Reference no: EM133225584

Case: You are on duty in the intermediate care unit and scheduled to take the next admission. The emergency department (ED) nurse calls to give you the following report: "This is Barb in the ED, and we have a 62-year-old man, K.L., with lower GI bleeding. He is a sandblaster with a 12-year history of silicosis. He is taking 40 mg of prednisone per day. During the night, he developed severe diarrhea. He was unable to get out of bed fast enough and had a large maroon-colored stool in the bed. His wife 'freaked' and called the paramedics. He is coming to you. His vital signs (VS) are stable-110/64, 110, 28, Spo2 93%-and he's a little agitated. His temperature is 98.2° F (36.8° C). He has not had any stools since admission, but his rectal examination was guaiac positive and he is pale but not diaphoretic. We have him on 5 L O2/NC. We started a 16-gauge IV with LR at 125 mL/hr. He has an 18-gauge Salem Sump to continuous low suction; that drainage is guaiac negative. We have done a CBC with differential, chem panel, coagulation times, a T&C for 4 units, ABGs, and a UA. He's all ready for you."

Question 1. Describe the ongoing assessment you need to obtain.

Question 2. What assessment data would lead you to determine K.L.'s condition was stabilizing?

Question 3. What is the expected outcome associated with giving esomeprazole?

Question 4. Later, when he seems to be feeling better, K.L. tells you he is really embarrassed about the mess he made for you. How are you going to respond to him?

Question 5. K.L. is being prepared for discharge. What do you need to address in your teaching with K.L.?