Question

Counadin 5mgm po qd Digoxin 0.125 mg po qd KCL 20 mEq po bid Toimentin 400mgm po tid (non-steroid NSAID) Doing a guiek assessment, you find a pale man who is sleepy but arousable and oriented He is still dizzy, hypertensive and tachycardia You heat S 3 and S 4 beart sounds. Peripheral pulses are present and trace pedal edema is present. Lung sounás are clear. Bowel sounds are present, gastric tendemess is noted and the liver margin is 4cm below the costal margin. A Swanz Ganz catheter and an arterial line are insened. 1. State the home medication(s) that probably precipitated Mr. West's Gl bleeding 2. Explain the most serious potential complication of Mr. West's bieeding and tbe 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 bieeding and loss of fluid volume from the history the patient and wife gave you and from your ssessment. 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 M:. 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 90mmHs 1. Explain the rationale for the use of fresh frozen plasms

Answer 1

1.The home medications that had probably precipitated Mr.Wests GI bleeding are :-

- Coumadin

- Tolmenrin

2. The most serious complication of Mr .West bleeding is Hypovolemic shock due to severe hemorrhage. As he had severe bleeding it will lead to loss of blood volume and ultimately shock and severe dehydration .

3. Documentation of initial assessment done by the nurse :-

A 70 year patient named Charles west has come to the emergency with complaints of dark red diarrhoea for last 3 days and night . When he got dizzy , disoriented and weak they brought him to the emergency . On assessment was pale looking ,sleepy but arousable and oriented. On physical examination he was having tachycardia , hypertension , trace pedal edema and heart sound S3 and S4 are heard .Lung was clear ,bowel sounds were present , mild gastric tenderness was present.

4. List of sign and symptoms of GI bleeding are :-

- dark red diarrhoea

- pale look

- tachycardia

- dizzy and sleepy

- weakness

- pedal edema