Question

PN 200 Fundamentals of Nursing II Case Study: Hypovolemia/Deficient Fluid Volume Charles West, a 70 y/o man was brought to the Emergency Department at 4:30 AM by his wife. She told the emergency room triage nurse that he has a lot of "dark red" diarrhea for the past 3 days and last night. When he became very dizzy, disoriented and weak this morning, she decided to bring him to the hospital. Mr. West's vital signs were B/P 70/- (diastolic blood pressure inaudible) Pulse 110 weak and easily obliterated, and respirations 24. A 16-gauge IV catheter was inserted and Lactated Ringer's infusion at 125 m/L per hour was started. The triage nurse obtained the following history from the patient and his wife. The patient has had idiopathic dilated cardiomyopathy (ICDM) for several years. The onset was insidious, but the cardiomyopathy is now severe, as evidenced by a left ventricle ejection fraction of 13% found during a recent cardiac catheterization. He experiences frequent problems with CHF because of the IDCM. Two years ago he experienced a cardiac arrest that was attributed to hypokalemia. He also has a long history of hypertension and arthritis. Fifteen years ago he was diagnosed with a peptic ulcer. An endoscopy showed a 25mmX15mm duodenal ulcer with adherent clot. The ulcer was cauterized, and Mr. West was admitted to the Medical intensive care unit for treatment of his volume deficit. You are the admitting nurse. As you are making him comfortable, Mrs. West gives you a paper bag filled with the bottles of the medications Mr. West has been taking. Vasotec 5mgm po bid Coumadin 5mgm po qd Digoxin 0.125 mg po qd KCL 20 mEq po bid Tolimentin 400mgm po tid (non-steroid NSAID) Doing a quick assessment, you find a pale man who is sleepy but arousable and oriented. He is still dizzy, hypertensive and tachycardia. You hear S3 and S 4 heart sounds. Peripheral pulses are present and trace pedal edema is present. Lung sounds are clear. Bowel sounds are present, gastric tenderness is noted and the liver margin is 4cm below the costal margin. A Swanz-Ganz catheter and an arterial line are inserted. 1. State the home medication(s) that probably precipitated Mr. West's GI bleeding. 2. Explain the most serious potential complication of Mr. West's bleeding and the rationale for your selection. 3. Demonstrate documentation of the patient's admission assessment in the nurse's notes 4. Prepare a list of signs and symptoms (both direct and indirect) of GI bleeding and loss of fluid volume from the history the patient and wife gave you and from your assessment, 5. Prepare a list of additional complications that you would anticipate as a result of the patient's hypovolemia as well as the rational for your selections Mr. West receives a total of 4 units of PRBC's, 5 units of FFP (fresh frozen plasma) and many units of crystalloid solution to keep his systolic B/P above 90mmHg.

Answer 1

1, certain medications induce GI bleeding. taking NSAIDs and anticoagulants that the patient takes cause side effects of GI bleeding. These drugs damage the lining of the stomach and make ulcers and severe bleeding.
2, the patient is potential for most serious complications like Anemia due to severe loss of blood count, Chance of myocardial infarction due to the inadequate blood supply to heart, hypovolemia due to severe fluid loss, perforation cause nasogastric aspiration pneumonia.
3, Vital signs-diastolic blood pressure -70, pulse -weak 110, respiration -24
Appearance-pale, drowsy and oriented
Heart-s2 and s4 heart sounds heard
bowel-sound present and there is gastric tenderness
Liver-4cm below the costal margin.
The patient has a history of hypertension and arthritis, idiopathic dilated cardiomyopathy, cardiac arrest and hypokalemia
past history-peptic ulcer 15 years ago and on medications
4, Signs and symptoms:
direct: Dark red color diarrhea, weak pulse, shortness of breath, anemia, dizziness, gastric tenderness, and an enlarged liver.
5, Hypovolemia cause severe fluid imbalance due to blood loss. there will be a loss of plasma than whole blood. it decreases cardiac output due to the loss of circulating blood volume.
6, Fresh frozen plasma is whole blood. It is a long volume expander that corrects the hemostatic disorder. It is the main source of coagulation factor replacement. It stops the bleeding for the patient.