Mrs. Patricia McBride is a 55 year-old female who has just arrived in the emergency department (ED). She reports severe abdominal pain with bright hematemesis that started about five (5) h
Mrs. Patricia McBride is a 55 year-old female who has just arrived in the emergency department (ED). She reports severe abdominal pain with bright hematemesis that started about five (5) hours ago, after leaving the hospital following an esophagogastroduodenoscopy (EGD).
You are the ED nurse assigned to take care of Mrs. McBride. The patients spouse Mr. McBride who accompanies your patient tells you, shortly after she got home from this mornings test, she was still having pain in her abdomen. She usually takes four (4) tablets of Ibuprofen throughout the day to help with her stomach pain. After she developed Helicobacter. Pylori, she found Ibuprofen and celcoxib really helps. Before she was discharged earlier today, the nurse who gave my wife the paperwork she needed to sign before we left; told Patricia if her stomach continued to hurt, she could take Ibuprofen 800mg every 8 hours as needed. When her pain wasnt getting any better, I got to thinking maybe instead of four (4) tablets if I gave her five (5) 200mg tablets of Ibuprofen the pain medication would start to work faster. I was kind of concerned when she told me her stomach hurt, but then suddenly, shes doubled in half. It was when she started to vomit bright red blood, I became a little frightened. She told me she felt like she was going to get sick, I questioned if it could be related to her indigestion that shes always complaining about. But the next thing I know shes vomiting blood, like really bright red blood, my first thought was well there goes five wasted pills, but when she wouldnt stop throwing up, thats when I told her this was serious, I was taking her to the emergency room, and here we are.
When you assess Mrs. McBride, you find her in a fetal position, moaning, anxious, cold, and demonstrating acute confusion. Her abdomen is rigid and tender. She reports her pain 10 out of 10 using a numeric pain rating scale (NPRS) throughout her entire abdomen. Capillary refill is longer than 3 seconds, blood pressure is 90/60 mm Hg, pulse rate is 114 beats/minute, respiratory rate is 24 breaths/minute, and temperature is 99°F (37.2° C).
1. Give a summary of this patient, discuss the knowledge guiding your thinking surrounding these main problems.
2. Based on Mrs. McBrides history, what primary diagnosis do some of Mrs. McBrides signs and symptoms most likely indicate? Identify clues that support your temporary diagnosis; include your speculation of whats going on with: (2 part question)
1. The sudden severe abdominal pain,
2. The bright red blood.
3.
In this scenario there were several problems, what were the main problems that you identified and explain each answer?
4 After completing your assessment and based on your findings, describe how you expect Mrs. McBrides medical diagnosis will be managed. Meaning identify what nursing interventions will you provide based on your findings, including your rationale for each intervention?
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