Abdominal Assessment: A story towards mastery
Abdominal Assessment: A story towards mastery
By : Budek
http://www.pinoybsn.tk
Nag mumuni muni si Nars Budek sa emergency unit ng Ospital ng Fatima medical center. Bigla biglang may pumasok na pasyente para sa admission. Masakit raw ang kanyang tyan.
Inobserbahan siya ni Nars Budek. Aba, napakabilis ng kanyang pag hinga. Namumutla pa ang kaniyang mga labi at parang tuyong tuyo at nagbabakbak.
“Ang bilis rin ng kanyang heart rate ah, 110 bpm, tachycardic ito, siguro may masamang nararamdaman o may nararamdamang sakit?” Ang naisip ni Budek.
Ang pasyente natin ay si nanay ester, isang matandang pasyente. Siya ay 74 taong gulang na na may chief complaint na “MASAKIT ANG TIYAN KO”
What are the possible causes of abdominal pain in the elderly ?
Nurse Budek thinks of : Constipation? Gas accumulation? Impaction? Inflammatory Bowel Disease? Appendicitis? Cholecystitis? Cholelithiasis? Ulcers? Peritonitis? Colon cancer? Ovarian or uterine cancer? PID? And many many more.
“Okay nanay, dadalhin ko muna po kayo sa lab para po sa isang work up.”
Hmm… work up? Did nanay ester understands what nurse budek said…. WORK UP? Perhaps, this will be better :
“Okay nanay, pupunta na po tayo sa laboratoryo para po maisagawa natin ang ibat ibang pagsusulit upang malaman kung ano po ang sanhi ng pananakit ng inyong tiyan.”
Natanggap na ni Nars Budek ang mga laboratory results. Hmmm, 13 mg/dl ang kanyang hemoglobin at 56% ang kanyang hematocrit. Ang potassium level nya ay nasa 5.0 meq/L. Ang WBC nya ay nasa 8,000 / cc3. Wala namang diprensya ang kanya lab results ah.
Really? Are you sure that all the lab results are normal? Let us review the normal values :
WBC : 8,000 / cc3 is normal. An increase beyond 10,000 / cc3 is indicative of infection.
Hgb : Hemoglobin levels of aling ester are within normal limits. Meaning, there is no or minimal bleeding.
Hct : Hematocrit levels of aling ester are high, indicating that she is dehydrated or bleeding.
K : The potassium level is within the normal limits of 4.5 to 5.5 meq/L.
Using the selected lab results above, we can then eliminate many possible causes of the abdominal pain of aling ester. Remove : PERITONITIS, APPENDICITIS, INFECTION, INFLAMMATORY BOWEL DISEASE AND ULCERS.
“Aling ester halika po at humiga po kayo rito at titingnan ko po ang inyong tiyan.”
Did Nurse Budek use an effective approach on asking aling ester to lie down for an abdominal assessment?
How about this :
“Aling ester, Abutin nyo po ang kamay ko. halika po kayo rito at aalalayan ko kayo papunta dito sa higaan para po tingnan ko ang inyong tiyan.”
The client is age 74 and in PAIN. It is NOT therapeutic to ask the client to come and lie down on the examiners table on her own.
“Aling ester, mahiga po kayo dito at titingnan ko po kayo.”
What should be aling esters position for an abdominal assessment?
A. Supine, with head and feet FLAT on bed
B. High fowlers with the feet in extension
C. Prone position
D. Low fowlers with the knee on flexion
“Aling ester, itataas ko na po ng kaunti ang ulo ninyo at paki baluktot po lamang ang inyong tuhod.”
Correct answer is LETTER D. To promote abdominal relaxation, The head of the bed should be SLIGHTLY elevated and the knee of the client on flexed position.
A and B will promote abdominal rigidity making it hard for Nurse Budek to PALPATE the abdomen.
If your answer is C, you should try to imagine how can you assess the patient’s abdomen if she is in prone position?
Humiga na si aling ester at mag uumpisa na si Nurse Budek sa pag assess ng tiyan ni aling ester.
What should be Nurse Budek’s INITIAL STEP in assessing aling ester’s abdomen?
A. Palpation
B. Inspection
C. Auscultation
D. Percussion
Tiningnan ni Nurse Budek ang tiyan ni aling ester, Hmm.. wala namang kakaiba sa tiyan ni aling ester. Round sha, may mga stretch mark marahil dulot ng kanyang pagbubuntis at panganganak. Lubog ang pusod at malinis naman ito. Wala naman akong nakikitang gumagalaw galaw mukhang maaliwalas at tahimik naman ang kanyang tiyan kung titingnan.
Kinuha ni Nurse Budek ang stethoscope at kanyang pinakinggan ang tiyan ni aling ester. “Aba eh! Wala akong marinig na kung ano man. Hypoactive ang bowel sound ni aling ester. Sa loob ng isang minuto ay nakarinig ako ng tatlong bowel sound.”
How did Nurse Budek concluded that aling ester’s bowel sound is hypoactive?
A. The bowel sounds are more than 35 per minute
B. There is NO bowel sounds on aling ester’s assessment
C. There is less than 5 bowel sounds per minute on the assessment
D. The bowel sounds are less than 15 per minute
Sa isip ni Nurse Budek, “Ang normal bowel sounds ay 5-35, nabasa ko iyan kay saunders nung akoy nag aaral pa! Kawawa naman si nanay, mukhang constipated ata ah?”
“Teka nga I auscultate ko dito sa ILEO-CECAL VALVE para maka sigurado sa aking bilang.”
Where is the ILEO-CECAL VALVE?
A. Left lower quadrant
B. Right lower quadrant
C. Left upper quadrant
D. Right upper quadrant
Why did Nurse Budek use the ILEO-CECAL VALVE Location to further assess aling esters bowel sounds?
A. Because that is the location where bowel sounds are produced
B. The ICV is the only location in the large intestine where bowel sounds are heard
C. Bowel sounds are always heard in the ICV more than any other quadrants
D. ICV is located in the small intestines, it is where gas are formed and release giving a gurgling sound
Nilagay ni Nurse Budek ang kanyang steth sa may RIGHT LOWER QUADRANT upang marinig ang tunog sa may ileo-cecal valve kung saan, parati itong mayroong bowel sounds kumpara sa ibang abdominal quadrant.
“ I percuss ko na nga ang tiyan ni nanay. Tingnan natin kung marami ng laman laman ito. “
Sa pag percuss ng tiyan ni aling ester, Nakarinig si Budek ng isang DULL o mababang tunog sa may LEFT LOWER QUADRANT ni aling Ester. “ Aha, mukhang meron ditong isang hindi kanais nais na bagay ah. “
What are the different sounds that Nurse Budek can percuss on aling Ester’s abdomen?
1. DULLNESS : May be percussed on the R U Q because of the Liver and in the L U Q because of the spleen.
An impaction of feces also produce a DULL sound on percussion.
2. HYPERRESONANCE/RESONANCE : An over inflated area such as the LUNGS can produce a hyperresonanec/resonant sound.
3. FLAT : FLUID sounds FLAT on percussion. Usually heard on bowel obstruction due to volvulus, diverticulosis/litis and intussusception.
4. TYMPANY : The TUNOG TAMBOL, is heard when the intestine or stomach is air filled.
At sa huling bahagi, kinapa [ PALPATION ] ni Nurse budek ang tiyan ni aling ester. Nag umpisa siya sa Right lower quadrant, papuntang right upper quadrant hanggang makakapa siya ng isang maliit at matigas na mass sa may left lower quadrant ni aling ester.
“ Ito yung dull na narinig ko kanina “ Ang nasabi ni Budek.
Why did Nurse Budek follows : INSPECTION, AUSCULTATION, PERCUSSION AND PALPATION in exact and correct order in assessing aling esters abdomen?
A. Doing Percussion and Palpation last will help limit stimulation of bowel sound therefore, An accurate assessment of the abdominal status is recorded.
B. Inspection and Ausculation are done first as not to cause PAIN on aling ester that will prevent her from not cooperating with the abdominal assessment.
C. Palpation is done last on an elderly client because of the sensitivity of the abdominal muscle that might cause severe discomfort to aling ester.
D. Inspection is done first as to directly observe the general status of aling ester’s abdomen before doing specific assessments of each quadrants.
“Hayyy, Mukhang alam ko na aling ester kung bakit masakit ang tiyan natin ha.” Ang sabi ni Nurse Budek.
“Ay,!!” sa loblob ni Budek. “May hanging question nga pala tayo. Bakit nga ba hinuli ko ang palpation at sinunod ang step na I,A,PE,PA. O “ I am PePa.” Kasi nga, pag pinalpate ko agad, ma ii stimulate ko ang bowel sound ni nanay kaya hindi accurate ang bowel sound na maririnig ko, hindi ko masasabi na HYPO o HYPERACTIVE ang bowel sound ni nanay dahil na apektuhan ng percussion o palpation. Hindi ba, manipulation increases peristalsis, baka mamaya mag 30 pa ang bowel sounds ni nanay ester at hindi maging tama ang aking palagay na kaya masakit ang tiyan nya dahil hypoactive ang pag galaw ng kanyang bituka at CONSTIPATED SIYA.”
“Nanay ester, kailan po kayo huling nadumi?” Ang tanong ni Nurse Budek.
“Abay hindi ko na matandaan iho. Malamang isang linggo na akong hindi nadudumi eh, iyon ba ang dahilan bakit masakit ang aking tiyan? “ Ang sabi ni aling ester.
“Abay opo nanay, dapat po Isang dumi kada dalawang araw po ang pinaka mababa ninyong pag dumi, sabi po iyan sakin ng aking bestfriend na si Lippinncott “ Sabi ni Nurse Budek.
“Nay, Ang dry dry naman niyang bibig nyo. Umiinom po ba kayo ng maraming tubig sa isang araw? “ Sabi ni Nurse Budek
“Abay oo naman ano, marami akong iniinom na tubig sa isang araw.”
Did Budek asked the right question? Let us see if this question is better….
“Nay, ang dry dry naman niyang bibig nyo, Ilang baso po bang tubig ang iniinom nyo sa isang araw?” Ang tanong ni Nurse Budek.
“Nakaka tatlong baso ako sa isang araw, sapat na ba iyon?” tugon ni aling ester.
“ Nay, dapat po 6-8 glassess ang iniinom natin bawat araw. Kaya naman pala hindi kayo madumi ng regular walang panulak at dulas ang inyong bituka eh. “ Sagot ni Nurse Budek.
Ibinahagi ni Budek ang kanyang natuklasan kay Doctor tuklaw na nangangalaga kay aling ester. Ipinag utos ng doktor ang Fleet enema kay aling ester ngunit nag reklamo si Nurse Budek.
Why did Nurse Budek reacted and disagreed to the doctors order of fleet enema?
A. Fleet enema is contraindicated among elderly
B. Fleet enema can cause dependence
C. Fleet enema will causes fluid overload
D. Fleet enema will cause further dehydration
“Doktor, san ba kayo graduate? Bat fleet enema eh tanda tanda na ni nanay dehydrated pa.. gusto nyong lalong ma dehydrate si nanay?” Ang matapang na sagot ni Budek
“Ah ganun ba? Ano ba dapat?” Sabi ni Dr. Tuklaw
“ Kasi hypertonic saline ang fleet, Each 118-mL delivered dose contains 19 g monobasic sodium phosphate monohydrate and 7 g dibasic sodium phosphate heptahydrate. Kung hypertonic sha imagine, sisipsipin nito ang tubig sa large intestine ni nanay at lalong matutoyo si nanay. Baka ma cardiac arrest pa yan due to hypokalemia sige ka. “ Ang mayabang na sabi ni budek.
“ I NSS enema ko nalang di kaya tap water, mamili ka dok ano ang gusto mo?” Ang tugon ni Budek.
“Bahala ka sa buhay mo” Ang tugon ni Dr. Tuklaw
“ Ok , I order mo ako ng NSS enema para wala tayong problema sa fluid and electrolate balance” Ang tugon ni Budek.
“ Yes doc, masusunod po “ Ang sagot ni Dr. Tuklaw
Binalikan ni Nurse Budek si nanay ester sa kanyang silid.
“ Nanay ester, Ready ka na ba sa gagawin natin?” Sabi ni Budek.
“ Oo, ready na.. masakit ba yan? Ano ba ang gagawin mo sa akin?” Ang tugon ni aling ester.
“ Bali papalabasin mo natin ang mga dumi po ninyo na naiwan at bumara na diyan sa inyong bituka para po hindi na kayo masaktan at maisayos po natin ang normal na pag dumi ninyo “ Ang sagot ni budek.
“ Nay, pumuwesto na po kayo. …….”
What should be aling ester’s postion when preparing to give an enema?
A. Left sims position
B. Prone position
C. Right sims position
D. Dorsal Recumbent position
“ Nay, pumuwesto na po kayo. Tumagilid po kayo at humiga sa inyong kaliwa at I baluktot niyo po ang kanang tuhod ninyo [ LEFT SIMS POSITION ], Tulungan ko po kayo” Ang sabi ni Nars Budek.
“ Bakit ganito pa dapat ang aking posisyon? Ano ang importansya nitong ganitong posisyon nurse?” Ang tanong ni aling Ester.
Why is the patient positioned in the LEFT SIMS position when administering an enema?
A. The Left sims position will facilitate descent of the solution towards the rectum and the colon
B. The Left sims position is used to prevent injury to the bladder when inserting the enema tube
C. The Left sims position will prevent the solution from going into the kidneys that will cause hydronephrosis
D. Female clients are put in the LEFT SIMS position to prevent leakage of the solution towards the cervix that will cause sever inflammatory reaction.
“Nay, kasi po ang rectum po natin ay PABABA pag tayoy naka left sims. Kung naka right sims ka eh babalik lang po yung tubig palabas dahil po paangat po ang kaalangan niyang daluyan, hindi po siya makakarating ng tama sa colon” Ang tugon ni Budek. [Refer to the normal anatomy of the large intestine]
At nang matapos na ni Nurse Budek ang pag I enema kay nanay, Limang malalaking bilog bilog na kasinglaki ng chico ang kanyang nakuha at matapos nito, malalambot na ang dumi na lumabas kay nanay Ester.
“Hayyy, gumaan na ang aking pakiramdam Nurse Budek, salamat sa tulong mo ha.. hindi na siya masakit” Ang pasasalamat ni nanay Ester.
Ngumiti si budek sabay bigkas “ Nay, tandaan… tubig tubig tubig at masustansya at balanseng pagkain na mataas sa fiber tulad ng gulay at prutas para hindi na mangyari iyan ulet sa inyo. ”
Napangiti si aling ester at siya ay parang nasalangit sa gaan ng kanyang pakiramdam at ginhawang nararamdaman.
Follow up questions :
Answer the following questions :
1. What is the minimum and maximum height of the enema can?
2. How long should budek insert the rectal tube? What kind of lubricant should he use?
3. What should be nurses budek’s first intervention in case cramping occurs during enema instillation?
4. When should nurse budek STOP irrigating aling ester’s colon?
5. What are the contraindications when administering an enema?
Answers in COMMENTS.
By : Budek
http://www.pinoybsn.tk
Nag mumuni muni si Nars Budek sa emergency unit ng Ospital ng Fatima medical center. Bigla biglang may pumasok na pasyente para sa admission. Masakit raw ang kanyang tyan.
Inobserbahan siya ni Nars Budek. Aba, napakabilis ng kanyang pag hinga. Namumutla pa ang kaniyang mga labi at parang tuyong tuyo at nagbabakbak.
“Ang bilis rin ng kanyang heart rate ah, 110 bpm, tachycardic ito, siguro may masamang nararamdaman o may nararamdamang sakit?” Ang naisip ni Budek.
Ang pasyente natin ay si nanay ester, isang matandang pasyente. Siya ay 74 taong gulang na na may chief complaint na “MASAKIT ANG TIYAN KO”
What are the possible causes of abdominal pain in the elderly ?
Nurse Budek thinks of : Constipation? Gas accumulation? Impaction? Inflammatory Bowel Disease? Appendicitis? Cholecystitis? Cholelithiasis? Ulcers? Peritonitis? Colon cancer? Ovarian or uterine cancer? PID? And many many more.
“Okay nanay, dadalhin ko muna po kayo sa lab para po sa isang work up.”
Hmm… work up? Did nanay ester understands what nurse budek said…. WORK UP? Perhaps, this will be better :
“Okay nanay, pupunta na po tayo sa laboratoryo para po maisagawa natin ang ibat ibang pagsusulit upang malaman kung ano po ang sanhi ng pananakit ng inyong tiyan.”
Natanggap na ni Nars Budek ang mga laboratory results. Hmmm, 13 mg/dl ang kanyang hemoglobin at 56% ang kanyang hematocrit. Ang potassium level nya ay nasa 5.0 meq/L. Ang WBC nya ay nasa 8,000 / cc3. Wala namang diprensya ang kanya lab results ah.
Really? Are you sure that all the lab results are normal? Let us review the normal values :
WBC : 8,000 / cc3 is normal. An increase beyond 10,000 / cc3 is indicative of infection.
Hgb : Hemoglobin levels of aling ester are within normal limits. Meaning, there is no or minimal bleeding.
Hct : Hematocrit levels of aling ester are high, indicating that she is dehydrated or bleeding.
K : The potassium level is within the normal limits of 4.5 to 5.5 meq/L.
Using the selected lab results above, we can then eliminate many possible causes of the abdominal pain of aling ester. Remove : PERITONITIS, APPENDICITIS, INFECTION, INFLAMMATORY BOWEL DISEASE AND ULCERS.
“Aling ester halika po at humiga po kayo rito at titingnan ko po ang inyong tiyan.”
Did Nurse Budek use an effective approach on asking aling ester to lie down for an abdominal assessment?
How about this :
“Aling ester, Abutin nyo po ang kamay ko. halika po kayo rito at aalalayan ko kayo papunta dito sa higaan para po tingnan ko ang inyong tiyan.”
The client is age 74 and in PAIN. It is NOT therapeutic to ask the client to come and lie down on the examiners table on her own.
“Aling ester, mahiga po kayo dito at titingnan ko po kayo.”
What should be aling esters position for an abdominal assessment?
A. Supine, with head and feet FLAT on bed
B. High fowlers with the feet in extension
C. Prone position
D. Low fowlers with the knee on flexion
“Aling ester, itataas ko na po ng kaunti ang ulo ninyo at paki baluktot po lamang ang inyong tuhod.”
Correct answer is LETTER D. To promote abdominal relaxation, The head of the bed should be SLIGHTLY elevated and the knee of the client on flexed position.
A and B will promote abdominal rigidity making it hard for Nurse Budek to PALPATE the abdomen.
If your answer is C, you should try to imagine how can you assess the patient’s abdomen if she is in prone position?
Humiga na si aling ester at mag uumpisa na si Nurse Budek sa pag assess ng tiyan ni aling ester.
What should be Nurse Budek’s INITIAL STEP in assessing aling ester’s abdomen?
A. Palpation
B. Inspection
C. Auscultation
D. Percussion
Tiningnan ni Nurse Budek ang tiyan ni aling ester, Hmm.. wala namang kakaiba sa tiyan ni aling ester. Round sha, may mga stretch mark marahil dulot ng kanyang pagbubuntis at panganganak. Lubog ang pusod at malinis naman ito. Wala naman akong nakikitang gumagalaw galaw mukhang maaliwalas at tahimik naman ang kanyang tiyan kung titingnan.
Kinuha ni Nurse Budek ang stethoscope at kanyang pinakinggan ang tiyan ni aling ester. “Aba eh! Wala akong marinig na kung ano man. Hypoactive ang bowel sound ni aling ester. Sa loob ng isang minuto ay nakarinig ako ng tatlong bowel sound.”
How did Nurse Budek concluded that aling ester’s bowel sound is hypoactive?
A. The bowel sounds are more than 35 per minute
B. There is NO bowel sounds on aling ester’s assessment
C. There is less than 5 bowel sounds per minute on the assessment
D. The bowel sounds are less than 15 per minute
Sa isip ni Nurse Budek, “Ang normal bowel sounds ay 5-35, nabasa ko iyan kay saunders nung akoy nag aaral pa! Kawawa naman si nanay, mukhang constipated ata ah?”
“Teka nga I auscultate ko dito sa ILEO-CECAL VALVE para maka sigurado sa aking bilang.”
Where is the ILEO-CECAL VALVE?
A. Left lower quadrant
B. Right lower quadrant
C. Left upper quadrant
D. Right upper quadrant
Why did Nurse Budek use the ILEO-CECAL VALVE Location to further assess aling esters bowel sounds?
A. Because that is the location where bowel sounds are produced
B. The ICV is the only location in the large intestine where bowel sounds are heard
C. Bowel sounds are always heard in the ICV more than any other quadrants
D. ICV is located in the small intestines, it is where gas are formed and release giving a gurgling sound
Nilagay ni Nurse Budek ang kanyang steth sa may RIGHT LOWER QUADRANT upang marinig ang tunog sa may ileo-cecal valve kung saan, parati itong mayroong bowel sounds kumpara sa ibang abdominal quadrant.
“ I percuss ko na nga ang tiyan ni nanay. Tingnan natin kung marami ng laman laman ito. “
Sa pag percuss ng tiyan ni aling ester, Nakarinig si Budek ng isang DULL o mababang tunog sa may LEFT LOWER QUADRANT ni aling Ester. “ Aha, mukhang meron ditong isang hindi kanais nais na bagay ah. “
What are the different sounds that Nurse Budek can percuss on aling Ester’s abdomen?
1. DULLNESS : May be percussed on the R U Q because of the Liver and in the L U Q because of the spleen.
An impaction of feces also produce a DULL sound on percussion.
2. HYPERRESONANCE/RESONANCE : An over inflated area such as the LUNGS can produce a hyperresonanec/resonant sound.
3. FLAT : FLUID sounds FLAT on percussion. Usually heard on bowel obstruction due to volvulus, diverticulosis/litis and intussusception.
4. TYMPANY : The TUNOG TAMBOL, is heard when the intestine or stomach is air filled.
At sa huling bahagi, kinapa [ PALPATION ] ni Nurse budek ang tiyan ni aling ester. Nag umpisa siya sa Right lower quadrant, papuntang right upper quadrant hanggang makakapa siya ng isang maliit at matigas na mass sa may left lower quadrant ni aling ester.
“ Ito yung dull na narinig ko kanina “ Ang nasabi ni Budek.
Why did Nurse Budek follows : INSPECTION, AUSCULTATION, PERCUSSION AND PALPATION in exact and correct order in assessing aling esters abdomen?
A. Doing Percussion and Palpation last will help limit stimulation of bowel sound therefore, An accurate assessment of the abdominal status is recorded.
B. Inspection and Ausculation are done first as not to cause PAIN on aling ester that will prevent her from not cooperating with the abdominal assessment.
C. Palpation is done last on an elderly client because of the sensitivity of the abdominal muscle that might cause severe discomfort to aling ester.
D. Inspection is done first as to directly observe the general status of aling ester’s abdomen before doing specific assessments of each quadrants.
“Hayyy, Mukhang alam ko na aling ester kung bakit masakit ang tiyan natin ha.” Ang sabi ni Nurse Budek.
“Ay,!!” sa loblob ni Budek. “May hanging question nga pala tayo. Bakit nga ba hinuli ko ang palpation at sinunod ang step na I,A,PE,PA. O “ I am PePa.” Kasi nga, pag pinalpate ko agad, ma ii stimulate ko ang bowel sound ni nanay kaya hindi accurate ang bowel sound na maririnig ko, hindi ko masasabi na HYPO o HYPERACTIVE ang bowel sound ni nanay dahil na apektuhan ng percussion o palpation. Hindi ba, manipulation increases peristalsis, baka mamaya mag 30 pa ang bowel sounds ni nanay ester at hindi maging tama ang aking palagay na kaya masakit ang tiyan nya dahil hypoactive ang pag galaw ng kanyang bituka at CONSTIPATED SIYA.”
“Nanay ester, kailan po kayo huling nadumi?” Ang tanong ni Nurse Budek.
“Abay hindi ko na matandaan iho. Malamang isang linggo na akong hindi nadudumi eh, iyon ba ang dahilan bakit masakit ang aking tiyan? “ Ang sabi ni aling ester.
“Abay opo nanay, dapat po Isang dumi kada dalawang araw po ang pinaka mababa ninyong pag dumi, sabi po iyan sakin ng aking bestfriend na si Lippinncott “ Sabi ni Nurse Budek.
“Nay, Ang dry dry naman niyang bibig nyo. Umiinom po ba kayo ng maraming tubig sa isang araw? “ Sabi ni Nurse Budek
“Abay oo naman ano, marami akong iniinom na tubig sa isang araw.”
Did Budek asked the right question? Let us see if this question is better….
“Nay, ang dry dry naman niyang bibig nyo, Ilang baso po bang tubig ang iniinom nyo sa isang araw?” Ang tanong ni Nurse Budek.
“Nakaka tatlong baso ako sa isang araw, sapat na ba iyon?” tugon ni aling ester.
“ Nay, dapat po 6-8 glassess ang iniinom natin bawat araw. Kaya naman pala hindi kayo madumi ng regular walang panulak at dulas ang inyong bituka eh. “ Sagot ni Nurse Budek.
Ibinahagi ni Budek ang kanyang natuklasan kay Doctor tuklaw na nangangalaga kay aling ester. Ipinag utos ng doktor ang Fleet enema kay aling ester ngunit nag reklamo si Nurse Budek.
Why did Nurse Budek reacted and disagreed to the doctors order of fleet enema?
A. Fleet enema is contraindicated among elderly
B. Fleet enema can cause dependence
C. Fleet enema will causes fluid overload
D. Fleet enema will cause further dehydration
“Doktor, san ba kayo graduate? Bat fleet enema eh tanda tanda na ni nanay dehydrated pa.. gusto nyong lalong ma dehydrate si nanay?” Ang matapang na sagot ni Budek
“Ah ganun ba? Ano ba dapat?” Sabi ni Dr. Tuklaw
“ Kasi hypertonic saline ang fleet, Each 118-mL delivered dose contains 19 g monobasic sodium phosphate monohydrate and 7 g dibasic sodium phosphate heptahydrate. Kung hypertonic sha imagine, sisipsipin nito ang tubig sa large intestine ni nanay at lalong matutoyo si nanay. Baka ma cardiac arrest pa yan due to hypokalemia sige ka. “ Ang mayabang na sabi ni budek.
“ I NSS enema ko nalang di kaya tap water, mamili ka dok ano ang gusto mo?” Ang tugon ni Budek.
“Bahala ka sa buhay mo” Ang tugon ni Dr. Tuklaw
“ Ok , I order mo ako ng NSS enema para wala tayong problema sa fluid and electrolate balance” Ang tugon ni Budek.
“ Yes doc, masusunod po “ Ang sagot ni Dr. Tuklaw
Binalikan ni Nurse Budek si nanay ester sa kanyang silid.
“ Nanay ester, Ready ka na ba sa gagawin natin?” Sabi ni Budek.
“ Oo, ready na.. masakit ba yan? Ano ba ang gagawin mo sa akin?” Ang tugon ni aling ester.
“ Bali papalabasin mo natin ang mga dumi po ninyo na naiwan at bumara na diyan sa inyong bituka para po hindi na kayo masaktan at maisayos po natin ang normal na pag dumi ninyo “ Ang sagot ni budek.
“ Nay, pumuwesto na po kayo. …….”
What should be aling ester’s postion when preparing to give an enema?
A. Left sims position
B. Prone position
C. Right sims position
D. Dorsal Recumbent position
“ Nay, pumuwesto na po kayo. Tumagilid po kayo at humiga sa inyong kaliwa at I baluktot niyo po ang kanang tuhod ninyo [ LEFT SIMS POSITION ], Tulungan ko po kayo” Ang sabi ni Nars Budek.
“ Bakit ganito pa dapat ang aking posisyon? Ano ang importansya nitong ganitong posisyon nurse?” Ang tanong ni aling Ester.
Why is the patient positioned in the LEFT SIMS position when administering an enema?
A. The Left sims position will facilitate descent of the solution towards the rectum and the colon
B. The Left sims position is used to prevent injury to the bladder when inserting the enema tube
C. The Left sims position will prevent the solution from going into the kidneys that will cause hydronephrosis
D. Female clients are put in the LEFT SIMS position to prevent leakage of the solution towards the cervix that will cause sever inflammatory reaction.
“Nay, kasi po ang rectum po natin ay PABABA pag tayoy naka left sims. Kung naka right sims ka eh babalik lang po yung tubig palabas dahil po paangat po ang kaalangan niyang daluyan, hindi po siya makakarating ng tama sa colon” Ang tugon ni Budek. [Refer to the normal anatomy of the large intestine]
At nang matapos na ni Nurse Budek ang pag I enema kay nanay, Limang malalaking bilog bilog na kasinglaki ng chico ang kanyang nakuha at matapos nito, malalambot na ang dumi na lumabas kay nanay Ester.
“Hayyy, gumaan na ang aking pakiramdam Nurse Budek, salamat sa tulong mo ha.. hindi na siya masakit” Ang pasasalamat ni nanay Ester.
Ngumiti si budek sabay bigkas “ Nay, tandaan… tubig tubig tubig at masustansya at balanseng pagkain na mataas sa fiber tulad ng gulay at prutas para hindi na mangyari iyan ulet sa inyo. ”
Napangiti si aling ester at siya ay parang nasalangit sa gaan ng kanyang pakiramdam at ginhawang nararamdaman.
Follow up questions :
Answer the following questions :
1. What is the minimum and maximum height of the enema can?
2. How long should budek insert the rectal tube? What kind of lubricant should he use?
3. What should be nurses budek’s first intervention in case cramping occurs during enema instillation?
4. When should nurse budek STOP irrigating aling ester’s colon?
5. What are the contraindications when administering an enema?
Answers in COMMENTS.
1. What is the minimum and maximum height of the enema can?
* 12 inches minimum up to 18 inches maximum.
2. How long should budek insert the rectal tube? What kind of lubricant should he use?
* 3-4 inches , water soluble lubricant [ KY Jelly ]
3. What should be nurses budek’s first intervention in case cramping occurs during enema instillation?
* Stop the folow of the irrigant by clamping the tube
4. When should nurse budek STOP irrigating aling ester’s colon?
* When the returns are clear
5. What are the contraindications when administering an enema?
* Contraindications are but not limited to : Peritonitis, Ulcerative Colitis, Chrons Disease, Appendicitis, Diverticulitis, Retroperitoneal Abscess.
Posted by
Budek |
8:43 AM
ang ganda ng story. I AM PEPA lagi ko tong tatandaan :) pls post more nurse budek :)
Posted by
Anonymous |
9:10 AM
wow this is great!
Posted by
Anonymous |
8:51 PM
thanx so much for sharing this.. =)
Posted by
Kxecsi |
12:41 AM
kakatuwa at the same time maraming natutunan.. hehe.. galing!
Posted by
asystole |
9:14 AM
ang galing..
sna marami pang nurse bodek..
tska palitan na si doc. tuklaw..
please post more..
Posted by
jurou |
11:17 AM
ok talaga style ni budek.. it makes learning so easy.. hindi ko alam un number 4 at 5.. hehe.. 1-3 lang ako tama.. ^_^ kip it up budek!
Posted by
Marc |
1:14 PM
tnx sa story...its help me so much...especially sa revalida ko...sana merong story about CVP
tnx po ulit
Posted by
Anonymous |
9:39 PM
wow! gling galing nurse budek.. more to come ha ??? wait ko..
Posted by
phoebe |
1:15 AM
wow galing!! more to come plss..
Posted by
phoebe |
1:18 AM
wow, great job... gling!!! sarap mgbasa d2, slamat sir budek! post k ng mrmi....
Posted by
Anonymous |
12:56 PM
kua budek! dis is really towards mastery! really awesome!grabe!
bkit ganun ung sa anxiolytics/antiparkinsons nageerror? hindi nb existing ung file n un?
sana kung may mga materials p kau sendan nyo q sa eadd q.. pls??
chesqa_emptiness@yahoo.com
Posted by
Anonymous |
2:13 PM
sobrabg galing nyo.sir budek.as in bow tlaga ako.keep on creating more stories like this.GOspeed.
Posted by
Anonymous |
10:43 AM
sir budek it was really a nice story!!!its just the basic and the reality in hospital setting but you've made it so easily!!!!hope more stories to be posted.thanks
Posted by
Anonymous |
9:41 PM
nurse budek thanks after 3 years in nursing di ko na makakalimutan and abdominal assessment.....
Posted by
Anonymous |
11:31 AM
Cool story, mareretain talaga sa brain moh hehehe...thanks though.
U'r the best talaga.
Posted by
Anonymous |
8:26 AM
ang ganda ng story grabe!!!!!!
sna mgpost k p ng marami hehehe
Posted by
Anonymous |
1:16 PM
salamat po sa magandang kwento dami po ako natutunan sir!
Posted by
Anonymous |
5:01 AM
tnk u po sir malaking tulong po talaga!
Posted by
Anonymous |
5:06 AM
thank you so much sir budek it helps me a lot.
Posted by
Anonymous |
10:52 PM
you never fail to give the hotest tips in town. thanks such a blessing. godspeed. ^-^
Posted by
Anonymous |
11:11 PM
wow super duper ka talaga sa galing sir budek,i enjoyed reading your story,and at thesame time natutuhan ko pang mabuti about abdominal assessment,thanks very much for sharing us your knowledge,mabuhay pa kayo and god bless po!
Posted by
Anonymous |
4:37 AM
it is great. its really a big help for me this coming board. =) ang kulit ng kwento. it made me laugh while im learning!
Posted by
Anonymous |
2:08 AM