Exam IV Review Questions
Case Study #2 continued: After several contacts with his HCP for LLQ pain, initially labeled constipation, a 33 y/o male is admitted with a diagnosis of acute diverticulitis. 2. What interventions do you plan to implement during hospitalization? (select all that apply) A.Regular diet B.IV of D5 ½ NS at 125 mL/hour C.Ampicillin/sulbactam (Unasyn) 3 grams every 6 hours IV D.Acetaminophen prn 650 mg every 4 hours prn pain or fever over 38C E.Ondansetron 4 grams every 8 hours IV prn nausea 3. What assessment findings would indicate the patient's status is worsening? (select all that apply) A.Fever and chills B.Abdomen is soft to palpation C.Abdominal distention D.Abdominal pain that is exacerbated by any movement E.Nausea
2. B.IV of D5 ½ NS at 125 mL/hour C.Ampicillin/sulbactam (Unasyn) 3 grams every 6 hours IV D.Acetaminophen prn 650 mg every 4 hours prn pain or fever over 38C E.Ondansetron 4 grams every 8 hours IV prn nausea 3. A.Fever and chills C.Abdominal distention D.Abdominal pain that is exacerbated by any movement E.Nausea
Case Study #2 continued: After several contacts with his HCP for LLQ pain, initially labeled constipation, a 33 y/o male is admitted with a diagnosis of acute diverticulitis. 4. The patient improves in a couple of days and is discharged home on oral antibiotics with plans for a colonoscopy in 6 weeks. Why does the patient need to wait 6 weeks for the colonoscopy? 5. The colonoscopy reveals numerous diverticuli with the majority located in a section of the descending colon. What teaching should this patient receive? A.Increase fiber, fluids, and physical activity B.Avoid all foods with nuts and seeds C.Take acetaminophen for discomfort D.Take laxatives such as bisocodyl to prevent future episodes
4. Inserting the scope into an inflamed colon risks rupture of the bowel. 5. A.Increase fiber, fluids, and physical activity Rationale: This patient has diverticulosis. The best way to prevent the development of more divericuli or a recurrence of diverticulosis is to prevent constipation (increase fiber, fluids, and physical activity). Probiotics may also help.
Case Study #1 continued: Adam, a 48-year-old business executive, is brought to the emergency room by a co-worker. At work, he started vomiting a large amount of coffee-ground appearing material and requested to go to the hospital. Adam has a 9-year history of peptic ulcer disease (PUD) and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained with fiberoptic endoscopy were positive for H. pylori and he was treated with original triple therapy. His ulcer disease has been controlled with medications since that time. 7. On reviewing the health care provider's orders for Adam, you would expect to find that collaborative care for his perforation includes interventions that were used when he was hemorrhaging, with the addition of ..... 8. Twenty-four hours after admission, Adam's perforation has failed to seal spontaneously, and the health care provider informs him that surgery is necessary to close the perforation. He will be having a Billroth II procedure. Describe the procedure.
7. IV Antibiotics 8. = The distal two thirds of the stomach will be removed with anastomosis of the gastric stump to the jejunum.
Case Study #1 continued: Adam, a 48-year-old business executive, is brought to the emergency room by a co-worker. At work, he started vomiting a large amount of coffee-ground appearing material and requested to go to the hospital. Adam has a 9-year history of peptic ulcer disease (PUD) and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained with fiberoptic endoscopy were positive for H. pylori and he was treated with original triple therapy. His ulcer disease has been controlled with medications since that time. 4. Adam's bleeding is controlled with treatment. His lowest H&H, occurring 24 hours after admission, is 11.5 g/dl (115 g/L) and 32%. Two days after admission his NG tube is removed, and oral intake is started. In reviewing Adam's diet with him, you evaluate that he understands the dietary recommendations for PUD when he says: A."I can eat and drink most foods and fluids that don't cause me distress." B."I should substitute coffee and tea for alcohol at my social business functions." C."I must eat bland foods at least six times a day to promote healing of my ulcer." D."I should eliminate all milk and milk products because they stimulate gastric acid production."
A."I can eat and drink most foods and fluids that don't cause me distress."
Case Study #1 continued: Adam, a 48-year-old business executive, is brought to the emergency room by a co-worker. At work, he started vomiting a large amount of coffee-ground appearing material and requested to go to the hospital. Adam has a 9-year history of peptic ulcer disease (PUD) and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained with fiberoptic endoscopy were positive for H. pylori and he was treated with original triple therapy. His ulcer disease has been controlled with medications since that time. 6. Adam is discharge on quadruple therapy of a PPI, bismuth, metronidazole, and tetracycline. Ten days after his discharge from the hospital, Adam is readmitted with a suspected perforation of the ulcer. Select the assessment findings that indicate a perforation. Select all that apply. A.Decreased bowel sounds B.Grunting, shallow respiration C.Rigid, board-like abdomen D.Shoulder pain E.Sudden, severe upper abdominal pain
A.Decreased bowel sounds B.Grunting, shallow respiration C.Rigid, board-like abdomen D.Shoulder pain E.Sudden, severe upper abdominal pain
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 6. The client becomes angry and leaves the hospital against medical advice (AMA). Two days later, the client is transported back to the emergency department by ambulance. The client is minimally responsive with a Glasgow Coma Scale rating of 8. The client is admitted with a diagnosis of hepatic encephalopathy and elevated ammonia levels. The healthcare provider prescribes the following: Lactulose 300 mL retention enema every 6 hours and Rifaximin 550 mg BID by NG tube. Which outcome indicates to the nurse that the lactulose and rifaximin are having the desired therapeutic effect? A.Increased mental alertness B.Decreased craving for alcohol C.Decreased serum albumin level D.Clay-colored bowel movements.
A.Increased mental alertness
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 2. In the client with cirrhosis, which lab values does the nurse anticipate will be increased from the normal value? (select all that apply) A.Total serum bilirubin B.AST/ALT C.Serum albumin D.APTT/PT/INR E.Sodium and potassium
A.Total serum bilirubin B.AST/ALT D.APTT/PT/INR
A patient admitted with diabetes, malnutrition, osteomyelitis, and chronic alcohol use has an elevated serum amylase level of 480 U/L and an elevated serum lipase level of 610 U/L. Which diagnosis does the nurse expect? A. Starvation B. Pancreatitis C. Systemic sepsis D. Diabetic ketoacidosis
B. Pancreatitis
The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective ? A."I will take my lipid-lowering medication at the same time each night." B."I may experience some discomfort if I eat a high-fat meal in the next few weeks." C."I need someone to stay wit me for about a week after surgery." D."I should not splint my incision when I deep breathe and cough."
B."I may experience some discomfort if I eat a high-fat meal in the next few weeks."
Case Study #3: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 1. During the nursing assessment, the client's wife asks the nurse if its true only alcoholics get cirrhosis. Which nursing response best promotes accurate and effective communication? A.List the reasons only alcoholics get cirrhosis. B.Explain there are several types of cirrhosis. C.Illustrate how alcoholics will eventually develop cirrhosis. D.Define the difference between social drinkers and alcoholics.
B.Explain there are several types of cirrhosis.
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 7. Management of ascites is focused on sodium restriction, diuretic therapy, and fluid removal. Which action should the nurse take while monitoring the client's fluid volume status? A.Instruct the client to perform self-catherization B.Measure abdominal girth daily C.Administer prn anti-emetics before meals D.Encourage the client to eat frequent high-protein snacks
B.Measure abdominal girth daily
Case Study #1 continued: Adam, a 48-year-old business executive, is brought to the emergency room by a co-worker. At work, he started vomiting a large amount of coffee-ground appearing material and requested to go to the hospital. Adam has a 9-year history of peptic ulcer disease (PUD) and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained with fiberoptic endoscopy were positive for H. pylori and he was treated with original triple therapy. His ulcer disease has been controlled with medications since that time. Your initial assessment reveals the following: •Vital signs: blood pressure 102/62 mm Hg, heart rate 98 beats/min, respiratory rate 24 breaths/min, and temperature 98.0° F (36.7° C); •Capillary refill at 4 sec; •Skin cool and slightly moist; •No distention of jugular veins; •Clear lung sounds; •Soft abdomen with hyperactive bowel sounds. As you finish Adam's assessment, he vomits 460 mL of dark, coffee-ground appearing vomitus. The hemoccult test on the vomitus is positive for blood. A STAT hemoglobin and hematocrit (H&H) is ordered for Adam, IV fluids are started at 125 mL/hr, and a nasogastric tube is inserted and connected to low continuous suction. Additional laboratory tests are also ordered. 2. The results of Adam's initial H&H are 14.3 g/dL and 42%. You know that these results.... A.Should increase as fluid replacement is continued. B.Reflect an equal loss of plasma and red blood cells (RBCs). C.Indicate that Adam has not lost a significant amount of blood. D.Are an indication for immediate transfusion with packed RBCs.
B.Reflect an equal loss of plasma and red blood cells (RBCs).
Which assessment data best indicates the client recovering from an open cholecystectomy may require pain medication? A.Pulse is 65 beats per minute B.Shallow respirations C.Hypoactive bowel sounds D.Use of a pillow to splint when coughing
B.Shallow respirations
Case Study #1 continued: Adam, a 48-year-old business executive, is brought to the emergency room by a co-worker. At work, he started vomiting a large amount of coffee-ground appearing material and requested to go to the hospital. Adam has a 9-year history of peptic ulcer disease (PUD) and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained with fiberoptic endoscopy were positive for H. pylori and he was treated with original triple therapy. His ulcer disease has been controlled with medications since that time. 9. Adam has no postoperative complications and progresses well in his recovery. You plan teaching for Adam in preparation for his discharge. Select all that apply. A.Drink at least 8 oz of fluid with meals. B.Teaching about dumping syndrome management. C.Eat small, frequent meals with moderate amounts of protein and fat. D.Follow-up visits will be needed to evaluate the need for cobalamin injections. E.Maintain lifestyle changes previously used to prevent ulcer redevelopment.
B.Teaching about dumping syndrome management. C.Eat small, frequent meals with moderate amounts of protein and fat. D.Follow-up visits will be needed to evaluate the need for cobalamin injections. E.Maintain lifestyle changes previously used to prevent ulcer redevelopment.
The client diagnosed with Crohn's disease is crying and tells the nurse, "I can't take it anymore. I never know when I will get sick and end up here in the hospital. Which statement is the best initial response by the nurse? A."I understand how frustrating this must be for you." B."You must keep thinking about the good things in your life." C."I can see you are very upset. I'll sit down and we can talk." D."Are you thinking about doing anything like committing suicide?"
C."I can see you are very upset. I'll sit down and we can talk."
Case Study #2 continued: After several contacts with his HCP for LLQ pain, initially labeled constipation, a 33 y/o male is admitted with a diagnosis of acute diverticulitis. 7. You are caring for the patient on post-op day 2. Bowel sound are hypoactive, abdomen is distended and tender to light palpation, patient denies passing flatus and reports spasms of abdominal pain. What intervention is most appropriate? A.Administer morphine sulfate IV per the prn order B.Report findings to the surgeon C.Assist the patient to ambulate in the hall D.Advise the patient this is expected due to NPO status.
C.Assist the patient to ambulate in the hall
A client with irritable bowel syndrome has instructions to take psyllium 2 rounded teaspoons full twice a day for constipation. What is most important for the nurse to include in the teaching plan? A.Urine may be discolored. B.Stop taking the laxative once a bowel movement occurs. C.Each dose should be taken with a full glass of water or juice. D.Daily use may inhibit the absorption of some fat-soluble vitamins.
C.Each dose should be taken with a full glass of water or juice.
Case Study #2: After several contacts with his HCP for LLQ pain, initially labeled constipation, a 33 y/o male is admitted with a diagnosis of acute diverticulitis. 1. What assessment findings do you think would indicate the need for hospitalization rather than outpatient treatment? A.LLQ pain B.Need for antibiotics C.Elevated WBC and guarding D.Decreased appetite and constipation
C.Elevated WBC and guarding
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 8. The client's condition remains stable, but he is having difficulty following the prescribed diet. Occasionally, friends bring in chips and soft drinks. Early one morning the client tells the nurse his bowel movement is black and tarry. The nurse notifies the healthcare provider. Which new order does the nurse question? A.Perform hemoccult testing on stools x 3 B.Call lab to draw a CBC C.Encourage coughing and deep breathing every hour D.Administer propranolol (Inderal) 20 mg PO BID
C.Encourage coughing and deep breathing every hour
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 4. With a confirmed diagnosis of cirrhosis, which assessment finding warrants immediate intervention? A.Increased girth B.Scleral jaundice C.Hematemesis D.Pruritis
C.Hematemesis
A patient is admitted for appendicitis. What manifestations does the nurse expect? A. LUQ or epigastric pain, radiating to the back B. LLQ pain, fever, and constipation C. RUQ pain, fatigue, anorexia, and jaundice D. RLQ pain, guarding, rebound tenderness
D. RLQ pain, guarding, rebound tenderness
The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which person should the nurse refer for an immunoglobulin (IG) injection? A. A friend who delivers meals to the patient and family each week. B. A relative with a history of hepatitis A who visits the patient daily. C. A child living in the home who received the hepatitis A vaccine 3 months ago. D. A caregiver with no history of hepatitis A antibodies who lives in the same household with the patient.
D. A caregiver with no history of hepatitis A antibodies who lives in the same household with the patient.
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 9. Later that morning, the client calls for the nurse and reports he feels dizzy and is vomiting bright red blood. When the nurse arrives, he is standing in the middle of the room. He is pale and his skin feels cool and clammy. What intervention is a priority for the nurse? A.Take and record the client's blood pressure B.Go to the med cart to obtain an anti-emetic C.Call the lab to draw a STAT CBC D.Assist the client to bed and position them side lying
D.Assist the client to bed and position them side lying
A 46-yr-old client has been experiencing frequent episodes of "heart burn" and regurgitation of sour-tasting fluid, especially after a large meal. The client is diagnosed with a hiatal hernia. The nurse knows that the client understands her treatment regimen when she states she will: A.Elevate her legs when she is sleeping. B.Increase her roughage in her diet C.Drink more fluids with her meals. D.Avoid caffeine, alcohol, and chocolate.
D.Avoid caffeine, alcohol, and chocolate.
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. The healthcare provider prescribes the following: •Spironolactone 75 mg PO daily •Furosemide 20 mg PO BID •20% albumin 75 g IV daily via saline lock •Vitamin K 10 mg IM now •Folic acid 1 mg PO daily •Thiamin 100 mg IM now •Thiamine 50 mg PO daily x 5 days 5. When administering the albumin infusion through a vein in the right hand, the nurse notes that the peripheral edema in the client's arms and hands has changed from a +3 to a +2. It is most important for the nurse to implement which intervention? A.Administer a diuretic B.Check the IV site C.Stop the infusion and check the client's blood pressure D.Continue the albumin infusion
D.Continue the albumin infusion
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 3. The client has several lab values which indicate cirrhosis. The client has an increase in total serum bilirubin and serum alkaline phosphatase levels, prolonged APTT and PT/INR, and elevated liver enzymes. The client states they become increasingly fatigued, and even though appetite is poor, abdomen is becoming enlarged. The client reports bruising easily and frequent nosebleeds. Based on the prolonged APTT and PT/INR, what clinical manifestations would the nurse anticipate visualizing upon assessment? A.Weight loss B.Peripheral edema C.Jaundice D.Petechiae
D.Petechiae
Case Study #3 continued: A client is brought to the Emergency Department following an automobile accident. The car the client was driving swerved off the road into the median, where the car's front end hit a highway bridge. The client is treated for minor injuries, and several lab tests are ordered. The client's blood alcohol level (ethyl alcohol) is 0.04% and liver enzymes are elevated. Assessment findings include lethargy, an enlarged liver on palpation, jaundiced skin and sclera, and ascites. The client is admitted for further evaluation with a medical diagnosis of cirrhosis. The following morning when the client is more alert, and the nurse is able to obtain a more thorough history. 10. The nurse positions the client in bed, calls for assistance, and assesses his vital signs and oxygen saturation level to be as follows: temperature 98.6 F (37 C), heart rate 148 beats per minute, respirations 32 breaths per minute, blood pressure 74/40 mmHg, and oxygen saturation level of 88%. The client is experiencing bleeding esophageal varices. He is given a liter bolus of 0.9% normal saline IV and scheduled for immediate endoscopic sclerotherapy. With the procedure, the bleeding stops, and the client's condition stabilizes. He tells the nurse he thinks its time to stop drinking and get his life under control. The client asks the nurse how to begin the process. Which interprofessional team member should the nurse contact with a referral? A.Hospital chaplain B.Charge nurse C.Dietitian D.Social worker
D.Social worker
Case Study #1 continued: Adam, a 48-year-old business executive, is brought to the emergency room by a co-worker. At work, he started vomiting a large amount of coffee-ground appearing material and requested to go to the hospital. Adam has a 9-year history of peptic ulcer disease (PUD) and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained with fiberoptic endoscopy were positive for H. pylori and he was treated with original triple therapy. His ulcer disease has been controlled with medications since that time. 5. Adam is very anxious about being in the hospital and keeps saying he can't afford to be away from work right now. When discussing the management of his illness after he is discharged, you recognize that at this time it is probably most important for him to A.stop smoking again. B.recognize symptoms of disease recurrence. C.avoid the use of over-the-counter medications for minor pains. D.use effective coping mechanisms to reduce business-related stress.
D.use effective coping mechanisms to reduce business-related stress.
Case Study #1 continued: Adam, a 48-year-old business executive, is brought to the emergency room by a co-worker. At work, he started vomiting a large amount of coffee-ground appearing material and requested to go to the hospital. Adam has a 9-year history of peptic ulcer disease (PUD) and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained with fiberoptic endoscopy were positive for H. pylori and he was treated with original triple therapy. His ulcer disease has been controlled with medications since that time. Adam is admitted and undergoes endoscopy to directly visualize the bleeding site and to use electrocoagulation to stop the bleeding. A bleeding ulcer on the posterior aspect of the duodenum is found and coagulated. When he returns to the unit, new orders include the following. 3. What is the rationale for each? Pantoprazole (Protonix) IV IV of LR at 125 mL/hr Vitals per post-op protocol then q4h H&H q6h Hourly urine output pH of gastric contents Sucralfate (Carafate) 1 g q6h via NG tube
Pantoprazole (Protonix) IV -- decrease gastric acid secretion IV of LR at 125 mL/hr -- to support fluid & electrolyte balance Vitals per post-op protocol then q4h -- to monitor complications r/t oxygenation, perfusion, bleeding, and infection H&H q6h -- to evaluate blood loss and oxygen carrying capacity Hourly urine output -- to monitor fluid balance pH of gastric contents -- to test efficacy of meds Sucralfate (Carafate) 1 g q6h via NG tube -- to coat the GI mucosa
Case Study #2 continued: After several contacts with his HCP for LLQ pain, initially labeled constipation, a 33 y/o male is admitted with a diagnosis of acute diverticulitis. 6. Over the next two years, the patient has four episodes of diverticulitis, all treated on an outpatient basis. The patient is referred to a gastroenterologist. The decision is made to proceed with a colon resection. Eight inches of the descending colon is removed with the tissue described as constricted and scarred. Identify three priority nursing problems for this patient.
•Pain •Risk for ineffective breathing pattern (highest in PACU or with opioid administration for pain control) •Risk for hemorrhage (highest in the hours immediately after surgery) •Risk for infection (surgical site; post-op pneumonia; UTI due to foley) •Risk for fluid volume deficit •Risk for DVT •Risk for nausea •Risk for anxiety
Case Study #1: Adam, a 48-year-old business executive, is brought to the emergency room by a co-worker. At work, he started vomiting a large amount of coffee-ground appearing material and requested to go to the hospital. Adam has a 9-year history of peptic ulcer disease (PUD) and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained with fiberoptic endoscopy were positive for H. pylori and he was treated with original triple therapy. His ulcer disease has been controlled with medications since that time. Recently, he has been under much more stress than usual because of company merger negotiations. He started smoking again after having quit for 7 years, and he has also been drinking more alcohol in the last 3 months when he meets with other business executives. His work demands have caused a major disruption of his life, and he has not taken his medications routinely or eaten or slept well. He has a chronic intermittent headache, but he has been careful not to use aspirin, taking ibuprofen instead, for relief of the headache. He reports that he has had increasingly dark stools for the past week and developed severe nausea before he started vomiting this morning. He says he has no real pain, only mild upper abdominal discomfort and nausea. 1. What concerns do you have?
•Recent increase in stress •Smoking •Increased alcohol consumption •Stopped taking meds •Not eating or sleeping adequately •Taking ibuprofen (NSAID) •Dark stools (possible GI bleed) •Nausea and vomiting •Upper abdominal discomfort