Help with case study!!!

[SarahT316]

I am a new nursing student. We were given a case study as part of the final. However, all of this is very new to me and I'm struggling with it. Any help would be appreciated. Thanks! Attaching a copy of the case study...

John Adams is 55 years of age and is a male patient who is admitted to the ICU with the diagnosis of acute esophageal varices bleed. Pt. has long standing history of alcoholism and cirrhosis of the liver. The patient has quit drinking alochol for the past six months and has been active in AA. Also has a history of CAD and angina. Admitting vitals: BP: 88/50, P:110, R:26 and T: 99 F. O2 saturation is 88% on room air and pt. is on 2L/min of Oxygen with O2 saturation of 94%. The patient's hemoglobin is 6 g/dL, hemotocrit is 12% and the platelets are 75,000. The pt. has a prolonged PT and PTT. BUN and serum creatinine are also elevated. THe patient has in place from the emergency department a nasal gastric tube to low wall suction. The emergency department physician placed a right subclavian triple lumen catheter and there is NS infusing at 100 mL per hour. The emergency department nurse administered Vit K. Additional orders on the chart from the gastroenterologist include: octreotide (Sandostatin) 5mcg bolus followerd with continuous infusion 500 mcg in 250 mL D5NS at 25 mcg per hour. Type and cross of 6 units of PRBCs STAT and transfuse 2 units of PRBCs over 2 hours each and administer furosemide (lasix) 20 mg IVP in between each unit. Repeat CBC one hour after the transfusion is completed.

In what order should the nurse institute the physician order? Perform dosage calculations.

The nurse observes the NG secretions and upon admission to the ICU there was 200 mL of dark red colored drainage. The nurse continues to monitor the drainage and as the nurse hangs the first unit of PRBCs 200mL of bright red bloody drainage is dumped in to the collection canister. What should the nurse do?

what I have so far:

First step: give blood, followed by the bolus

Bolus: (5mcg/mL) = (500mcg/ 250mL) yielding 2.5mL bolus

Per hr. (500 mcg/250mL) = (25 mcg/ x mL) yilding 12.5 mL/hr

[pockunit, ADN, RN]

This is for a final? Are you allowed to get outside help?

[tnbutterfly - Mary, BSN]

Moved to Nursing Student Assistance for more response.

[SarahT316]

Yes! It's part of our take home exam. We are allowed to work on it with our classmates, but everyone else is as lost as me.

[pockunit, ADN, RN]

I don't know, maybe you'd want to check vitals if 200 mL of blood just shoots out of the ng tube?

[Esme12, ASN, BSN, RN]

I am a new nursing student. We were given a case study as part of the final. However, all of this is very new to me and I'm struggling with it. Any help would be appreciated. Thanks! Attaching a copy of the case study...

John Adams is 55 years of age and is a male patient who is admitted to the ICU with the diagnosis of acute esophageal varices bleed. Pt. has long standing history of alcoholism and cirrhosis of the liver. The patient has quit drinking alcohol for the past six months and has been active in AA. Also has a history of CAD and angina.

admitting vitals: BP: 88/50, P:110, R:26 and T: 99 F. O2 saturation is 88% on room air and pt. is on 2L/min of Oxygen with O2 saturation of 94%. The patient's hemoglobin is 6 g/dL, hematocrit is 12% and the platelets are 75,000. The pt. has a prolonged PT and PTT. BUN and serum creatinine are also elevated.

THe patient has in place from the emergency department a nasal gastric tube to low wall suction. The emergency department physician placed a right subclavian triple lumen catheter and there is NS infusing at 100 mL per hour. The emergency department nurse administered Vit K.

Additional orders on the chart from the gastroenterologist include:

1) octreotide (Sandostatin) 5 mcg bolus

2) followed with continuous infusion 500 mcg in 250 mL D5NS at 25 mcg per

hour.

3) Type and cross of 6 units of PRBCs STAT and transfuse 2 units of PRBCs over

2 hours each and

4) administer furosemide (lasix) 20 mg IVP in between each unit.

5) Repeat CBC one hour after the transfusion is completed.

In what order should the nurse institute the physician order? Perform dosage calculations.

The nurse observes the NG secretions and upon admission to the ICU there was 200 mL of dark red colored drainage. The nurse continues to monitor the drainage and as the nurse hangs the first unit of RBCsin to the collection canister.

What should the nurse do?

what I have so far:

First step: give blood, followed by the bolus

Bolus: (5mcg/mL) = (500mcg/ 250mL) yielding 2.5mL bolus

Per hr. (500 mcg/250mL) = (25 mcg/ x mL) yielding 12.5 mL/hr

Welcome to AN! The largest online nursing community!

We are happy to help....but we will not do your home work for you but we can help you think about what needs to be done. Is this a full case study? Do you need to include a care plan?

Looking at what you have provided....What should the nurse do?

First....look at your vital signs. Are they normal? Are they low or high on admission? Would those vitals need to be repeated? The biggest thing about any patient is the assessment. The second is knowledge about the disease process. What do the labels mean to you? What significance will they have about this patients care? Are there any critical values? With this patients history of esophageal varices......does the 200mL of bright red bloody drainage is dumped concern you?

This is where the steps of the nursing process begin and what you should be doing in each step when you are caring for the patient.:

1. assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
   
2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
   
3. planning (write measurable goals/outcomes and nursing interventions)
   
4. implementation (initiate the care plan)
   
5. evaluation (determine if goals/outcomes have been met)
   

So....this patients vitals were 88/50, P:110, R:26 on admission. Since then they have received Vitamin K and a central line inserted. He comes to the ICU and the patient dumps an additional of bright red blood.....you have just begun the first unit of packed cells. What should be your first response? ( remember.....P= Problem E=Etiology S=Signs and Symptoms). What do you want to know first? What information is most valuable at this very moment.

Assess the patient right? What are the vitals? What is their color? Are they having trouble breathing? YOur first response is ......check your patient first.

Looking at the orders since you are hanging blood are we to assume that the Type and cross of 6 units of RBCs STAT already complete? Since you are hanging the first of the 2 units when you saw the additional 200 cc's of blood collect in the NGT suction canister.

The emergency department did you a huge favor by inserting the multi-lumen/triple lumen catheter. You already have O.9ns infusing at 100cc/hr. You have the blood infusing to another port.

You can now give any meds, or start IV drips, and not disturb the PRBC infusing......

What else should you monitor with this patients assessment, labs and history? With an elevated BUN and Cr.....what would be a concern for you? With the patients cardiac history/angina what else should concern you? What should you look for with the patients low HgB/HCT? Can a low H/H cause angina and SOB? Can a low H/H and circulating blood volume make the patient a safety risk?

Does this help?

[aperkins272]

update?