Question

CARE PLAN DEHYDRATION 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 Toimentin 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 S 3 and S 4 heart sounds. Peripheral pulses are present and trace pedal edema is present. Lung sounds 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. are 1. State the home medication(s) that probably precipitated Mr. West's Gl bleeding. 2. Ex plain the most serious potential complication of Mr. West's bleeding and the rationale for your selection. e documentation of the patient's admission assessment in the n e a list of signs and symptoms (both direct and indirect) of GI bleeding and loss 4. Prepar 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. 1. Explain the rationale for the use of fresh frozen plasms

Answer 1

Q. No. 1. Answer :

Home medications NSAIDS like Toimentine 400mg, may cause the GI bleeding, because prolonged usage of nsaids may cause the gastrodeodenal mucosa may leads to bleeding.

Q. No. 2. Answer :

Most potential serious complications of gi bleeding includes anemia, chest pain, syncope, fatigue, short ness of breath due to decreased oxygen levels in the blood, bowel ischemia also may develops.

These are complications due to bleeding there is no proper oxygen carrying capacity in blood so that these are may arises.

Q. No. 3. Answer :

Patient admission assessment in nurses notes :

Name : Mr. Charles west,

Age : 70 years,

Sex : male,

Chief complaints :

Dark red diarrhea, dizziness, disorientated, weaknesses in these morning,

Vital signs are :

Blood pressure is 70 systolic and diastolic not detected,

Weak and easily obliterated purse 110 beats per minute.

Respirations : 24 breaths per minute.

Past history like :

ICDM, peptic ulcer.

Physical assessment :

General assessment : Drowsy, arousable and oriented,

S3 and s4 heart sounds listened, peripheral pulse felt. Mild pedal edema seen.

Q. No. 4. Answer :

Direct and indirect signs and symptoms of gi bleeding :

* abdominal pain,

* short ness of breath,

* chest pain,  

* nausea,

* vomiting,

* dizziness,

* fatigue,

* bruising around the navel,

* hypotension,

* numbness,

* severe head ache,

* diarrhea with blood or Malena.

These are the some of direct and indirect signs and symptoms of gi bleeding.