Question

You review EPIC for Mr. Smith and find that he was admitted to the hospital last night with the diagnosis of bleeding esophageal varices. He is 38 years old, 6’ tall, and weighs 155 lbs. He has a history of alcohol abuse and bipolar disorder. He is on bedrest with bathroom privileges, NPO, and has an IV with lactated ringers running at 125mL/hr. He is a bit confused and has been shivering. His temp is 100.6° F. He is scheduled for a variceal ligation.

Medications (Refer to Abram’s Pharm. p. 854-855)

IV octreotide 50 mcg/hr x 3 days

Thiamin 100 mg PO every morning

MVI tablet each morning

Propranolol 20 mg PO BID

Lithium 900 mg PO each morning

Labs:

Alanine aminotransferase (ALT) – 80 Units/L

Aspartate aminotransferase (AST) – 250 Units/L

Hgb 6.8

Hct 21

Potassium – 3.3 mEq/L

Folate – 3 nmol/L (7-36 nmol/L)

Thiamine – 55 nmol/L (70-180nmol/L)

Vit B12 – 100 ng/L (130-700 ng/L)   What question would you ask the nurse giving report when he states that the consent form still needs to be signed for the variceal ligation?

Answer 1

1.The following question can be asked from the nurse who is giving a report on not getting a consent

• As the patient is known case of bipolar disorder,his MSE has to be asked whether he is mentally sound or not because the patient is in a state of confusion
• Was he and his family members are informed about the procedure and doubts clarified
• What to be done when the patient has no relatives to sign a consent
• About the relatives present with the patient are not