ladd’s procedure, the additional bowels were then resected, and an appendectomy as well as a G-tube replacement was done with the patient.
What did I observe?
All in all, the patient, have a total remaining of 54cm of small bowel in the IVC and the colon. It was only until the TPN and NPO Post-operation phase when Tegun’s bowel functions returned. Since then tropic feedings were administered and advanced until the patient has regained his own bowel functions.
Chart Observations
ADEK started on August 29, upon looking at the charts of Tegun, the results suggested that MCT oil should also added to BM to fortify feeds to 22kcal/oz. to help with weight gain on August 14. Since then, additional concentration was then added to the feeds from 22kcal/oz to 28kcal on August 23. However, all of the treatments used (Elecare, BM, and MCT) did not cause any improvement in weight. The high concentration formula (28kcal/oz.) even caused high output diarrhea. The was PPN restarted on August 24 in order to compensate for the poor weight gain on PO feeds, and the feeding pattern was changed to a continuous x20 hr/day via GT.
Anything your preceptor point out that you had not thought of?
I didn’t notice that the symptoms could lead to hyperbilirubinemia this is what the preceptor suggested to me. Thus, the primary physician suggested that the use of Actigal from August 17 (which cause an improvement in his bili). However, because of Tegun’s worsening diarrhea, the treatment was then discontinued on August 24. After this treatment, Tegun was then transferred to Intestinal Rehab service on August 24 because of the poor growth. Since then, he was back on TPN for nutrition optimization and slowly advanced his enteral feedings His TPN was able to be stopped on September 11, 2017. The IVF being administered was then stopped on September 14 2017.
Evaluation, Diagnosis, and Assessment
Based on his hospital records (the Chart presented) and the observation that I gathered, I was able to see that Tegun’s vital statistics an...