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Case Study Gastrointestinal Hemorrhage
Scenario
You are the nurse on duty on the intermediate care unit, and you are scheduled to take the next admission. The emergency department (ED) nurse calls to give you the following report: “This is Barb in the ED, and we have a 42-year-old man, K.L., with lower GI (gastrointestinal) bleeding. He is a sandblaster with a 12-year history of silicosis. He is taking 40 mg of prednisone per day. During the night, he developed severe diarrhea. He was unable to get out of bed fast enough and had a large maroon-colored stool in the bed. His wife ‘freaked’ and called the paramedics. He is coming to you. His vital signs (VS) are stable—110/64, 110, 28—and he's a little agitated. His temperature is 98.2° F (36.8° C). He has not had any stools since admission, but his rectal exam was guaiac positive and he is pale but not diaphoretic. We have him on 5 L O 2 /NC. We started a 16-gauge IV with lactated Ringer's at 125 mL/hr. He has an 18-gauge Salem Sump to continuous low suction; that drainage is also guaiac positive. We have done a CBC with differential, chem 14, coagulation times, a T&C (type and crossmatch) for 4 units RBCs, arterial blood gasses, and a urinalysis (UA). He's all ready for you.”
CASE STUDY PROGRESS
K.L. arrives on your unit. As you help him transfer from the ED stretcher to the bed, K.L. becomes very dyspneic and expels 800 mL of maroon stool.
CASE STUDY PROGRESS
K.L. reports that he is getting nauseated but not thirsty. VS are 92/58, 116, 32.
a. Initiating a pulse oximetry monitoring
b. Measuring K.L.'s vital signs every 15 minutes
c. Obtaining consent from K.L. for a possible blood transfusion
d. Assessing K.L.'s peripheral circulation
e. Emptying each Foley catheter collection bag each hour
f. Monitoring K.L.'s hemoglobin and hematocrit levels
Chart View
Arterial Blood Gases
pH 7.47
Pa CO2 33 mm Hg
Pa O2 65 mm Hg
HCO 3 23 mmol/L
Sa O2 91%
Complete Blood Count
Hgb 7.8 g/dL
Hct 23%
CASE STUDY PROGRESS
The gastroenterologist is notified by K.L.'s physician and schedules an immediate colonoscopy and endoscopy. You accompany K.L. to the endoscopy suite and give him midazolam (Versed) and morphine sulfate IV during the procedures
CASE STUDY PROGRESS
During the colonoscopy, K.L. begins passing large amounts of bright red blood. He becomes more pale and diaphoretic and begins to have an altered level of consciousness.
CASE STUDY PROGRESS
The physician is able to find the site of the bleeding and cauterize the affected vessels. There is no further evidence of active bleeding. K.L. is transferred back to the unit. His condition is stabilized with fluids, blood, and fresh frozen plasma (FFP). He received esomeprazole (Nexium) 40 mg IV push (IVP) and is placed on 40 mg PO bid.
CASE STUDY OUTCOME
The physician concludes that the GI hemorrhage was prednisone-induced. Because the prednisone was being used to suppress the progression of silicosis, the physician will attempt to decrease his maintenance dose of prednisone while monitoring his respiratory status.
#. Preparation for this patient's arrival by the following steps :-
- Making the bed available ready for the patient
- Checking the oxygen flow meter and humidifier system for its functionality.
- Switching on the monitor system , ready with the BP apparatus , ECG leads ,Pulse oximetry, Thermometer etc for vital assessment
- Preparing the necessary documents needed to be filled at the moment of addmission .
- Informing the physician , dietitian , and other paramedics about the new admission .
- Preparing the equipment needed for maintaining the drainage and IV fluid therapy
- Calling the Blood Bank for arranging 4units RBC and it's transfer to the ICU as the patient is shifted to the ICU .
#. The first three actions to be taken are :-
- Check the vitals ( Temperature, RR,BP, SPO2 )
- Provide oxygen therapy and inform the physician .
- Clean the patient and change his dressing and arrange for blood transfusion .
#. The additional interventions needed to be instituted is IV fluid administration as he is feeling nauseated and not feeling thirsty so he would not take anything from mouth ,also his BP is at low side and also he is having per rectal bleeding so administration of IV fluid is necessary to avoid complications such as hypovolemic shock .
#. The assessment indicators that would be monitored in K.L are :-
- Monitor input and output volume
- BP monitoring
- Weight monitoring
- ABG value
please help answer this case study (Please type the answer because I could not read when...
please help answer this case study Case Study Gastrointestinal Hemorrhage Scenario You are the nurse on duty on the intermediate care unit, and you are scheduled to take the next admission. The emergency department (ED) nurse calls to give you the following report: “This is Barb in the ED, and we have a 42-year-old man, K.L., with lower GI (gastrointestinal) bleeding. He is a sandblaster with a 12-year history of silicosis. He is taking 40 mg of prednisone per day....
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