Gastrointestinal Case Studies 1. Cirrhosis -Mr. Garcia is a 43-year old male who presented to the ED complaining of nausea and vomiting x 3 days. The...
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Gastrointestinal Case StudiesCirrhosis b.     What diagnostic studies might you anticipate for Mr. Garcia?

1.     - Mr. Garcia is a 43-year old male who presented to the ED complaining of nausea and vomiting x 3 days. The nurse notes a large, distended abdomen and yellowing of the patient's skin and eyes. The patient reports a history of IV drug use and alcohol use.

a.     What initial nursing assessment should be performed?

Mr. Garcia's vitals are stable, BP 100/58, bowel sounds are active but distant, and the nurse notes a positive fluid wave test on his abdomen. The patient denies itching but is constantly scratching at his chest. He is oriented to person only and his brother at the bedside reports he has not been himself today. He keeps trying to get out of bed.

c.     Which finding is most concerning and needs to be reported to the provider?  Explain your response.

d.     What further diagnostic and lab studies should be ordered to determine Mr. Garcia's priority problem?

The provider places orders for the following:

Keep SpO2 > 92%

Keep HOB > 30 degrees

Insert 2 large bore PIV's

500 mL NS IV bolus STAT

100 mL/hr NS IV continuous infusion

Hydrocodone/Acetaminophen 5-500 mg 1 tabs q4h PRN for moderate pain

Hydrocodone/Acetaminophen 5-500 mg 2 tabs q4h PRN for severe pain

Diphenhydramine 25 mg PO q8h PRN itching

Ondansetron 4 mg IV q6h PRN nausea

Lactulose 20 mg PO q6h


Mr. Garcia's LFT's and Ammonia level are elevated. He is extremely confused, agitated and appears somewhat short of breath. The patient's current vital signs are as follows:

                        HR 82              RR  22

BP 94/56         SpO2 93%

                        Temp 98.9°F


e.     Which order should be implemented first?  Why?

f.      Which order should be questioned?  Why?

g.     Why is Mr. Garcia so confused and agitated?  Explain the pathophysiology of your answer.


The provider calls to tells you he wants to perform a paracentesis on Mr. Garcia. He will be gathering the supplies and will be at the bedside in 10 minutes.

h.      Is it safe for Mr. Garcia to get a paracentesis currently?

i.      What medication will help with Mr. Garcia's confusion? What is the mechanism of action for this medication?

j.      List 3 nursing diagnoses which are appropriate for Mr. Garcia


In two days, Mr. Garcia's condition has improved.  His wife is at the hospital and is inquiring about how to care for him at home.

k.     What nutritional teaching should be included in the discharge teaching for Mr. Garcia?


2.     Pancreatitis

 

Mrs. Miller presented to the emergency room with complaints of epigastric pain of 10/10 with nausea and vomiting.  She is obese, a heavy smoker, and drinks alcohol. Mrs. Miller is being admitted with a diagnosis of acute pancreatitis. 

a.     Briefly explain acute pancreatitis and discuss its incidence. 

b.     What are the major causes acute pancreatitis?

c.     Can a person have chronic pancreatitis? If so, what is the incidence, and how would you define chronic pancreatitis?

d.     Discuss the common clinical manifestations of acute pancreatitis

e.     Briefly discuss the diagnostic tests which help confirm the diagnosis of pancreatitis


Mrs. Miller is scheduled for a KUB asks "What is the test I am having done today?" 

f.      How would the nurse describe a KUB to Mrs. Miller?

g.     Briefly discuss the treatment options for pancreatitis and explain why Mrs. Miller has an NG tube to low wall suction.

h.     Discuss the complications which can arise if pancreatitis is not treated.

i.      Identify 3 priority nursing diagnoses for a patient with acute pancreatitis

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