Peptic ulcer disease-gastrointestinal bleeding

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Reference no: EM133992729

Question

Peptic Ulcer Disease/Gastrointestinal Bleeding

A 62-year-old female client was admitted to a medical-surgical unit yesterday with partial-thickness burns to her right forearm secondary to a cooking accident. The client lives with her husband, has two adult children, and a history of rheumatoid arthritis for which she is prescribed celecoxib. Fluid resuscitation was completed, burns were dressed with a low-adherent silver dressing, and the client's pain has effectively been managed with intravenous analgesics. This morning, a nurse responds to the client's call light and finds the client lying on her side with an emesis basin filled with coffee-ground vomitus.

1. What assessment is most important for the nurse to do right now at this time

The nurse reports focused assessment data to the provider who suspects a peptic ulcer and prescribes an esophagogastroduodenoscopy (EGD) with Helicobacter pylori testing and possibly a biopsy.

Assess data:

• Alert and oriented x 3

• Lying in a left Sims position, states she doesn't want to move

• Temperature 38.2° C, Heart rate 92 beats/min, Blood pressure 118/58 mm Hg, Respiratory rate 21 breaths/min, Oxygen saturation 94% on room air

• Pain: 2/10 right forearm; 4/10 midline abdomen between the umbilicus and xiphoid process

• Respirations equal but shallow

• Radial pulses 2+

• Capillary refill < 3 seconds

• Abdomen round and tender to touch

• Hematemesis, 250 mL coffee-ground

• Right arm dressing intact

2. What is the desirable outcome for this client?

3. What interventions can achieve the desirable outcome?

4. How should the interventions be accomplished?

The EGD revealed a hemorrhaging peptic ulcer which was injected with chemicals to stop the bleeding. The client's recovery from the procedure was unremarkable and the client was subsequently transferred back to the medical-surgical unit. Two hours later, the client reports the sudden onset of sharp, severe abdominal pain. The client is experiencing tachycardia, tachypnea, and a rigid abdomen with rebound tenderness.

5. What data is of immediate concern? What is the most likely explanation for this data?

6. What actions will the nurse take at this time?

Reference no: EM133992729

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