case study .. Help !

[Saja Karaja]

Mr B is a 57-year-old man who was admitted yesterday after starting to pass black stools. He complain that he has a two-day history of severe stomach pains and has suffered on and off with indigestion for some months.

He is a life-long smoker, with mimld chronic cardiac failure (CCF) for which he has been taking enalapril 5 mg BID for 2 years. He also recently started taking naproxen 500 mg BID for arthritis

Yesterday his hemoglobin was reported as 10.3 g/dL , platelets 162 × 109/L, INR 1.1 He was mildly tachycardic (104 bpm) and had a slightly low blood pressure of 105/77 mmHg and was given 1.5 L of saline.

He has just returned from endoscopy this morning and has been newly diagnosed as having a bleeding duodenal ulcer. He has been written up for his usual medication for tomorrow if he is eating and drinking again.

What risk factors does he have for a bleeding ulcer?

Has his treatment been appropriate so far? Why?

Any tests he may still need?

Write 2 nursing diagnosis?

What are the subjective data in this case?

What are the objective data in this case?

What discharge teaching should he get?

[vanilla bean]

No one here is going to do your homework for you. I see from your past posting history that you've already been told as much. Here's how it works: you share your work and what you've come up with so far, and people will possibly come along to help point you in the right direction if you're off track or if you're still struggling with something specific.

[Saja Karaja]

okk ,, i will show you what I have done

What risk factors does he have for a bleeding ulcer?

He is taking naproxen , he is a life long smoker ,

Has his treatment been appropriate so far? Why?

Any tests he may still need?

Upper GI barium studies , stool and serum studies

Write 2 nursing diagnosis?

Acute Pain R/T irritation of the mucosa and muscle spasms AMB sever stomach pain

Imbalanced nutrition: Less than body requirements r/t inability to digest AMB suffered on and off with indigestion for some months

What are the subjective data in this case?

57 old years , male , starting to pass black stool , Complain that he has a two-day history of sever stomach pain ,smoker , has a mild chronic cardiac failure

Has suffered on and off with indigestion for some months , taking enalaoril 5mg BID for 2 years recently started taking naproxen 500mg BID for arthritis

What are the objective data in this case?

Bp 150/77 mmHg , pulse 104b/m , hemoglobin 10.3 g/dl , platelets 162 × 109/L , INR 1.1

What discharge teaching should he get?

1- Try to quit smoking .

2- Eat meals slowly

3- Avoid stressful situations

4- Avoid acid-producing substances ( caffeine, alcohol , milk and creams )

[AliNajaCat]

If he's losing blood, what is he at risk for then?

Look up stomach ulcers in your med/surg book. You'll see that "acid" isn't implicated in in most ulcers (we haven't put people on bland diets for donkey's years). What is? What gave him his? What does he need to know about this when he goes home? Why?

I think there may be a language barrier here-- the word is "severe," and there are others.

[Banana nut, BSN, RN, EMT-B]

Do you think he should stop taking naproxen? should that be an education point? Im a student too and im asking for my own understanding.