Active GI Bleed - Concept Map/Care Plan

Nursing Students Student Assist

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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

Mottling

Cap refil

Vfib

Confusion/icuitis

Perrla

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:

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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