Active GI Bleed - Concept Map/Care Plan

  1. I am working on my concept map/care plan for my critical care rotation.

    My patient has a history of MI and Diabetes. On the day i cared for this patient they had an active GI Bleed and Afib. I established that i would make

    1. Risk for Fluid Volume Deficit r/t

    I chose this as my number 1 priority because on the day i cared for this pt. they were actively bleeding. I would have chosen Cardiac as my number one had this not been the case. Also, the albumin was 2.2 i wonder if there was third spacing exacerbating this due to being NPO for an extended period of time.
    My evidence for this is
    Poor pulses - +1
    Edema - +2
    Cool extremities
    Clammy Skin
    Cap refil < 3 seconds
    Decreased bowel sounds - possibly not enough blood flow reaching the gut?
    Nausea - zofran on med list
    Distention/pain - again possibly not enough bloow flow to gut?

    This patients vital signs proved - Tachycardia, tachypnea, and hypotension.
    Labs: CR high, no ABGS or BUN available. Albumin 2.2
    Meds: Zofran, lasix, digoxin
    Input: NPO 1000ml/day NS
    Output: < 30ml/hr .... Bowel management system: Active GI bleeding.

    2. Decreased Cardiac Ouput r/t decreased ventricular filling, altered afterload, impaired contractitlity, altered rate and rhythm, increased o2 demand, and cardiac disease.

    3. Poor Tissue Perfusion r/t hypovolemia, myocardial ischemia, low hemoglobin, and reduced arterial blood flow.

    This patient had visible PAD "cowboy boots", edema 2+ in lower extremities.

    Do i seem to be headed in the right direction?
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    Joined: Feb '10; Posts: 1