Surgical Nurses: your input on scenario

[Town & Country]

Please read this scenario and give me your opinion.

"You have just received on your unit from PACU, a 45-year-old man that has just had a partial gastrectomy for a bleeding ulcer. You learn that the patient's history is as follows:

He is an active 45 year old with no general health problems. He was placed on Celebrex 2 weeks ago for a painful knee that was interfering with his Tennis and Golf. Today, he presented to the ER vomiting copious amounts of bright red blood, with a history of vomiting coffee ground material for the last two or three days. His CBC in the ED showed a Hgb of 5, Hct 15.2, Na 145, K+ 3.2, Choloride 110, BUN 72, Creatinine 0.9. He was immediately taken to surgery where it was found that a duodenal ulcer had perforated into a vessel and there was a severe hemorrhagic gastritis in the base of the stomach.

On arrival to the Surgical Unit, the patient is drowsy, cool, and pale. He has an IV and NG draining bloody fluid fairly briskly. He arouses easily to your voice and is oriented x 3. His VS are T 96.8, BP 102/70, HR 118, RR 16. There is no peripheral edema and the peripheral pulses are weakly palpated. He had a Foley catheter inserted in the lED and it is draining a small amount of dark amber urine. A unit of PRBC is infusing.

What essentials of this assessment are missing?"

[meownsmile, BSN, RN]

I would have a fit if they tried to bring this patient back to a general surgical floor. ICU for this dude, at least 24 hours.

[McGyverRN]

I agree. And I hope that he has gotten more than one unit of blood. What was the EBL in the OR? How often are H & H being checked?

[christvs, DNP, RN, NP]

Please read this scenario and give me your opinion.

"You have just received on your unit from PACU, a 45-year-old man that has just had a partial gastrectomy for a bleeding ulcer. You learn that the patient's history is as follows:

He is an active 45 year old with no general health problems. He was placed on Celebrex 2 weeks ago for a painful knee that was interfering with his Tennis and Golf. Today, he presented to the ER vomiting copious amounts of bright red blood, with a history of vomiting coffee ground material for the last two or three days. His CBC in the ED showed a Hgb of 5, Hct 15.2, Na 145, K+ 3.2, Choloride 110, BUN 72, Creatinine 0.9. He was immediately taken to surgery where it was found that a duodenal ulcer had perforated into a vessel and there was a severe hemorrhagic gastritis in the base of the stomach.

On arrival to the Surgical Unit, the patient is drowsy, cool, and pale. He has an IV and NG draining bloody fluid fairly briskly. He arouses easily to your voice and is oriented x 3. His VS are T 96.8, BP 102/70, HR 118, RR 16. There is no peripheral edema and the peripheral pulses are weakly palpated. He had a Foley catheter inserted in the lED and it is draining a small amount of dark amber urine. A unit of PRBC is infusing.

What essentials of this assessment are missing?"

I would want to know how many units of RBCs did he get so far, does he have pain, any SOB, and nausea, what are his lung and bowel sounds like, what is his O2 sat level, how "fairly briskly" is the NG tube draining, etc. Oh & I'd also want to know why his BUN is so high if he has no general health issues otherwise. Also what is being done for his low Potassium level?