MS WINNIE UPPER AND LOWER GI BLEEDING CASE STUDY
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
Ms. Winnie
GENDER Female
SPIRITUAL/RELIGIOUS ■ Jehovah’s Witness
AGE 33
SETTING Hospital
PHARMACOLOGIC Norgestimate/ethinyl estradiol (Ortho Tri-Cyclen); ibuprofen (Advil); pantoprazole (Protonix); prochlorperazine (Compazine); omeprazole (Prilosec)
ETHNICITY White American
CULTURAL CONSIDERATIONS
PREEXISTING CONDITION
COEXISTING CONDITION
Flulike symptoms for one week
COMMUNICATION
DISABILITY
SOCIOECONOMIC Recently promoted to project manager
LEGAL
ETHICAL
ALTERNATIVE THERAPY
PRIORITIZATION
DELEGATION
Delegating within the scope of assistant nursing personnel responsibilities
Overview: This case requires recognition of the signs and symptoms of a gastrointestinal (GI) bleed and characteristics of upper versus lower GI tract bleeding. The nurse provides client education in preparation for a diagnostic procedure and explains the significance of the results. The procedure for administering a blood transfusion is reviewed. Discharge instructions are given.
Client Profile
Ms. Winnie is a 33-year-old woman who presented to the emergency department. She states, “I have been so sick. It must be the flu. Everyone at work has it. I am achy and tired. I keep vomiting and have not been able to keep anything down for the past three days. After a while, it is just these violent dry heaves since there is nothing more in my stomach to throw up. Tonight I vomited twice within three hours and it was red like blood. I got scared and came in.”
Case Study
Ms. Winnie’s vital signs are BP 110/60, HR 88, RR 20, temperature 100.5°F (38°C). Her skin is clammy and pale. Lab results are WBC 11,800 cells/mm3, RBC 3.31 million/μL, Hgb 11 g/dL, Hct 34%, platelets 150,000 mm3, K 3.8 mEq/L, Na 140 mEq/L. An electrocardiogram (ECG, EKG) shows normal sinus rhythm. A kidneys, ureters, and bladder (KUB) abdominal X-ray is done, and she will have an esophagogastroduodenoscopy (EGD) at 7:00 a.m. the next day. She is admitted with the diagnosis of probable upper GI bleed. Ms. Winnie expresses concern to the nurse, “Do you think I’ll be in the hospital long? I have been managing an important project for the past few months at the company I work for, and although my boss has been pretty understanding about me being out sick for the past few days, there is an important deadline coming up next week. Being in the hospital long may jeopardize my job.” She is started on intravenous (IV) fluids of normal saline (NS) at 100 mL per hour. Pantoprazole continuous IV drip and prochlorperazine as needed for nausea and vomiting are prescribed. Ms. Winnie is to have strict monitoring of her intake and output and her vital signs assessed every two hours. She will be on bed rest. Her stools are to be tested for occult blood. She will have a complete blood count (CBC) assessed every six hours.
Results of the KUB are reported as a nonspecific gas pattern with moderate amount of stool throughout the colon with no acute abnormality noted. The EGD reveals a normal duodenum with no vascular anomalies, ulceration, or inflamma-tion. There is a normal appearing gastric mucosa with no erosive changes, ulcer, or mass. A small Mallory-Weiss tear is noted.
Questions
- The nurse asks Ms. Winnie if she takes any medi-cations at home. Ms. Winnie states, “I take Ortho Tri-Cyclen once a day and I was taking Advil three to four times a day for the aches and pains of being sick.” Should the nurse suggest to the health care provider that these two medications be included in Ms. Winnie’s admission orders?
- Identify four nursing diagnoses that are appro-priate for Ms. Winnie upon admission.
- Which lab results are abnormal and what is the significance of the abnormal results in Ms. Winnie’s case?
- Distinguish between the characteristics of upper and lower GI bleeding.
- It is 1:00 a.m. and Ms. Winnie is settled into her room on the nursing unit. She asks the nurse“Do you have some saltine crackers and ginger ale to try and help settle my stomach?” Should the nurse give Ms. Winnie something to eat?
- The nurse recognizes the scenario in Question 5 as a teaching opportunity. How might the nurse explain why an EGD has been prescribed for Ms. Winnie and what she can expect during the procedure?
- What are the nursing responsibilities after Ms. Winnie has the EGD and returns to her room?
- Discuss the Mallory-Weiss tear found during Ms. Winnie’s EGD. What is a Mallory-Weiss tear? What are the common symptoms of a Mallory-Weiss tear and what causes it?
- Which factors determine if blood products will be administered to a client with GI tract bleeding secondary to a Mallory-Weiss tear?
If a transfusion is needed and Ms. Winnie’s blood type is A positive, what are compatible blood types? Explain why a person can only receive compatible blood types. Although unlikely with a Mallory-Weiss tear, the nurse realizes that if Ms. Winnie’s bleeding does not resolve, she may need a blood transfusion. The nurse has not administered blood in a while and reviews the agency policy and procedure. Place the following ten steps of administering a blood transfusion in the proper order. Monitor vital signs per agency policy. Obtain blood products from the blood bank, keeping in mind that packed blood red cells (PRBC) transfusions should be completed within four hours of removal from refrigeration. Remain with the client during the first fifteen to thirty minutes of the transfusion (infusion of the first 50 ml of blood product) to assess for adverse reactions. Administer the blood product using appropri-ate filter tubing. Filters remove aggregates and possible contaminants. If blood is to be diluted, use only normal saline. Verify the medical prescription for type of blood product, dose, and transfusion time. Discontinue the transfusion when complete and dispose of the bag and tubing properly. Document type of blood product infused, time of infusion, and any adverse reactions. Obtain venous access with a larger-bore needle (19-gauge). Assess baseline vital signs, urine output, skin color, and history of transfusion reactions.With another registered nurse, verify the client by name and identification number, check blood product compatibility, and note expiration time. Do not use the client’s room number as a form of client identification.
- Later in the shift, the nurse is looking through Ms. Winnie’s chart and comments to herself, “I think I may have reviewed the policy and procedure book for nothing.” Why does the nurse believe she may not need to know how to administer blood to Ms. Winnie after all?
- Which aspects of Ms. Winnie’s plan of care could the registered nurse assign to assistive nursing per-sonnel such as a certified nursing assistant (CNA)?
- Should Ms. Winnie be concerned about her job? What do you anticipate will be her length of stay in the hospital?
- If it is determined that Ms. Winnie has a bacte-rial infection and she is discharged with a prescrip-tion for an antibiotic, what teaching is appropriate regarding the use of an antibiotic with an oral contraceptive?
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). 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