Dave You are an RPN working the day shift on the surgical unit. It…

Dave You are an RPN working the day shift on the surgical unit. It… Dave You are an RPN working the day shift on the surgical unit. It is 0800 in the morning and you are scheduled to take the next admission. The ER nurse calls on the phone to give you the following report: “We have a 62 year-old Hispanic male (Dave) who is widowed, lives alone and has been admitted by Dr. Young with an Upper GI bleed.  He works the night shift at a factory on the assembly-line. He drinks one mickey (12 ounces) of whiskey per day and smokes one pack of cigarettes per day.  For the past year he has taken 1 aspirin daily to help to decrease his risk of a heart attack or stroke.  His current weight is 140 pounds and he has lost approximately 20 pounds over the last 6 weeks due to lack of appetite. He is approximately 5’6″.  Last night at work, he vomited a large amount of hematemesis. His co-workers called the paramedics and he was brought into the ER.”  “His last vital signs were: 94/50, 36.8, 118, 28. 02 sat’s 91% on 5 L/minute via nasal prongs.  He is confused and drowsy; but does rouse easily when spoken to, and is easily irritable with any type of movement.  He has not vomited since coming into the ER. We are unsure when his bowels have moved last although he has not had a BM since arriving to the ER.  He is very jaundiced in colour and has marked ascites. He is currently complaining of general itchiness and has a dull pain in the upper right abdominal quadrant (underneath his ribcage) that is radiating to his back.  According to the ER physician, Dave has a history of cirrhosis of the liver and has had several recent admissions due to hepatic encephalopathy.”   “We started two peripheral IV’s –  one is Normal Saline infusing at 125/hour and the second is a continuous IV Pantoloc drip infusing at 8 mg/hour. We have also inserted a #14 French indwelling foley catheter. The blood-tech has drawn the following bloodwork this morning: CBC, PT/PTT, INR, Ammonia, Electrolytes, Creatinine, BUN, Liver profile and has Cross and Typed him for 4 units of PRBCs. The lab has already called with the Ammonia level which is critically high (Ammonia = 75 micromoles/L) and Dr. Young was notifed. Dr. Young has requested that he be paged with any other abnormal bloodwork – so please watch for the bloodwork results. Dave is to receive 2 units of PRBC’s today if his hemoglobin is less than 75 g/L.” “Dave is to receive Lactulose 30 ml po q6 hours to induce 3 to 4  BM’s over the next 24 hours – please give the first dose asap.  He is scheduled to have an endoscopy tomorrow as the OR is completely booked today. He is ready to be transferred to you now.”    *see case study questions on page 2Questions 1. Compare the signs and symptoms of an Upper and Lower GI Bleed. Given Dave’s history, explain what risk factors have significantly contributed to his GI bleed.  2. Discuss the pathophysiology of cirrhosis of the liver and how it is linked to his GI bleed (hematemesis)? 3.  Briefly discuss how hyperammonemia is linked to hepatic encephalopathy; relate this discussion to Dave. Include the signs and symptoms along with the treatment of hepatic encephalopathy. 4. Provide a description of the therapeutic benefits, risks, and nursing actions of Lactulose; and also of Pantoloc that are specific to Dave.  5. Discuss the nursing responsibilities related to a blood transfusion. Outline the dangerous reactions that can occur during a blood transfusion and the nursing actions if those reactions occur.   6. What are your top concerns as Dave’s nurse? What interventions do you plan related to those concerns.   **to answer the questions you can refer to the slides for cirrhosis posted on D2L (week 1’s folder) and Nursing Skills Online for blood transfusions (see NSO for week 13); text books; and/or the WWW  (remember to choose a credible website).                 Health Science Science NursingShare QuestionEmailCopy link Comments (0)

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