John Adams Years Explained for Students (Easy Guide)
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Original Question
John Adams, 55 years of age, is admitted to the intensive care unit with the diagnosis of acute esophageal varices bleed. The patient has a long-standing history of alcoholism and cirrhosis of the liver. Six months ago, the patient received an EGD, which diagnosed the esophageal varices. The patient has quit drinking alcohol for the past 6 months and has been active in Alcoholics Anonymous. The patient has a history of coronary artery disease and angina. The patient has been taking propanolol. The admission vital signs include: BP, 88/50; P, 110; R, 26; and T, 99°F. The supplemental oxygen is on room air and the patient is placed on 2 L/min of oxygen per nasal cannula with supplemental oxygen. The patient’s hemoglobin is 6 g/dL, the hematocrit is 12%, and the platelets are 75,000. The patient has a prolonged PT and PTT. The liver profile shows a mild elevation of the aspartate aminotransferase (AST) and the alanine aminotransferase (ALT). The BUN and serum creatinine are also elevated. The patient has in place from the emergency department a nasogastric tube to low, intermittent suction. The emergency department physician placed a right subclavian triple lumen catheter and there is NS infusing at 100 mL/hr. The emergency department nurse administered vitamin K. Additional orders on the chart from the gastroenterologist include the following: octreotide (Sandostatin) 5-mcg bolus followed with continuous infusion 500 mcg in 250 mL D5NS at 25 mcg/hr. Type and cross of 6 units of PRBCs STAT and transfuse 2 units of PRBCs over 2 hours each. administer furosemide (Lasix) 20 mg IVP in between each unit. Repeat CBC 1 hour after the transfusion is completed Case Study Questions 1. Why does the patient history include propanolol? 2. What does “the patient has a prolonged PT and PTT” mean? Why is the an expected lab value, given the patient’s condition? 3. What is the purpose of the Vitamin K? 4. What is the purpose of the octreotide? 5. What is the purpose of the blood transfusion order? 6. What is the purpose of furosemide between units of PRBCs. 7. What is the purpose of the CBC after the blood transfusion? 8. How and in what order should the nurse institute the physician orders that are listed above? 9. The nurse observes the nasogastric secretions and, upon admission to the ICU, there was 200 mL of dark red-colored drainage. The nurse continues to monitor the drainage and, as the nurse hangs the first unit of PRBCs, 200 mL of bright red bloody drainage is dumped into the collection canister. What should the nurse do?
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