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Valerie Jones 79 y/o Female Primary Diagnosis: Upper…
Valerie Jones
79 y/o
Female
Primary Diagnosis:
Upper Gastrointestinal Bleeding
Pathophysiology
Bleed may originate in esophagus, stomach or duodenum. Common with peptic ulcer disease associated with H pylori infection. Rupture in the wall causes hemorrhaging
Possible Complications
Hypovolemia/Hypovolemic Shock
Low O2
Oxygen < 92%
blood transfusion
apply O2 PRN
Low H & H
Hgb < 12
Hct < 36
monitor output from gastric suctioning for bleeding
blood transfusion
Encourage intake of fluids
Low Blood Pressure
systolic < 110
administer medications if ordered
fluid bolus
call provider if exceed 200 mL/hr
Treatments
Vital signs every 15 minutes
Telemetry ON
Apply O2 PRN to maintain sats > 92%
IV NS 100- 200 mL/hr; titrate to keep SBP >110
Insert Urine catheter
Insert NG to LCS
Call MD if UO < 30 mL/hr
NPO
Find the source of bleeding
Risk for aspiration
Risk for dehydration and malnutrition r/t vomiting
Monitor K and Na
Full Code
unstable condition
admit to ICU
Medications
2 units of PRBC ASAP
Labs
CBC; monitor H& H
Chem 12: monitor kidney function and electrolytes
Platelets
Type and Crossmatch RBC
Found on the floor by daughter this morning, she was coherent but moaning and covered in bright red vomit