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Patient is a 62 year old male who was admitted to Intercommunity on May 22, 2011. He

is in Eriksons life cycle stage of generativity vs. stagnation. The indicators of positive resolution

are creativity, productivity, and concern for others. The indicators of negative resolution are self

indulgence, self concern, lack of interests and commitments (Berman, Erb, Kozier & Synder, p.

352, 2008). My patient was on the positive side this life cycle he still works and shows concern

for his family. He was anxious because he didnt know what to expect. He wanted to make sure

he would still be able to work and support his family.

The patients admitting diagnosis is bowel obstruction. Bowel obstruction occurs when

intestinal contents cannot pass through the GI tract. Mechanical obstruction is a dectectable

occlusion of the intestinal lumen. A nonmechanical obstruction may result from a neuromuscular

or vascular disorder. When the bowel is obstructed, electrolyte rich fluids cannot be absorbed

from the bowel, and are lost into the peritoneal cavity. The location of the obstruction determines

the extent of fluid, electrolyte, and acid-base balances. Some common clinical manifestations are

vomiting, pain, bowel movement, and abdominal distention (Bucher, Dirksen, Heitkemper,

Lewis & OBrien, p. 1061, 2007).

Patient had a colonoscopy done on May 23, 2011. After the patient was sedated, he was

placed in the left lateral position. The Olympus video colonoscope was passed with ease. The

right side of the colon was reached fairly easily. In the ascending colon close to the cecum there

appeared to be marked thickening of the folds of the wall of the colon and there was narrowing

of the lumen of the colon. Multiple biopsies were taken to evaluate for malignancy. A 5mm

polyp in the descending colon was removed with biopsy forceps and two additional polyps in the

rectum one 3mm and the other 1cm were removed.

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The patient has had recurrent, diffuse abdominal pain with abdominal distention and

feeling of a lump in the right side of the abdomen associated with recurrent diarrhea for the past

two months. He was evaluated with a CAT scan and the CAT scan showed thickening of the

ascending colon wall and suspicion of colitis or possible malignancy of the colon. That is the

reason why they decided to do a colonoscopy.

The medications the patient received during the procedure were Versed and Demerol.

Versed (midazolam) is a benzodiazepine, antianxiety, sedative/hypnotic. It provides

sedation/anxiolysis/amnesia during therapeutic, diagnostic or radiographic procedures. It acts at

many levels of the CNS to produce generalized CNS depression, short term sedation and

postoperative amnesia. Side effects to watch for include respiratory depression, drowsiness,

agitation, headache, blurred vision, apnea, laryngospasm and cardiac arrest. Make sure you

monitor blood pressure, pulse and respirations continuously during administration (Deglin &

Vallerand, p. 823, 2009). The other medication that was given during the procedure was Demerol

(meperidine). Demerol is an opioid analgesic used to treat moderate to severe pain. It is also used

as an anesthesia adjunct and for preoperative sedation. It alters the perception of and response to

painful stimuli, while producing generalized CNS depression. Side effects to watch for include

respiratory depression, seizures, confusion, sedation, hypotension, constipation, nausea and

vomiting. May be administered with food or milk to minimize GI irritation (Deglin et.al, p. 785,

2009).

A nursing diagnosis for this patient would be, Anxiety r/t stress from change in health

status amb the inability to continue working while in the hospital. A secondary intervention

would be to teach the patient relaxation techniques such as deep breathing, imagery, progressive

relaxation and use of relaxation tapes. The rationale for this intervention would be that the

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patients ability to master relaxation techniques provides a sense of control and enhances self

care ability (Swearingen, p. 739, 2008). A tertiary intervention would be to encourage patient in

evaluating lifestyle and identifying activities and stresses of family and work. The rationale for

this would be that these measures enable the patient to examine areas of life that may contribute

to anxiety and make decisions about how to engender changes gradually without undue anxiety

(Swearingen, p. 740, 2008).