Discuss the various health conditions and the reasons why an end-to-end anastomosis may need to be performed on a patient diagnosed with prolonged intestinal obstruction.

Discuss what would be expected of the RN (you) in looking after Mrs Catherine
Windsor from the day of her admission for an abdominal surgical procedure. Utilise
the principles of clinical reasoning to assist in determining what the nurse should
assess, monitor, and plan including why/what/how and when to intervene and the
rationales associated with these during the evolving situation.
Student’s instructions
You are advised to read Levett-Jones’ et al. article on ‘The five rights of clinical
reasoning’ and Banning’s article on ‘Clinical reasoning and its application to nursing’
(on DiReCt). There are other articles on DiReCt and in various journals and text
books that would assist you in completing this assignment.
As the nurse is the first point of patient contact in patient care, there is an
expectation that the nurse will be in a prime position to identify when a patient is at
risk of experiencing a critical event through the presentation of warning signs. As
these warning signs may be “missed or not always identified or managed
appropriately” (Levett-Jones et.al. 2010), it is likely that the patient may deteriorate to
a stage where/when suitable rescue (management) may not be possible.
The nurse who “collects cues, processes the information, come to an understanding
of a patient problem or situation, plan and implement interventions, evaluate
outcomes, and reflect on and learn from the process” (Levett-Jones et.al. 2010) is
said to undertake the process of clinical reasoning. Clinical reasoning “focuses on
the assimilation and analysis of health care evidence” …. which is viewed “as the
hallmark of the expert nurse” (Banning 2008).
Case Study:
Mrs Catherine Windsor, 61yrs old, has Type 2 diabetes treated with medication,
exercise and dietary control. She lives alone and her children live out of state. Over
the past six months Mrs Windsor has noticed that she was losing weight, has had
repeated urinary tract infections, having a poor appetite, is lethargic and doesn’t
have as much strength as she used to have. Her weight is 54kgs and her height is
174cms. She used to be a keen gardener. She is quite anxious about the surgery.
She also admits to taking Dandelion and St John’s Wort for the last year.
With various tests performed over the last fortnight, Mrs Windsor was diagnosed as
having prolonged intestinal obstruction. She was admitted for surgery to remove a
cancerous growth in her transverse colon. She went to theatre at 1000hrs. She had
an end-to-end anastomosis performed over a stent. The operation progressed as
expected with no unexpected events.
Question 1 5 marks
Discuss the various health conditions and the reasons why an end-to-end
anastomosis may need to be performed on a patient diagnosed with prolonged
intestinal obstruction.
Question 2 10 marks
Describe, with appropriate rationale, the subjective and objective assessment data
that would need to be collected during the pre-operative phase?
Question 3 10 marks
Discuss the specific pre-operative nursing cares that would be provided to Mrs
Windsor?
Upon returning from theatre at 1300hrs, Mrs Windsor has an NG tube insitu and she
has an IDC on hourly drainage. Prior to returning to the ward, Mrs Windsor was
administered 25mgs Metoclopramide. She has also returned to the ward with a PCA
insitu for pain control. A unit of whole blood (350mL) is running over 4hrs.
Medications have been prescribed as per chart.
Question 4 10 marks