Name: _____________________________ Date: _____________________ Class: NUR 438
Brief Patient History
Mr. S is a 75-year-old man who has a long history of chronic atrial fibrillation treated with warfarin, CHF, ESRD, and DM II. Over the past week, Mr. S has experienced intermittent epigastric pain and black stools. He is now dizzy and weak.
Mr. S is admitted to the intensive care unit from the emergency department. He recently began taking ciprofloxacin for a urinary tract infection. He also has been taking an aspirin each day because he heard it was good for you. Also, he recently began taking over-the-counter ibuprofen for his stomach pain and general aches.
Mr. S’s admission laboratory work reveals a hemoglobin level of 7 g/dL and an international normalized ratio (INR) of 7. His baseline vital signs include the following: blood pressure of 80/60 mm Hg, heart rate of 150 beats/min (atrial fibrillation), respiratory rate of 30 breaths/min, SPO2 92%, and temperature of 37.3 degrees Celsius.
Diagnosis is acute gastrointestinal bleeding
You have started and finished the FFP, and are currently transfusing the allogenic PRBCs. Ten minutes after starting the PRBC transfusion, Mr. S begins to C/O back pain, chills, and SOB. After taking his oral temperature you note it is now 38.8 degrees Celsius. He appears anxious, and is pulling at his lines and tubes.
1. What is this patient’s mean arterial pressure (MAP)? Is his MAP adequate, and why? Please show your work for the math equation.
2. What signs and symptoms may Mr. S exhibit secondary to his low H&H laboratory values?
3. What is the importance of administering the FFP prior to the PRBC’s in Mr. S’s case?
4. What should the length of time be to transfuse Mr. S’s PRBC’s, and why?
5. Mr. S is O positive blood type. What blood types can he receive, and what blood types can receive his blood type?
6. What is the importance of Rh factor when considered which type of blood to administer to patients?
7. What does allogenic mean? What does autologous mean?
8. What do you think is occurring with Mr. S?
9. What should be your immediate actions/interventions?
10. What nursing diagnoses should you give for this patient?
11. What education can be provided to this patient upon discharge?