Upper GI Bleed Case Study Assignment
The purpose of this assignment is to help you develop critical thinking skills that would be required in the clinical setting. The responses you provide to the questions are to be in-depth and show evidence that you have used a variety of different sources when developing your answers. Answers are to be embedded throughout the case study and must be in your own words meaning do not cut and paste from your references. Please submit the assignment in a thoughtful, scholarly format (complete sentences), and cite references used at the end of the assignment.
Do not seek help from anyone else to complete this assignment as this is independent study and must be completed by you and you alone. This will be sent through Turnitin to check for plagiarism. If found, you will be reported to the office of Student Conduct and if found to have copied another’s work you will receive an “F” for clinical which is a course failure.
Mr. Jack Smith, a 61 year old white male, who weighs 91kg has been admitted to the Emergency Department (ED) complaining of (C/O) dizziness, dyspnea, restlessness and anxiety. He is married and currently works as an accountant. He reported that he has been throwing up blood over the last two days. He is vomiting coffee ground emesis. He has no past medical history of any kind, nor a family history of Gastrointestinal (GI) problems. He did admit to drinking six to eight alcoholic beverages almost every day for the past 10 years. His skin is cool and clammy. He has a distended abdomen with hyperactive bowel sounds.
Current vital signs (V/S): BP: 100/62 MAP 74, HR: 120 bpm, RR: 28 B/min., Temp. 98.3F (oral)
Pertinent Lab Results:
CBC: WBC 11.78 RBC 3.2 Hgb 7.0 Hct 21.0 Plt 150
Chemistry Panel: Na 133 Cl 95 K 3.3 Ca. 8.3 Co2 20 Glucose 89 BUN 41 Cr. 2.0 GFR 35
Coag Panel: PT 39 INR 2.2
Liver Panel: AST (SGOT) 950 ALT (SGPT) 1000 Alkaline Phosphatase 170 Total bilirubin 2.5
Other: Ammonia 70 LDH 500 Albumin 2.3 Point of care Glucose: 87 mg/dl
Admit Orders:
Admit to the Intensive Care Unit (ICU)
Continuous ECG and pulse oximetry monitoring
Vital Signs: Q 1hr
Implement CIWA protocol with Q1hr assessments
O2 to maintain SpO2 >92% notify provider if requiring PRNB Mask
Diet Type: NPO
Place Foley catheter with Q1hr I/Os
Place 30F 3 way rectal tube
Labs: H&H Q 4hrs. and Type & Crossmatch for 2 unis PRBCs
Order 2 units PRBCs and notify provider when ready
Medications: IV fluid: Normal Saline (0.9% NaCl) 125 ml/hr
Pantoprazole continuous IV infusion at 8mg/hr
Octreotide continuous IV infusion at 50mcg/hr
Ceftriaxone 2gm/50ml D5W IVPGBK Daily
Lactulose 30 gm Q 6 hrs per rectal tube, clamp for 30min post administration
The ICU nurse received an SBAR report from the ED nurse prior to the patient’s arrival to the unit.
1. In preparation for the patient’s arrival the ICU RN should include what items when setting up the room?
The patient was transferred from the stretcher to the ICU bed x4 assists from the ICU & ED personnel. The patient arrived to the ICU with the following intravenous drips running:
0.9% NaCl 125ml/hr
Pantoprazole 8mg/hr
Octreotide 50mcg/hr
2. Explain the indication for each of the drugs ordered above?
3. Explain briefly the pathophysiology of esophageal varices and portal hypertension?
4. Explain the laboratory results listed above and why high or low?
5. What is the priority nursing assessment intervention for this patient as it relates to his history of alcohol use? What does this assessment tool include?
6. What two major concerns do you have as the nurse caring for this patient as they relate to his medical condition?
The intensivist decided to insert a Sangstaken – Blakemore tube (S-BT), watch the YouTube video https://www.youtube.com/watch?v=YAV10eVO1yo and answer the following:
7. Explain the indication for the S-BT insertion?
8. List the parts of the S-BT (Anatomy of the S-BT)? Include what each part is used for.
9. What safety measures the nurse should consider when S-BT in place?
10. How is S-BT is verified for placement?
11. After the RN placed the Foley catheter, the patient’s urine was noted to be cloudy and dark amber with an average of 30-40 ml/hr. Explain the nursing measures to prevent CAUTI for this patient?
12. What top three nursing concerns with supporting evidence do you have for this patient? Include at least 5 nursing interventions for EACH of your nursing concerns.
13. What patient and family teaching needs to be done for this patient and his loved ones? Begin teaching from the time the patient arrived to the ICU.
