Assignment: Assessing, Diagnosing, and Treating Pre- and Post-Operative Care Patients – Intestines, Hernias, and Abdominal Wall Lesions
Week 8: Assessment and Care of Patients With Conditions of the Intestines, Hernias, and Abdominal Wall Lesions
After experiencing issues with bowel movements, Terri Gillmore went to the hospital where she was diagnosed with a perforated appendix. Her condition, worsened over time and pain medications did not alleviate her symptoms. Additional diagnostic testing revealed that the actual cause of Terri’s symptoms was Crohn’s disease, which was so severe that providers recommended surgery (University of Maryland Medical Center, 2013). As Terri’s case demonstrates, abdominal conditions can be challenging to diagnose, causing distress and pain for patients. Thus it is essential for you not only to know which diagnostic tests to order and when to order them, but also to be aware of when it is appropriate to consult with specialists and other professionals on your multidisciplinary team.
This week, as you study the pre- and post-operative care of patients with conditions related to intestines, hernias, and abdominal wall lesions, you examine strategies for assessment, diagnosis, and treatment.
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Learning Objectives
By the end of this week, students will:
- Evaluate medical and surgical patients with conditions of the intestines, hernias, and abdominal wall lesions
- Develop differential diagnoses for medical and surgical patients with conditions of the intestines, hernias, and abdominal wall lesions
- Develop treatment plans for medical and surgical patients with conditions of the intestines, hernias, and abdominal wall lesions
Learning Resources
Required Readings
Colyar, M. R. (2015). Advanced practice nursing procedures (1st ed.). Philadelphia, PA: F. A. Davis Company.
- Chapter 110, “Anoscopy”
- Chapter 112, “Flexible Sigmoidoscopy”
- Chapter 121, “Pilonidal Cyst/Abscess I & D”
- Chapter 124, “Thrombosed Hemorrhoid Removal”
Doherty, G. M. (2015). Current diagnosis and treatment: Surgery (14th ed.). New York, NY: McGraw Hill.
- Chapter 29, “Small Bowel”
- Chapter 30, “Large Intestine”
- Chapter 31, “Anorectum”
- Chapter 32, “Hernias & Other Lesions of the Abdominal Wall”
Fisher, D., Malpas, P., Dominitz, J., Cash, B., Evans, J., & Decker, G. (2011). Complications of colonoscopy. Gastrointestinal Endoscopy, 74(4), 745–752. Retrieved from http://www.asge.org/assets/0/71542/71544/56321364-c4d8-4742-8158-55b6bef2a568.pdf
Neugut, A. I., & Lebwohl, B. (2013). Colonoscopy and colorectal cancer mortality: Both sides of the story. Therapeutic Advances in Gastroenterology, 6(3), 189–191. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625020/
Required Media
i-Human Patient Cases. (2014). Retrieved from https://ih2.i-human.com/users/sign_in
Singh, I. (2013). NEJM thoracentesis+ [Video file]. Retrieved from https://www.youtube.com/watch?v=RLNzv170_7Q&list=PLCq48yXbRGqnzYyV2J5aP0kGLU429VMUw
Assignment: Assessing, Diagnosing, and Treating Pre- and Post-Operative Care Patients – Intestines, Hernias, and Abdominal Wall Lesions
Conditions associated with the intestines, hernias, and abdominal wall lesions typically are the result of work environment factors, genetics, or infection. Patients who present with these conditions need extensive diagnostic tests and often require referral to a specialist. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat pre- and post-operative patients who present with health conditions related to the intestines, hernias, and abdominal wall lesions.
To prepare:
- Review this week’s Learning Resources. With the intestines, hernias, and abdominal wall lesions in mind, consider how to assess, diagnose, and treat patients in pre- and post-operative care.
- Review this week’s i-Human case study. Based on the patient information provided, think about the health history you would need to collect from the patient.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
- Identify three to five possible conditions to consider in a differential diagnosis for the patient.
- Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
- Develop a treatment plan for the patient that includes health promotion and patient education strategies for medical and surgical patients with conditions of the intestines, hernias, and abdominal wall lesions.
To complete:
As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 2 Learning Resources.
Assignment: Assessing, Diagnosing, and Treating Pre- and Post-Operative Care Patients – Intestines, Hernias, and Abdominal Wall Lesions
| Novice | Emerging | Proficient | |
|---|---|---|---|
| HPI Statement |
0 (0%) – 5 (5%)
Poorly written HPI statement. Incomplete ideas and sentences. Lacks basic history taking skills
|
6 (6%) – 10 (10%)
Well written HPI statement but may be missing 1-2 key components from the history
|
11 (11%) – 15 (15%)
Clearly written HPI statement with comprehensive information gathering from case questions.
|
| Objective testing and physical exam |
0 (0%) – 5 (5%)
Poorly written physical examination. May be missing 3 or more key exam findings that are critical to patient’s diagnosis. Includes 3 or more inappropriate exams or tests.
|
6 (6%) – 10 (10%)
Well written physical examination but may be missing 1-2 key exam findings critical to patient’s diagnosis. May include 1-2 unnecessary exams or tests.
|
11 (11%) – 15 (15%)
Clearly written physical examination covering all critical components of a focus exam. Tests that are ordered are appropriate for patient and cost effective.
|
| Assessment |
0 (0%) – 10 (10%)
Differential diagnosis list too brief and inconclusive. May be missing 3 or more critical components. Priority list may be out of order. Primary diagnosis may be wrong.
|
11 (11%) – 19 (19%)
Well written differential diagnoses. May be missing 1-2 critical components. Correct primary diagnosis identified.
|
20 (20%) – 25 (25%)
Clearly written differential diagnoses. Primary diagnosis identified.
|
| Plan for patient |
0 (0%) – 15 (15%)
Poorly written plan. May be missing 3 or more key issues that are critical to patient’s diagnosis.
|
16 (16%) – 25 (25%)
Well written plan but may be missing 1-2 key issues critical to patient’s diagnosis.
|
26 (26%) – 30 (30%)
Clearly written plan covering all critical components for patient’s final diagnosis.
|
| Clinical Questions |
0 (0%) – 10 (10%)
Correctly answered 0-69% of the clinical question
|
11 (11%) – 13 (13%)
Correctly answered 70-89% of the clinical question
|
14 (14%) – 15 (15%)
Correctly answered 90-100% of the clinical questions
|
Assignment: Assessing, Diagnosing, and Treating Pre- and Post-Operative Care Patients – Intestines, Hernias, and Abdominal Wall Lesions