The wife of C.W., a 70-year-old man, brought him to the emergency...

Question The wife of C.W., a 70-year-old man, brought him to the emergency… The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at 4:30 this morning. She told the ED triage nurse that he had had dysentery for the past 3 days, and, last night, he had a lot of “dark red” diarrhea. When he became very dizzy, disoriented, and weak this morning, she decided to bring him to the hospital. C.W.’s vital signs (VS) were 70/- (systolic blood pressure [BP] 70 mm Hg, diastolic BP inaudible), 110, 20, 99.1° F (37.3° C). A 16-gauge IV catheter was inserted, and a lactated Ringer’s (LR) infusion was started. The triage nurse obtained the following history from the patient and his wife. C.W. has had idiopathic dilated cardiomyopathy for several years. The onset was insidious, but the cardiomyopathy is now severe, as evidenced by an ejection fraction (EF) of 13% found during a recent cardiac catheterization. He experiences frequent problems with heart failure (HF) because of the cardiomyopathy. Two years ago, he had a cardiac arrest that was attributed to hypokalemia. He also has a long history of hypertension (HTN) and arthritis. He has also had atrial fibrillation in the past but it has been under control recently. Fifteen years ago he had a peptic ulcer.An endoscopy showed a 25 × 15 mm duodenal ulcer with adherent clot. The ulcer was cauterized, and C.W. was admitted to the medical intensive care unit (MICU) for treatment of his volume deficit. You are his admitting nurse. As you are making him comfortable, Mrs. W. gives you a paper sack filled with the bottles of medications he has been taking: enalapril (Vasotec) 5 mg PO bid, warfarin (Coumadin) 5 mg/day PO, digoxin (Lanoxin) 0.125 mg/day, PO, potassium chloride 20 mEq PO bid, and diclofenac sodium (Voltaren) 50 mg PO tid. As you connect him to the cardiac monitor, you note that he is in sinus tachycardia. Doing a quick assessment, you find a pale man who is sleepy but arousable and oriented. He is still dizzy, hypotensive, and tachycardic.You hear S3 and S4 heart sounds and a grade II/VI systolic murmur. Peripheral pulses are all 2+, and trace pedal edema is present. Lungs are clear. Bowel sounds are present, mid-epigastric tenderness is noted, and the liver margin is 4 cm below the costal margin. A Swan-Ganz catheter and an arterial line are inserted.Lab Work: Sodium 138 mEq/L, Potassium 6.9 mEq/L, BUN 90 mg/dL, Creatinine 2.1 mg/dL, WBC 16,000/mm 3, Hgb 8.4 g/dL, Hct 25%, PT 23.4 seconds, INR 4.2C.W. receives a total of 4 units of packed red blood cells (PRBCs), 5 units of fresh frozen plasma (FFP), and several liters of crystalloids to keep his mean BP above 60 mm Hg. On the second day in the MICU, his total fluid intake is 8.498 L and output is 3.66 L for a positive fluid balance of 4.838 L. His hemodynamic parameters after fluid resuscitation are pulmonary capillary wedge pressure (PCWP) 30 mm Hg and cardiac output (CO) 4.5 L/min.What may have precipitated C.W.’s gastrointestinal (GI) bleeding?What is the most serious potential complication of C.W.’s bleeding?What concerns are there with the lab values that were drawn before PRBCs administered?Why will you want to monitor his fluid status very carefully?List at least four things you will monitor to assess C.W.’s fluid balance. Health Science Science Nursing MEDSURG 2 NUR 265 Share QuestionEmailCopy link Comments (0)