Problem: Describe a comprehensive assessment that could be utilized and discuss where and how the nurse could use this information to develop one (1) nursing diagnosis and one (1) nursing interventions for this patient.
Nurse Intervention: Continued perfusion of the kidneys to prevent kidney damage
Mr Arthur Barrett is a 74-year-old man diagnosed with cancer of the colon. He had sought medical treatment after noticing rectal bleeding, and occasional constipation and diarrhoea. Noting that Mr Barrett was anaemic and that he had a family history of bowel cancer, his GP performed a digital rectal examination. Although unable to identify a palpable rectal mass, the GP referred Mr Barrett to a gastroenterologist and a colonoscopy was subsequently scheduled. The colonoscopy revealed left-sided colon cancer and a bowel resection was scheduled. Mr Barrett was admitted the day before his surgery as he was 'high risk'. Admission observations: Temperature 36.7°C Pulse rate 90 Respiratory rate 18 Blood pressure 150/90 mmHg Co-morbidities: - COPD (chronic obstructive pulmonary disease) which Mr Barrett has had for 15 years. He uses a salbutamol inhaler and smokes occasionally. - Osteoarthritis: Mr Barrett takes the over the counter (OTC), non-steroidal antiinflammatory drugs (NSAIDs) ibuprofen and paracetamol PRN. - Type 2 diabetes (diet-controlled). Medical orders: Mr Barrett's doctor ordered the following: - Two Pico Preps to be given the night before surgery - Clear fluid diet until midnight and then nil orally - Enoxaparin sodium 40 mg SCI - Metronidazole 500 mg IV and cephalothin 2 g IV Day 1 post op: Temperature 37°C Pulse rate 112 (weak and thready) Respiratory rate 22 Blood pressure 90/50 mmHg Oxygen saturation level 97% Hourly urine output (average) 26 mL/hr Specific gravity of urine 1.022 BGL 4 mmol/L Day 2 post op: Temperature 37°C Pulse rate 121 beats/min (full, bounding and irregular) Respiratory rate 32 breaths/min Blood pressure 184/95 mmHg Oxygen saturation level 90% Hourly urine output (average) 15-30 mL/hr BGL 6.9 mmol/