Published Sep 18, 2003
Are you up for a challenge?
Thought someone might find this fun and allow everyone to learn and exchange ideas:
You have a 74 yr old man brought into the emergency room at 4:30am by his wife. She tells the ER nurse that he has had dysentry for the past 3 days and last night he had a lot of "dark red" diarrhea. He became very dizzy, confused, and weak this morning. Pts Vitals are BP-inaudible, HR 110, Resp 24. LR was started. Pts history include: idiopathic dilated cardiomyopathy. A recent echo showed a left ventricular ejection fraction of 13%. He has experienced several problems with CHF. He had a cardiac arrest two years ago which was attributed to the use of diuretics and hypokalemia. He also has a long history of arthritis and hypertension.
An endoscopy showed a 25x15mm duodenal uler with clot. The ulcer was cauterized and the client was admitted to ICU. Pts wife tells nurse of his currents meds which are Vasotec 5mg bid, Coumadin 5mg qd, Digoxin 0.125mg qd, KCL 20 meq bid, and Tolmetin 400mg tid. Cardiac monitor shows AF. On assessment the following is noted: client is sleepy but arousable and oriented. Pt c/o dizziness. BP 100/32, 110, 20. An S3/S4 is heard. Peripheral pulses are 2+, and a trace of pedal edema. Lungs are clear and there are bowel sounds. Midepigastric tenderness is noted and the liver margin is 4cm below the costal margin.
1) What type of anemia would u expect to see in this client compared to a client with a history of chronic peptic ulcer disease? Compare and contrast the pathology of each including the findings you would expect to find on the CBC.
2)Review physical assessment finding. discuss findings and the significance to you as you plan for this pts care.
Your client receives 4 units of packed red blood cells and 5 units of fresh frozen plasma. He also receives crystalloids to keep his systolic blood pressure greater than 90. On the second day, his total fluid intake is 8.45 liters and his output is 3.65 liters.
3) Identify 6 things you would monitor for to assess the client's fluid status.
The admission lab results reveal the following: K 6.2; BUN 90, Creatinine 2.1, Hgb 8.4; Hct 25%, WBC 16, INR 4.2
4)Briefly evaluate the lab information. What does this data tell you and how does it related to your nursing care of this client?
5) What would you do to make the client's wife feel more involved in his care and to help decrease her anxiety when her husband is in ICU?
Good luck and happy solving :roll
haha... nice case study.
I have always hate case study in college but i have to admit...it's a good way to think of answers instead of memorize them
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