Question

Your post-op patient has nausea, hypoactive bowel sounds, and repeated vomiting of dark brown emesis despite repeated antiemetics. What order do you anticipate from the provider? a) Administer antiemetics again b) Order an abdominal X-ray c) Administer a nasogastric tube d) Order a complete blood count (CBC)

Answer 1

Given the symptoms described, the most likely order that the provider will anticipate is c) Administer a nasogastric tube.

The symptoms of nausea, hypoactive bowel sounds, and repeated vomiting of dark brown emesis despite repeated antiemetics suggest a possible bowel obstruction. A nasogastric tube can help decompress the stomach and relieve the symptoms by removing any accumulated gastric contents and gas.

Administering antiemetics again (option a) may not be effective if the underlying cause is a bowel obstruction. An abdominal X-ray (option b) can provide information about possible bowel obstruction, but it does not provide immediate relief for the patient. Ordering a complete blood count (CBC) (option d) may provide some information about the patient's condition, but it does not directly address the immediate symptoms.

Answer 2

Despite other diagnostic options, the post-op patient experiencing nausea, hypoactive bowel sounds, and vomiting of dark brown emesis would likely be ordered a nasogastric tube by the provider. This facilitates not just diagnosis, but also critical treatment if gastrointestinal bleeding is present.

Step-by-step explanation:

Taking into account the symptoms described such as repeated vomiting of dark brown emesis called coffee ground emesis which indicates possible upper gastrointestinal bleeding and hypoactive bowel sounds, the most likely order from the provider would be c) Administer a nasogastric tube.

This condition is serious and requires immediate intervention to ascertain the source of the bleeding.

In the case of upper gastrointestinal bleeding, nasogastric intubation is often employed. In this process, a tube is inserted through the patient's nose and guided down into the stomach. This allows medical providers to evacuate stomach contents, in turn decreasing pressure and potentially reducing the risk of further bleeding. The tube also allows for gastric lavage to be performed, which can help to clear the view in an eventual endoscopy procedure.

While an abdominal x-ray (option b) and a complete blood count (option d) can certainly be valuable for diagnosing the condition, neither provides the necessary immediate intervention to potentially stop the bleeding. Administering additional antiemetics (option a) does not address the cause of the vomiting, and may not be effective if the vomit is resulting from gastrointestinal bleeding.

The patient's symptoms of nausea, hypoactive bowel sounds, and repeated vomiting of dark brown emesis notwithstanding repeated antiemetics isn't suggestive of an infection due to Clostridium difficile (C.diff) nor gastroenteritis but indicate possible gastrointestinal bleeding.

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