Gastrointestinal. Case study

Welcome to your Gastrointestinal. Case study

He reports intermittent dizziness and fatigue that have been worsening over the past 2 days. His skin is pale, cool, and clammy. His abdomen is slightly distended. He reports pain (4 on a scale of 1 to 10) in the mid-epigastric area and says he is thirsty.

Capillary refill is prolonged,
blood pressure is 100/90 mm Hg,
pulse is weak and thready at 130 beats/ min,
respiratory rate is 24 breaths/min, and temperature is 99°F (37.2°C).

Question 1 of 6 GI CS1

Mr. S, a 50-year-old man, has driven himself to the emergency department (ED) after vomiting a large amount of bright red blood twice within the past 3 hours. He arrives alert and oriented to person, place, and time but appears anxious and restless. He is able to provide only a vague history but admits to drinking “a few” last weekend. He knows that he is “supposed to stop drinking” and is supposed to take “something for my stomach,” but he cannot recall the name of the medication.

Which signs and symptoms are indicative to the nurse that risk for hypovolemic shock is the focus of the initial assessment and which ones are not?

	Indicative	No indicative
Alert and oriented
Vomiting a large amount of bright red blood
Drinking "a few" last weekend
Abdomen is slightly distended.
Cannot recall the name of the medication.
BP 100/90 mm Hg.
Capillary refill is 4.5 seconds.

Question 2 of 6 GI CS1

Mr. S is showing signs and symptoms of hypovolemia and priority collaborative interventions must be implemented. Team members must work together to quickly stabilize his condition.
What are the priority collaborative interventions to perform for this patient? Select all that apply

Prepare for endotracheal intubation.

Assist with the central line placement.

Check the stool for occult blood.

Administer supplemental oxygen.

Monitor vital signs and oxygen saturation q 15 min.

Insert a large bore nasogastric tube

Establish two peripheral IV lines with large-bore catheters.

Initiate electrocardiogram (ECG) monitoring.

Monitor airway, breathing, and circulation (ABCs).

Obtain past medical, surgical, and medication history.

Obtain blood for a complete blood count (CBC), clotting studies, and type and cross-match.

Administer IV normal saline (NS) fluid bolus 500 mL over 30 minutes.

Question 3 of 6 GI CS1

Mr. S showed signs and symptoms of hypovolemia and priority collaborative interventions were implemented.
Which two actions would cause the charge nurse to intervene immediately in case that occurs?

LPN/LVN inserts an indwelling urinary catheter.

AP offers the patient a small glass of water.

HCP raises the proximal side rails.

Respiratory therapist adds a humidifier to oxygen setup.

Nutritionist suggests increasing oral salt intake immediately.

Pharmacy tech delivers a diuretic medication prescribed earlier.

Physical therapist plans for a standing exercise session.

Nurse practitioner orders for a central venous pressure monitoring.

Question 4 of 6 GI CS1

Mr. S showed signs and symptoms of hypovolemia and priority collaborative interventions were implemented.
Now the HCP orders a STAT blood transfusion.
In an emergency, which type-specific non–cross-matched blood product could be used?

O negative

AB negative

A negative

AB positive

B positive

Question 5 of 6 GI CS1

Mr. S showed signs and symptoms of hypovolemia and priority collaborative interventions were implemented.
Now the HCP orders a STAT blood transfusion.
The nurse is preparing to administer a blood transfusion to Mr. S. To prevent complications and reduce the risk of transfusion reaction, the nurse must perform standard steps and follow protocols for preparing the equipment and monitoring the patient.

Instructions: In the left column are steps to perform for a blood transfusion. In the right column put the number to indicate the correct order of the steps, 1 being the first step and 9 being the last step.
Steps to perform for a blood transfusion

7. Inspect the bag for leaks, clots, or unusual color.

8. Compare the bag label with the chart and the blood bag forms.

6. Repeat vital sign measurement 15 minutes after infusion begins.

1. Prime the correct tubing and filter with normal saline.

4. Compare the blood band ID with the tag on the blood bag; this should be performed by two licensed people.

3. Transfuse the first 10 mL slowly; monitor the patient closely.

2. Take vital signs immediately before starting the transfusion.

9. Repeat vital signs every hour until the transfusion is complete

5. Document outcomes, names of personnel, and starting and ending times.

Question 6 of 6 GI CS1

After emergency treatments are given, Mr. S’s vital signs are a blood pressure reading of 130/80 mm Hg, a pulse of 90 beats/min, a respiratory rate of 24 breaths/min, and a pulse oximetry reading of 98% on room air. He has not vomited. Subjectively, he feels “better, but a little nervous.” The nurse notes that he is restless and has fine tremors (possible early signs of alcohol withdrawal syndrome). Mr. S is to be admitted to the medical-surgical unit for observation and continued management of acute gastritis with bleeding.
After the SBAR report is completed, Mr. S is prepared for transport to his room in the medical-surgical unit. He is greeted by the medical-surgical nurse who will assume responsibility for this care. The nurse assesses him and orients him to the environment. He is tired but also anxious to see the HCP. The HCP arrives and recommends that Mr. S have an EGD.
Mr. S agrees to have the EGD and is being prepared for the procedure. Which instruction will the nurse give to the AP?

Assist Mr. S as needed to the bathroom while he is undergoing bowel preparation.

Help Mr. S to take a shower with the special antibiotic cleaning solution.

Remind Mr. S that he is to have nothing by mouth for 8 hours before the procedure.

Assist Mr. S with undressing and removing all metal objects and then with donning a hospital gown.

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