Question

CARE PLAN-DEHYDRATIUN 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 l 10 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% 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 found during a recent cardiac catheterization. He experiences 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 are 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. 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 bleeding and the rationale for your selection. Demonstrate documentation of the patient's admission assessment in the nurse's notes repare a list of signs and symptoms (both direct and indirect) of GI bleeding and loss of fluid volume from the history the patient and wife gave you and from your assessment. repare a list of additional complications that you would anticipate as a result of the olemia as well as the rational for your selections patient's hypov receives a total of 4 units of PRBC's, 5 units of FFP (fresh frozen lasma) and many units of crystalloid solution to keep his systolic B/P above 90mmHe. for the use of fresh frozen plasms ain

Answer 1

1.Coumadin is a drug which is a blood thinner ,in addition the patient is taking an NSAID with a past history of duodenal ulcer ,this drug could have eroded the intestinal lining and resulted on GI bleeding

2.The most potential problem of his GI bleeding could been hypovolemic shock due to diarrhoea, severe anemia due to blood loss,severe hypotension due to decresea fluid volume,hyperkalemia due to electrolyte imbalances,decreased renal function and resulting in deposition of toxins in body, alteration in the mental status due to electrolyte imbalances,organ failure and death due to hypovolemia

3.The admission assessment in the nursing notes are

70yr /M admitted with c/o dark red diarrhoea for three days,dizziness ,weakness ,disoriented is a known case of ICDM,CHF,Hypertension ,Arthritis, on treatment .Past medical history of peptic ulcer and hypokalemia.Past surgical history of clipping of clot for duodenal ulcer and cardiac catheterization revealing 13% EF.

4.Signs and symptoms

• Diarrhoea ,dark red due to bleeding
• Hypotension and tachycardia due to fluid loss
• Dizziness, weakness due to severe anemia resulted due to GI bleeding
• Pedal edema is an indication of cardiac abnormality
• Hypovolemia due to fluid and electrolyte loss

5.The additional complication in relation to hypovolemia are

• Organ failure
• Death