1. Medical-Surgical
Emily Grace
Concepts:
Focused assessment
Patient with abdominal pain
Patient Name:
Emily Grace
Learning Objectives:
• Care of a patient with small bowel obstructions
• Manage a nasogastric tube
Brief Overview of Simulation:
Emily Grace is a 45-year-old woman who was admitted to a medical-surgical unit with a small bowel
obstruction. She has had a 4-day history of abdominal pain and vomiting, with up to 12 vomiting episodes per
day. The vomitus is blood streaked at times. Her medical history includes an 8-year history of hypertension
and type 2 diabetes for 12 years. Recent surgeries include an appendectomy 3 years ago.
Student Pre-Simulation Work:
Topics to Review Prior to the Simulation
• Nasogastric tube management: ensuring patency, how the tube functions, purpose of the tube, etc.
• Pathophysiology of a small bowel obstruction. What signs and symptoms would you expect to see in a
patient with a small bowel obstruction?
• Focused abdominal physical assessment nursing interventions for a patient with a nasogastric tube.
Orientation to Unit: Acute care—medical-surgical unit.

2. Primary Medical Diagnosis: Small Bowel Obstruction
Current Surgeries / Procedures:
Co-morbidities: Type 2 diabetes, Hypertension
Simulation Hospital
Patient name:
Emily Grace
Admit Date:
Today
Admitting provider name:
Dr. Morgan
DOB:
6/26/19XX
Age:
45
Gender:
Female
Ht:
5 ft 8 in
Wt:
180 lb
Religion:
Episcopalean
Dx:
Small bowel obstruction
Medications:
Ciprofloxacin 400 mg IV q 12 hr
Metronidazole 1200 mg IV infused over 1 hr for 1 dose
and then 500 mg IV q 6 hr
Morphine sulfate 2 mg IV q 2–4 hr as needed
Acetaminophen 650 mg rectally q 4 hr prn temp >100.3oF.
Promethazine hydrochloride 10 mg IV q 4–6 hr as needed for
vomiting or nausea
Lisinopril 20 mg per NG tube every day
Regular insulin: sliding scale q 4 hr. Subcutaneous
administration:
BG 70–150: give 0 units
BG 151–200: give 2 units
BG 201–250: give 4 units
History of Present Illness:
Emily Grace is a 45-year-old woman who was admitted to a medical-surgical
unit with a small bowel obstruction. She has had a 4-day
history of abdominal pain and vomiting, with up to 12 vomiting
episodes per day. The vomitus is blood streaked at times.
Medical History:
8-year history of hypertension
type 2 diabetes for 12 years
Surgical History (Procedures & Dates):
Appendectomy 3 years ago.

3. Social History: married, works as administrative assistant BG 251–300: give 6 units
BG 301–350: give 8 units
BG <70 or >350: notify on-call physician
Support/Contact person(s):
Husband
Tubes/Drains:
Nutrition:
Wounds/Skin:
Activity:

4. Simulation Hospital
PHYSICIAN ORDERS
Patient Name:
Emily Grace
Diagnosis:
Small bowel obstruction
Allergies & Sensitivities: Penicillin and Compazine
NKA
Date Time PHYSICIAN ORDER AND SIGNATURE
Yesterday 1600 Admit to medical-surgical unit
Vital signs: q 4 hr
Diet: NPO—may have occasional ice chips
Activity: up as tolerated with assistance
Assess for falls, and institute fall precautions
IV therapy: D5 0.45% NS with 20 mEq KCl/L @ 125 cc/hr

5. Medications:
Ciprofloxacin 400 mg IV q 12 hr
Metronidazole 1200 mg IV infused over 1 hr for 1 dose and then 500 mg IV q 6 hr
Morphine sulfate 2 mg IV q 2–4 hr as needed
Acetaminophen 650 mg rectally q 4 hr prn temp >100.3oF.
Promethazine hydrochloride 10 mg IV q 4–6 hr as needed for vomiting or nausea
Lisinopril 20 mg per NG tube every day
Regular insulin: sliding scale q 4 hr. Subcutaneous administration:
BG 70–150: give 0 units
BG 151–200: give 2 units
BG 201–250: give 4 units
BG 251–300: give 6 units
BG 301–350: give 8 units
BG <70 or >350: notify on-call physician
Diagnostic studies:
Blood sugar q 4 hr (bedside monitor)
CBC, electrolytes every morning
BUN, creatinine every morning
Flat and upright abdomen today
Salem sump to continuous suction—may irrigate prn
Accurate I&O. Record q 4 hr
Record daily weight
Dr. Morgan

6. SIMULATION HOSPITAL
Kardex Worksheet
Client Gender: M F X Age____45____ Admit date: ___Yesterday_________ DNR: Y N
Allergies: __ Penicillin and Compazine______________________________________________________
Admitting Diagnosis: Small Bowel Obstruction _________ Co-Morbidities: __HTN, type 2 diabetes_______________
Current Surgery: ______________________ Surgery Date: ___________
Type of Bath Mobility IV Therapy Therapeutic Devices
Complete x
Assist
Self
Shower
Other:
Skin Management
Braden/Risk Scale
Skin Care Products Used:
Wound Care Protocol:
Bedrest
Turn
C, & DB
BSC
Chair
BRP
Ambulation as tolerated
with assistance
Restraints
Fall/Risk Score assess,
institute fall precautions
Nutrition
Diet
Therapeutic Snack
TPN
Tube Feed
FSBS
Peripheral Site:
Central line/PICC Site
Primary IV Solution/Rate
D5 0.45% NS with 20 mEq KCl/L
@ 125 cc/hr
IV Additive:
IV pump
Gravity:
PCA Pump Setting:
TEDs _____________
SCDs
CPM
Plexi Pulse
Telemetry
Ice bags
Cooling Device
Marcaine Pump
Foley Cath X
NG Tube
Ostomy
Other:
Drain type & site:
Other:
NG Tube

7. Respiratory Care/Oxygen/ Breathing Tx
Physical Therapy Occupational Therapy/Speech Therapy
Enter Ranges
Recorded For: Date:Last night Date:Today Date: Date: Date:
Temperature
Pulse
Respirations
Blood pressure
Pain scale
FSBS
Pulse Oximetry
24 hour intake
24 hour output
Weight
NG outfup 600 mL 400 mL
Diet percentage B L D B L D B L D B L D B L D