Reference no: EM133851238

Question

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/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 inflammation. 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 medications 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?

2. Identify four nursing diagnoses that are appropriate for Ms. Winnie upon admission.

3. Which lab results are abnormal and what is the significance of the abnormal results in Ms. Winnie's case?

4. Distinguish between the characteristics of upper and lower GI bleeding.

5. 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 based on her condition!

6. 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?

7. What are the nursing responsibilities after Ms. Winnie has the EGD and returns to her room?

8. 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?

9. Which factors determine if blood products will be administered to a client with GI tract bleeding secondary to a Mallory-Weiss tear?