LFÓ - 7. Kafli
a) Both statements are true.
b) Both statements are false.
c) The first statement is true; the second is false.
d) The second statement is true; the first is false.
C.W., a 36-year-old woman, was admitted several days ago with a diagnosis of recurrent inflammatory bowel disease (IBD) and possible small bowel obstruction (SBO). C.W. is married, and her husband and 11-year-old son are supportive, but she has no extended family in the state. She has had IBD for 15 years and has been taking mesalamine (Asacol) for 15 years and prednisone 40mg/ day for the past 5 years. She is very thin; at 5 feet 2 inches (157 cm), she weighs 86lbs(39 kg) and has lost 40lbs(18 kg) over the past 10 years. She averages 5 to 10 loose stools per day. C.W's life has gradually become dominated by her disease, with anorexia, lactase deficiency, profound fatigue, frequent nausea and diarrhea, frequent hospitalizations for dehydration, and recurring, crippling abdominal pain that often strikes unexpectedly. The pain is incapacitating and relieved only by a small dose of diazepam (Valium), oral electrolyte solution (Pedialyte), and total bed rest. She confides in you that sexual activity is difficult: "It always causes diarrhea, nausea, and lots of pain. It's difficult for both of us." She is so weak she cannot stand without help. You indicate complete bed rest on the nursing care plan.
C.W.s condition deteriorates. On the third day after admission she experiences intractable abdominal pain and unrelenting nausea and vomiting. C.W. is taken to the operating room because of probable SBO and is readmitted to your unit from the postanesthesia care unit. During surgery, 38 inches (96 cm) of her small bowel was found to be severely stenosed, with 2 areas of visible perforation. Much of the remaining bowel is severely inflamed and friable. A total of 5 feet (152 cm) of distal ileum and 2feet(61 cm) of colon have been removed, and a temporary ileostomy was established. She has a Jackson-Pratt (JP) drain to bulb suction in her right lower quadrant (RLQ), and her wound was packed and left open. She has 2 peripheral IV lines, a Salem Sump nasogastric tube (NGT), and a Foley catheter. Her vital signs (VS) are 112/72,86,24,100.8∘F(38.2∘C ) (tympanic). You attach her NGT to low-continuous wall suction per the postoperative orders.
It is 4 days after C.W.s surgery. During the routine dressing change, you note a small pool of yellow-green drainage in the deepest part of the wound. You obtain an order for a wound culture.
You change the ileostomy appliance before the surgeon arrives. C.W. is evaluated, and it is determined that she has developed peritonitis, and needs to return to surgery for exploratory laparotomy. The surgery revealed another area of perforated bowel and generalized peritonitis. Another 12 inches (30.5 cm) of ileum were resected. The peritoneal cavity was irrigated with normal saline (NS) and 3 drainage tubes were placed: a Jackson-Pratt (JP) drain to bulb suction, a rubber catheter to irrigate the wound bed with NS, and a sump drain to remove the irrigation fluid. The initial JP drain remains in place. A right subclavian triple-lumen catheter was also inserted.
C.W. has been on NPO status since the surgery. The surgeon orders total parenteral nutrition (TPN) at a rate of 50 mL/hr. What is the purpose of these orders?