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J.S. is a 52 year old female who is presenting in the ER with frequent bloody...

J.S. is a 52 year old female who is presenting in the ER with frequent bloody stools.

J.S. has a history of ulcerative colitis, DM II, CAD, HTN, & hypercholesterolemia.

Patient presents pale, short of breath and fatigued.

Vitals:

T- 99.6

RR- 18

HR- 98

BP-146/76

O2Sat- 93% on room air

current meds:

Accuchecks AC/HS Regular insulin sliding scale

Aspirin 325mg PO Daily

Atenolol 25mg PO daily

Simvastatin 20mg PO HS

what will your assessment include as the nurse?

what diagnostic testings are needed?

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Answer #1

Nursing assessment

  • Collect the patient's detailed history associated with bleeding
  • Check if there are signs of orthostatic hypotension.
  • Check the medication containing NSAIDs that can interfere with bleeding(Aspirin)
  • Assess the stool color and density.If lower GI bleeding, bright red color and if upper GI bleeding, a tarry and greenish-black color will be seen
  • Assess skin and mucous membranes for signs of ecchymosis, discoloration, hematoma formation, or dribbling of blood.

Diagnostic testing

  • Hematocrit
  • Hemoglobin
  • platelet count,
  • prothrombin time
  • activated partial thromboplastin time (aPTT)
  • fibrinogen
  • bleeding time
  • vitamin K
  • coagulation time (CT).
  • Occult blood (stool & urine)
  • Abdominal CT and MRI
  • Colonoscopy
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