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Clinical Reasoning Case Study: Total Parenteral Nutrition

Name _____________________________

Chief Complaint CC/History of Present Illness:

Mrs. Morris is a 66-year-old woman who has been complaining of nausea, vomiting, weakness, abdominal pain and abdominal fullness for the past 3 days. She has had a fever for the last 24 hours and reports that her mid-abdominal pain is colicky and “crampy”. She states her “Crohn’s” has been acting up for the past 4 weeks with diarrhea, anorexia, extreme fatigue and weight loss. She is 65 inches tall and weighs 65 kg with a usual weight of 75 kg. Mrs. Morris was admitted to the Med/Surg unit with a complete small bowel obstruction, multiple adhesions, and exacerbation of Crohn’s disease. She is NPO and an exploratory lap is scheduled with lysis of adhesions and small bowel resection to remove diseased bowel. Mrs. Morris will be NPO postoperatively and it is expected that her GI tract will not be accessible for at least 10-14 days.

Social and Past Medical History:

Mrs. Morris currently lives alone in a senior living apartment. Her husband died of pancreatic cancer 2 months ago and they had no children. She has had Crohn’s disease since she was 37 years old and was diagnosed with diabetes type 2, five years ago.

Your Initial Nursing Assessment:

GENERAL APPEARANCE: anxious, appears weak and pale

SKIN/INTEG: skin dry, tenting noted, eyes sunken

RESP: breath sounds clear with equal aeration bilaterally, non-labored

CARDIAC: skin pale, warm & dry, S1S2, no edema, pulses 2+ in all extremities

NEURO: alert & oriented x4,

GI/GU: abdomen firm and distended. Absent bowel sounds, has not voided yet

MISC: complains of crampy, colicky abdominal pain in RLQ, 8/10, nausea and vomiting

Initial Vital Signs:

T: 100.8 F

P: 110

R: 22

BP: 100/60

O2 sats: 98%

Lab/diagnostic Results:







9 g/dL

Basic Metabolic panel











2.9 g/dL

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