TREATMENT Dilemma Surgery or Medical Management STUDENT Worksheet Mohammed Abdi, 82 years old Overview: When a patient requires surgery to save his life, most will choose this option with
TREATMENT Dilemma Surgery or Medical Management STUDENT Worksheet Mohammed Abdi, 82 years old
Overview: When a patient requires surgery to save his life, most will choose this option with no reservations. But what if surgery requires lengthy rehabilitation and a colostomy for the rest of his life? Medical management is an option, but has less than a 50-50 chance of surviving. How can the nurse can ensure that the patient fully understands all treatment options when there is both a language and a cultural barrier is the essence of this dilemma.
Clinical Dilemma Activity: STUDENT
Surgery or Medical Management I.
Scenario
History of Present Problem: Mohammed Abdi is an 82-year-old who was admitted to the ED for severe abdominal pain with right sided tenderness the past six hours. An abdominal CT scan confirmed that he has acute diverticulitis with moderate amount of intraperitoneal free air throughout the abdomen. His WBC is 19.8 with neutrophils of 95%. He has a current temp of 101.2 (oral), heart rate of 98, respiratory rate of 18, and blood pressure of 102/58. The general surgeon has been consulted and communicates to Mohammed that he will need immediate surgery to wash out the abdomen and remove bowel contents that have spilled into the peritoneum. The surgery will also require the need for a permanent colostomy and 2-4 weeks of acute and transitional care. Mohammed is clearly apprehensive about having a “bag of poop” attached to his body the rest of his life and wants to know if there are any other options.
Personal/Social History: Mohammed is Muslim and emigrated from Somalia ten years ago. He understands little English. He lives alone in an assisted living apartment. His wife died ten years ago. He has one daughter who lives in the local area and is active in his life.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem:
Clinical Significance:
RELEVANT Data from Social History:
Clinical Significance:
II. The Dilemma Begins… Current Concern: The surgeon proposes another alternative that would involve more conservative medical management. Instead of having surgery and a colostomy, Mohammed’s bowel perforation could be treated with IV antibiotics and his response monitor closely. In some cases, the body is able to seal the bowel perforation spontaneously if it is small enough. The likelihood of this outcome is less than 50%. If medical management is not successful, he is at an extremely high risk of sepsis progressing to septic shock that would make him unsuitable to be surgically treated and he would likely die as a result. He comments to the nurse through an interpreter after the surgeon has left, “I have lived a good life and have pleased Allah. I am ready to go to paradise.” What data from the current concern is important & RELEVANT; therefore it has clinical significance
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