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You are the nurse on duty on the intermediate care unit, and you are scheduled to take the next admission. The emergency department (ED) nurse calls to give you the following report: "This is Barb in the ED, and we have a 42-year-old man, K.L., with lower GI [gastrointestinal] bleeding. He is a sandblaster with a 12-year history of silicosis. He is taking 40 mg of prednisone per day. During the night he developed severe diarrhea. He was unable to get out of bed fast enough and had a large maroon-colored stool [hematochezia] in the bed. His wife 'freaked' and called the paramedics. He is coming to you. His vital signs [VS] are stable--110/64, 110, 28--and he's a little agitated. His temperature is 36.8° C. He hasn't had any stools since admission, but his rectal exam was guaiac positive and he is pale but not diaphoretic. We have him on 5 L O2/NC [oxygen by nasal cannula]. We started a 16- gauge IV with lactated Ringer's [LR] at 125 ml/hr. He has an 18-gauge Salem sump to continuous low suction; the drainage is guaiac positive. We have done a CBC with differential, chem 14, PT/INR and PTT, a T&C [type and crossmatch] for 4 units RBCs, and a urinalysis [uA]. He's all ready for you."

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1. How should you prepare for this patient’s arrival?

CASE STUDY PROGRESS

K.L. arrives on your unit. As you help him transfer from the ED stretcher to the bed, K.L. becomes very dyspneic and expels 800 ml of maroon stool.

2. What are the first three actions you should take?

CASE STUDY PROGRESS

K.L. reports that he is getting nauseated but not thirsty. VS are 106/68, 116, 32.

3. What additional interventions would you need to institute?

CASE STUDY PROGRESS

Arterial blood gas (ABG) results are as follows (these results reflect values at sea level): pH 7.45, PaCO2 33 mm Hg, PaO2 65 mm Hg, HCO3 23 mmol/L, base excess [bE] +1.0, SaO2 91%.

4. Interpret the preceding ABGs. What do they tell you?

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

How about giving us your thoughts on each of the questions and we'll help guide you down the critical thinking pathway. :up:

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Specializes in Family Nurse Practitioner.

No place do I see...Students, please post this case study to the nurses at allnurses.com and have them do your homework for you. :)

We are happy to help and guide you through the questions now because won't be there for you when you are a real nurse faced with this scenario in the future.

1) Which equipment would you need set up in the room for this patient? Look at what he is currently using...suction, oxygen, IV fluids etc.

2) You have a patient whose breathing and circulation is compromised. What would you do? Picture the scenario in your head.

3) What do those vitals tell you? Compare them to the vitals in the ED. What is a nursing intervention for nausea?

4) What about those ABGs are off? What are the normal ABG values? His pH is on the high end of normal. What does that tell you? Do you think the abnormality is respiratory or metabolic or a combination? Why or why not?

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CASE STUDY PROGRESS

Arterial blood gas (ABG) results are as follows (these results reflect values at sea level): pH 7.45, PaCO2 33 mm Hg, PaO2 65 mm Hg, HCO3 23 mmol/L, base excess [bE] +1.0, SaO2 91%.

4. Interpret the preceding ABGs. What do they tell you?

What's your interpretation of these results? What DO they tell you? Why do you think so?

This guy is obviously in a lot of trouble. What do you see coming down the road? What would you do to prepare for his care?

Hints: What is in your med/surg text(s) about GI bleeds? Did you look?

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Thank you every body I did the case study already

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