solve from 5 to 10
Transcribed Image Text from this Question
CASE STUDY 3 3 Ms. Winnie GENDER Female AGE 33 SETTING SPIRITUAL/RELIGIOUS • Jehovah’s Witness PHARMACOLOGIC – Norgestimate/ethinylestradiol (Ortho Tri-Cyclon); ibuprofen (Advil: pantoprazole (Protonix prochlorperazine (Compainel omeprazole (Prilosec LEGAL Hospital ETHNICITY – White American CULTURAL CONSIDERATIONS ETHICAL PREEXISTING CONDITION ALTERNATIVE THERAPY PRIORITIZATION COEXISTING CONDITION Flulike symptoms for one week COMMUNICATION DELEGATION Delegating within the scope of assistant nursing personnel responsibilities DISABILITY MODERATE SOCIOECONOMIC Recently promoted to project manager THE DIGESTIVE SYSTEM Lovel of difficulty: Moderate 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 murse 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. 79 Client Profile Case Study 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.” 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/mm. RBC 3.31 million/iL, Hgb 11 g/dL. Het 34%, platelets 150,000 mm”, K 38 mEq/L. Na 140 mEq/L. An electrocardiogram (ECG, EKG) shows normal simas rhythm. A kidneys, ureters, and bladder (KUB) abdominal X-ray is done, and she will have an esophagogastroduodenoscopy (EGD) at 7:00 AM the next day. She is admitted with the diagnosis of probable upper GI bleed. Ms. Winnie expresses concem 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 myjob.” 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 1. The nurse asks Ms. Winnie if she takes any medi- “Do you have some saltine crackers and ginger ale to cations at home. Ms. Winnie states, “I take Ortho try and help settle my stomach?” Should the nurse Tri-Cyclen once a day and I was taking Advil three give Ms. Winnie something to cati to four times a day for the aches and pains of being 6. The nurse recognizes the scenario in Question 52s sick,” Should the nurse suggest to the health care a teaching opportunity. How might the nurse explain provider that these two medications be included in why an EGD has been prescribed for Ms. Winnie and Ms. Winnie’s admission orders: what she can expect during the procedure 2. Identify four nursing diagnoses that are appro 7 What are the nursing responsibilities after priate for Ms. Winnic upon admission. Ms. Winnie has the EGD and returns to her room? 3. Which lab results are abnormal and what is the 8. Discuss the Mallory-Weiss tear found cluring significance of the abnormal results in Ms. Winnie’s Ms. Wimie’s EGD. What is a Mallory-Weiss tear? case? What are the common symptoms of a Mallory-Weiss 4. Distinguish between the characteristics of upper tear and what causes it? and lower GI bleeding 9. Which factors determine if blood products will 5. It is 1:00 A.M. and Ms. Winnie is settled into be administered to a client with GI tract bleeding her room on the nursing unit. She asks the nurse. secondary to a Mallory-Weiss tear? 10. 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.
(Visited 2 times, 1 visits today)
