Josh Smith Adult 2 Sim #3 May 4, 2012 1) What factors increase this patients risk for GI Bleed?

No regular HC provider that she has check ups/tx with Medication to tx joint pain 4 regular aspirin q3-4h for 1 month Hx smoking Age Emesis r/t discomfort? Pain? Bleed? Either way, it can cause increased irritation and worsen the pt inner tissue of GI 2) What are the differences between upper and lower GI Bleeds? Upper GI Bleed this will be bleeding anywhere along the upper tract to include mainly the esophagus and stomach, but can extend to sm intestine Lower GI Bleed this location will be the lower portion of sm intestine, colon and rectum The differences between these bleeds stems from location and this will show with pt presentation of different S/S for instance, vomiting blood vs. coffee ground-like material can give the examiner an idea of where in the tract the bleed is occurring (esophagus or stomach). Likewise, if the pt stool has a bloody vs. coffee ground appearance; it can identify bleeding closer to the rectum. 3) How do we diagnose these conditions? Stool guaiac or occult blood sampling Labs CBC, Coags, Amylase/Lipase, Fe, B12 levels, H. pylori screen Scopes Upper GI series (barium X-Ray exploration), Upper GI endoscopy (location of bleed and visualization of tissues within the tract), Colonoscopy and Sigmoidoscopy are also location-specific visual aids for Dx 4) What are the nursing implications associated with the administration of blood? Pre- admin VS, confirm order and consent in chart Confirm Type/Cross-Match of blood with blood band Pt ID and verify blood products with another RN Have all necessary items ready to go when blood arrives since there is a 30 min to hand and it has 2h to completely run Run at ml/hr designated by facility policy but start slowly so as to detect transfusion reactions/complications Reassess VS 15 min after start of transfusion to confirm pt safety/tol well Can run up to 2u on 1 tubing and only compatible with NS (must run and back prime concurrent on pump) S/S of transfusion reaction if any detected: STOP INFUSION AND CONTACT PROVIDER, also collect unit, tubing, etc and send to lab for cultures/testing FEVER #1 Tachycardia Chills Tachypnea LBP/flank pain Hypotension HA Anxiety N, V, D Hives/pruritus Flushing

5) What meds/procedures/surgeries might you anticipate with this kind of patient? IVF to replace volume deficit Blood/Blood Products/Expanders to increase volume PPIs to decrease acidic irritation and erosion of epithelial tissue If bleeding is location during scope Dx then can possibly be stopped then Dependent on location of bleed and amount of damage, active/stopped then can resect areas of bowel, repair and locating perfs Maybe vasoconstrictors r/t fluid deficit