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Pete Cobraiti GI Bleed

1: Pad the bed in preparation for significant bleeding.

• Make certain there are an O2 flow meter, oximeter, IV pole, suction setup, 1L of 0.9% NS, catheter-
tip syringe, and a large basin at the bedside.

2: Corticosteroids put you at risk for GI bleed. Age is also a risk factor for GI bleeds.

3: Patient is hemodynamically compromised/unstable because patient is becoming hypovolemic due to

loss of blood.

4: I would get a set of vitals, ask the patient if he feels sick or is getting thirsty (signs of hypovolemia).
Maybe Switch patient to nonrebreather face mask to give the patient more oxygen since patient’s
hemoglobin and hematocrit probably have decreased from bleeding. Increase head of the bed to assist
with oxygenation.

5: (1) Initiate pulse oximetry and place him on oxygen per unit protocol.

(2) Connect him to a cardiac monitor and place him on automated blood pressure monitoring.

(3) Clean K.L. and change the bed linen. Institute measures to protect him from cold.

(4) Start second IV of 0.9 %NS with an 18-gauge catheter. Because he is showing signs of shock,
prepare blood transfusion equipment.

(5) Keep him NPO in case surgical intervention is necessary

6: Note pupil size, equality, and response to light. Describe the patient's level of consciousness and
response to command’s and assess reflexes. Auscultate heart, lung, and bowel sounds. Inspect and
palpate the abdomen for distention. Auscultate for bowel sounds; hyperactive sounds can be caused by irritation
by blood or the abdomen might be silent, suggesting ileus or perforation. Palpate for bladder distention and
note the appearance of urine and the hourly output. Inspect the extremities for color, looking for pallor or
cyanosis, and palpate for diminished peripheral pulses, delayed capillary refill time, and edema. Palpate
skin for warmth and moisture, noting any coolness and diaphoresis.
7: Applying a pulse oximetry monitor
Measuring his VS every 15 min.
Emptying the Foley catheter collection bag each hour.

8: Respiratory alkalosis with hypoxemia, which is consistent with Class II hypovolemic shock

9: Both K.L.'s hemoglobin and hematocrit levels are low, indicating that the bleeding has been occur-
ring over a longtime period. The hemoglobin and hematocrit can help determine the extent of
bleeding, although they can be poor indicators of the severity of blood loss if the bleeding is acute.
If the patient's hematocrit is 30% before a bleeding episode, it will be 30% several hours later because
whole blood is lost in the same proportion as the plasma and blood cells. It might take as long as 72
hours for the redistribution of plasma from the extravascular space to the intravascular space to occur
and cause the patient's hemoglobin level and hematocrit value to decrease.

10: Midazolam is a short-acting benzodiazepine indicated for use in conscious sedation before
endoscopic procedures. Midazolam also has an amnesic effect on the patient. Morphine sulfate is a
Class II controlled substance (opiate) given for pain and sedation during the diagnostic procedure.

11: Monitor heart rate, blood pressure and respiration.

12: Switch O2 to nonrebreather mask at flush flow rate (100% O2).

Open up the IV with 0.9% NaCl.
Call the blood bank and secure the first units of RBCs.
Put K.L. in a modified Trendelenburg's position.
Get a set of VS

14: “Blood in the bowel is irritating and acts like a laxative. You were very ill and could not hold this
stool in.” Many adults are embarrassed and humiliated by “messing in the bed” or similar problems. It is
important we not minimize their feelings but reassure them that, as professionals, this is something we are
accustomed to