What is the most likely cause of mucosal injury and PUD in Mr. Hall’s case and explain the cause in detail? Explain other risk factors Mr. Hall has that would increase his susceptibility to mucosal injury?
Blood Pressure Lying: 92/54
Standing: 74/42
Pulse Lying: 110/min
Standing: 122/min
SpO2 96% on 2L NC
Respiratory Rate 24/min
Temperature 96.2 Oral
BUN 40 mg/dL
Creatinine 1.1 mg/dL
Hgb 8.8 grams/dL
Hct 42 %
WBC 14,000
H-Pylori Positive
Content: Wagner and Hardin-Pierce: Chapters 20 and 21
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1. What are all the possible causes of upper GI bleeding and their percentage of occurrence in all GI bleeding cases? ( .5 points)
2. What is the most likely cause of mucosal injury and PUD in Mr. Hall’s case and explain the cause in detail? Explain other risk factors Mr. Hall has that would increase his susceptibility to mucosal injury? (1.75 points)
3. Explain how Mr. Hall’s PUD could cause an abnormal BUN level. (.5 points)
4. Examine Mr. Hall’s hemoglobin (Hgb) and hematocrit (Hct). Based on his acute problem, explain these values. What are normal values for hemoglobin and hematocrit? (.5 points)
5. The gastroenterologist orders: Protonix 8mg/hr IV continuous. What are the action and uses, major adverse effects, and nursing implications for this drug? (1.25 points)
Scenario continued: Mr. Hall’s endoscopic examine showed an actively bleeding duodenal ulcer located just distal to the pyloric sphincter. It is approximately 0.8 cm in size. Repeat blood work reveals a hemoglobin of 8.2 grams/dL and a hematocrit of 40%.
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6. As part of the initial assessment, the nurse must evaluate Mr. Hall’s hemodynamic stability. What findings would be concerning to the nurse? (1 point)
7. The Emergency department physician has requested that the patient be transferred to the ICU. What are the guidelines for admission to the ICU and which apply to Mr. Hall? (1.25 points)
8. What is the next priority (following initial assessment) in the management of Mr. Hall’s acute GI bleed? Describe early management (be thorough). (1.25 points)
Reference