Question: Abdominal Assessment Mr. Paul Is A 71 Year Old Admitted To Room H-523 With A GI Bleed. VS=B/P 100/60 TPR=37°C 100-20. Pulse Ox= 96% RA Pain 7/10 C/o Abdominal Discomfort Color Pale, Skin Warm & Dry. Braden = 21. A & Ox 4, PERRLA, MAE X 4. Hand Grip = & Weak. Unsteady Gait When Ambulating. Needs Assistance Of 1. Denies Numbness Or Tingling To Extremities. …

Abdominal Assessment Mr. Paul is a 71 year old admitted to room H-523 with a GI Bleed. VS=B/P 100/60 TPR=37°C 100-20. Pulse Ox= 96% RA Pain 7/10 c/o abdominal discomfort Color pale, skin warm & dry. Braden = 21. A & Ox 4, PERRLA, MAE X 4. Hand grip = & weak. Unsteady gait when ambulating. Needs assistance of 1. Denies numbness or tingling to extremities. Lungs clear vesicular sounds. No cough. PPP x 4 @ +2, No edema, No JVD. CR < 3 sec. Abdomen hyperactive BS in all four quadrants. Abd soft; Clo abdominal tenderness to RUQ & LUQ upon palpation. No distention. Negative rebound Black tarry stoolĆ visible blood. Pt clo diarrhea x 2 days. No co nausea. Foley catheter inserted to straight drain c clear amber urine. Falls precautions dit weakness. History of GERD! and depression Stat EGD completed. Results of biopsy pending. Pt states he is afraid of results of biopsy. CXR is normal. Use these Nursing Diagnosis. Acute pain, Risk for shock, and Risk for Anxiety. Primary Nursing Diagnosis Nursing Diagnosis 2 Nursing Diagnosis 13 Supporting Data Supporting Data Supporting Data STG STG STG Interventions with Rationale Interventions with Rationale Interventions with Rationale