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23 year-old male restrained passenger involved in a motor-vehicle accident, Taylor Reyes, was transported via emergency medical services (EMS) to a level II trauma center. On route to the hospital the patient’s vital signs were BP: 110/70; HR: 122; RR:23; SPO2:99% NC 2L; Pain 3/10; T:36.6C; GSC 15. EMS placed a right AC 22 gauge at the rate 50 ml/hr NS and C-spine precautions were initiated. Patient states he has no known drug allergies and complains of right lower quadrant abdominal pain. Patient states he has no known drug allergies and complains of right lower quadrant abdominal pain. Patient is anxious expressing concerns regarding not having medical insurance and pending financial burden of hospitalization.

Upon emergency department admission vital signs were BP:95/60; HR: 130; RR: 26; SPO2: 97% NC 2L; Pain: 6/10; T: 38.2 C. Assessment findings showed rigid abdomen with distention, rebound tenderness, abdominal guarding, seatbelt sign with visible ecchymoses of abdominal wall.

Question 1: What initial interventions should the nurse prioritize at this moment?

The patient is sent for diagnostic testing (MDCT, Fast, DPL, labs). The results show decreased hemoglobin and hematocrit (10; 30%), elevated WBC (15,000), slightly elevated liver enzymes (AST: 63; ALT: 49), scans showed hematoma of the mesocolon with IV contrast leak originating at the right colic artery and small bowel perforation of the descending colon.

Question 2: What is the priority management for this patient to remain stable? What are the concerns at this moment?

After successful surgical laparotomy the patient is transferred to the ICU and started on IV antibiotics/fluids. Repeat diagnostic workup is ordered and completed. Patient is placed on NPO status until return of flatus and bowel sounds, diet is to be advanced as tolerated.

Question 3: Which interdisciplinary teams should be involved in the patient’s care and discharge planning? What are three priority concerns regarding discharge at this time?