Evidence Based Article and The Other End of Stethoscope

Evidence Based Practice Diagnostic Testing for Small Bowel Obstruction

Last week, I had a 57 year old female who was admitted from the ED with severe abdominal pain. The physician ordered a CT of the Abdomen and it showed a small bowel obstruction. Early diagnosis of a small bowel obstruction is critical in preventing complications such as strangulation or perforation. In the past, plain x-ray films was used to diagnose SBO with a 20-52% accuracy. In 46 cases they performed a plain x-ray and CT on each case, the results show that CT was 100% accurate and showed all complete obstructions that lead to a more immediate surgery. My client in the past had a hysterectomy that lead to adhesions in the small intestines. The surgeon performed a lysis on the bowel adhesion, which relieved her abdominal pain and allowed her to have a bowel movement. The client stated she felt a lot better and was grateful that they found out what was wrong with her.

Diagnostic Performance of CT in the Detection of Intestinal Ischemia Associated With Small-Bowel Obstruction Using Maximal Attenuation of Region of Interest Am. J. Roentgenol. April 1, 2010 194:957-
CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause. D Frager, S W Medwid, J W Baer, B Mollinelli and M Friedman JR January 1994 vol. 162 no. 1 37-41


The Other End of the Stethoscope

After reading the chapters in the book, it really made me think about what it would be like to be a patient and what I would want from my caregiver. You don’t want them too professional where they don’t seem human and not enough where they seem incompetent. It seems like a hard median that each caregiver will have to develop on their own. Even though we talk about therapeutic communication and what we should and shouldn’t say sometimes going with human instinct is best and treating each patient individualized. I want to personally work on being more “human” and to be the caregiver that individual needs.

Emily, it is very hard to find that "happy medium" between being personal and professional. Especially as student nurses we know we are under the eye of instructors, experienced nurses, and tend to become concerned with knowing all the critical concepts of our patients disease and treatment process. Sometimes, I think it is important to step back and realize that it is just as important to reflect upon what we have done emotionally for our patient to meet those needs as well! By the way, it sounds like you had an interesting patient last week, do you know if your patient had a CT, Xray, or both?

Emily, it is very hard to find that "happy medium" between being personal and professional. Especially as student nurses we know we are under the eye of instructors, experienced nurses, and tend to become concerned with knowing all the critical concepts of our patients disease and treatment process. Sometimes, I think it is important to step back and realize that it is just as important to reflect upon what we have done emotionally for our patient to meet those needs as well! By the way, it sounds like you had an interesting patient last week, do you know if your patient had a CT, Xray, or both?

Very well said, practice on being more human. It seems quite silly to say, but it is true. When looking at the situation from the other end, it is completely understandable. Finding that balance between professionalism and personal-ism is a fine line, except if we can remind ourselves that the roles could change at anytime, for any of us.

I think we would all like to be treated like humans regardless of the situation. I think it would be harder to be understanding when you are not sure why you are in the situation you are in. I think the Why me? question would come up. But we have to meet them where they are and attempt to understand what they day must be like for them and then step back and provide care to the best of our abilities.

I agree with trying to treat patients more "Human". And honestly I feel like the only way we will master this skill is with time. The more years we get under our belt the better we will be able to communicate therapeutically.