Instructions:  use client data and evidence-informed literature support answers. Include in-text citations and references.

Instructions: 

1. use client data and evidence-informed literature support answers. Include in-text citations and references.
2. Be very concise! Use point-form, lists, tables (ie: column for data and one for rationale) rather than narrative.

Case Study

The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at 0430. She told the ED triage nurse that he had diarrhea for the past 2 days and that last night he had a lot of “dark red” diarrhea. When he became very dizzy, disoriented, and weak this morning, she decided to bring him to the hospital. C.W.’s vital signs (VS) in the ED were 70/− (systolic blood pressure [SBP] 70, diastolic blood pressure [DBP] inaudible), pulse rate 110, respiratory rate 22, oral temperature 99.1 ° F (37.3 ° C). A 16-gauge IV catheter was inserted and a lactated Ringer’s infusion was started. Two years ago, he had a cardiac arrest that was attributed to hypokalemia. He has a long history of hypertension and arthritis. He had atrial fibrillation in the past, but it has been under control recently. Fifteen years ago he had a peptic ulcer.

Endoscopy showed a 25- × 15-mm duodenal ulcer with adherent clot. The ulcer was cauterized, and C.W. was admitted to the medical intensive care unit (MICU) for treatment of his volume deficit. You are his admitting nurse. As you are making him comfortable, Mrs. W. gives you a paper sack filled with the bottles of medications he has been taking: enalapril (Vasotec) 5 mg PO bid, warfarin (Coumadin) 5 mg/day PO, digoxin (Lanoxin) 0.125 mg/day PO, potassium chloride 20 mEq PO bid, and diclofenac (Voltaren) 50 mg PO tid. As you connect him to the cardiac monitor, you note he is in sinus tachycardia and that he has peaked t waves. Doing a quick assessment, you find a pale man who is sleepy but rousable and slightly disoriented. He states he is still dizzy and feels weak and anxious overall. His BP is 98/52, pulse is 118, and respiratory rate 26. You hear S3 and S4 heart sounds and a grade II/VI systolic murmur. Peripheral pulses are all 2+, and trace pedal edema is present. Capillary refill is slightly prolonged. Lungs are clear. Bowel sounds are present, mid-epigastric tenderness is noted, and the liver margin is 4 cm below the costal margin. Has not yet voided since admission. Rates his pain level as “2.” A triple lumen IJ central line and a radial arterial line are inserted.

lab results

questions to answer:

1. From his history and assessment, identify 5 signs and symptoms of GI bleeding and loss of blood volume, and explain the patho-physiology for each one listed. What may have precipitated C.W.’s gastrointestinal (GI) bleeding?

2. From your head to toe assessment list which systems are impacted and the findings that led you to that conclusion. What nursing interventions would implement?

3. After examination of the lab results, what are the concerns with C.W.’s electrolyte levels? In view of the lab results, what diagnostic test will be performed and why? Identify what changes/findings you expect or are present and how those changes may impact the condition of C.W.

4. What other blood work results are of concern? Why?

Calculate C.W’s mean arterial pressure (MAP) and explain why this measure is important. Is C.W currently taking home medications that may impact his blood pressure? What other medications do you anticipate may be added?

5. Use client data to:

1. identify type of shock
2. explain the identifying factors of this shock state.
3. determine/identify appropriate interventions.

6. Which members of the interdisciplinary team are you expecting to participate in the care of C.W and what would you expect them to contribute?