[Answered]: Carol Williams, a 36-year-old woman, was admitted…

Carol Williams, a 36-year-old woman, was admitted several days ago with a diagnosis of recurrent inflammatory bowel disease (IBD) and possible small bowel obstruction (SBO). Carol is married, and her husband and 11-year-old son are supportive, but she has no extended family in the state. She has had IBD for 15 years and has been taking mesalamine (Asacol HD) for 15 years and prednisone 40m(g)/(d)ay for the past 5 years. she is very thin; at 5 feet 2 inches, she weighs 86 pounds and has lost 40 pounds over the past 10 years. She averages 5 to 10 loose stools per day. Carol’s life has gradually become dominated by her disease, with anorexia, lactase deficiency, profound fatigue, frequent nausea and diarrhea, frequent hospitalizations for dehydration, and recurring, crippling abdominal pain that often strikes unexpectedly. The pain is incapacitating and relieved only by a small dose of diazepam (Valium), oral electrolyte solution (Pedialyte), and total bed rest. She is so weak she cannot stand without help. You indicate complete bed rest on the nursing care plan. Carol’s condition deteriorates; on the third day after admission she experiences intractable abdominal pain and unrelenting nausea and vomiting. She is taken to the operating room because of probable SBO and is readmitted to your unit from the postanesthesia care unit. During surgery, 38 inches of her small bowel were found to be severely stenosed with two areas of visible perforation. Much of the remaining bowel is severely inflamed and friable. A total of 5 feet of distal ileum and 2 feet of colon have been removed, and a temporary ileostomy was established. She has a Jackson-Pratt (JP) drain to bulb suction in her right lower quadrant (RLQ), and her wound was packed and left open, and covered with a dry sterile dressing. She has two peripheral IVs, a salem sump nasogastric tube (NGT), and a Foley catheter. Her vital signs (Vs) are( 112)/(72), 86, 24, 100.8deg F (38.2deg C) (tympanic).