Mr Arthur Barrett Case Study; Nursing Diagnosis and Nursing Interventions

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’.

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 anti- inflammatory 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 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/L

PLEASE decribe A-G assessment and information to develop one nursing diagnosis and nursing interventions.

ANSWER

Appearance

Mr Arthur Barrett is a 74-year-old man who appears fatigued and unwell. He may have a pale complexion due to his history of rectal bleeding and anemia.

Behavior

Mr Barrett appears anxious and restless, possibly due to the impending surgery and the diagnosis of colon cancer.

Cognitive status

Mr Barrett’s cognitive status is not explicitly mentioned in the given information, so it can be assumed that he is alert and oriented to person, place, and time unless stated otherwise.

Vital signs

Temperature: 37°C (within normal range)

Pulse rate: 121 beats/min (elevated, full, bounding, and irregular, indicating possible tachycardia)

Respiratory rate: 32 breaths/min (elevated, indicating possible tachypnea)

Blood pressure: 184/95 mmHg (elevated, indicating hypertension)

Oxygen saturation level: 90% (below the normal range of 95-100%, indicating hypoxemia)

Fluid status

Hourly urine output: 15-30 mL/hr (below the expected range of 30 mL/hr or more, indicating possible decreased renal perfusion)

Blood glucose level (BGL): 6.9 mmol/L (within the normal range for a person with diet-controlled type 2 diabetes)

Pain

No information is provided about Mr Barrett’s pain levels or any specific pain-related symptoms. This aspect requires further assessment.

Other relevant data

Mr Barrett has a history of COPD, using a salbutamol inhaler, and occasional smoking(Crawley, 2016).

He also has osteoarthritis and takes over-the-counter NSAIDs (ibuprofen and paracetamol) as needed.

The medical orders include two Pico Preps for bowel preparation, a clear fluid diet until midnight, enoxaparin sodium 40 mg subcutaneously (a blood thinner), and intravenous administration of metronidazole 500 mg and cephalothin 2 g (antibiotics).

Based on the given information, one nursing diagnosis that can be considered is:

Impaired Gas Exchange related to decreased oxygen saturation level and elevated respiratory rate.

Possible nursing interventions may include

1. Assess and monitor oxygen saturation level, respiratory rate, and depth regularly.
2. Administer supplemental oxygen as prescribed to maintain oxygen saturation level above 92%.
3. Encourage and assist with deep breathing and coughing exercises to improve lung ventilation and oxygenation.
4. Monitor fluid balance closely, encourage fluid intake as allowed, and report any significant changes in urine output to the healthcare team.
5. Collaborate with the respiratory therapy team to provide appropriate respiratory treatments as needed.
6. Educate the patient about the importance of smoking cessation and adherence to prescribed inhalers for COPD management(Bsn, 2023).
7. Monitor pain levels and provide appropriate pain management interventions as necessary.
8. Collaborate with the healthcare team to adjust or modify medications to minimize potential interactions or adverse effects.

It’s important to note that the provided information is limited, and a comprehensive assessment and individualized care plan would require more data and a direct interaction with the patient.

References

Crawley, A. (2016, May 1). Pharmacologic management of COPD: Breadth of products for encouraging a breath of air. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865341/

Bsn, G. W., RN. (2023). Impairment of Gas Exchange Nursing Care Plan and Management. Nurseslabs. https://nurseslabs.com/impaired-gas-exchange/

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