Wagner and Hardin-Pierce:What is the most likely cause of mucosal injury and PUD in Mr. Hall’s case and explain the cause in detail?

Mr. Hall is a 34-year-old stock broker that is brought into the emergency department with acute abdominal distress. Mr. Hall stated that he has a very high stress job that keeps him on edge most of the time. He has been experiencing severe abdominal pain and tarry black liquid stools over the past 36 hours. He also stated that he has been experiencing pain in his upper abdomen intermittently for the past month one to two hours after he eats and the pain has been keeping him up at night. He stated that he has been taking 600mg of Ibuprofen three times a day for the pain. He has lost 5 pounds over the past month and is nauseated most of the time. This morning, he began vomiting bright red blood. Mr. Hall also had an episode of frank hematemesis upon arrival to the emergency department. The emergency physician sent him to the ICU for a higher level of care and ordered two units of PRBC to be infused NOW.

Past Medical History: Depression, hypertension, smoking 1 ppd for 10 years, and drinking two glasses of alcohol per night.
Past Surgical History: Appendectomy at age 10.

Blood Pressure Lying: 92/54
Standing: 74/42
Pulse Lying: 110/min
Standing: 122/min
SpO2 96% on 2L NC
Respiratory Rate 24/min
Temperature 96.2 Oral

BUN 40 mg/dL
Creatinine 1.1 mg/dL
Hgb 8.8 grams/dL
Hct 42 %
WBC 14,000
H-Pylori Positive

Content: Wagner and Hardin-Pierce: Chapters 20 and 21

1. What are all the possible causes of upper GI bleeding and their percentage of occurrence in all GI bleeding cases? ( .5 points)

2. What is the most likely cause of mucosal injury and PUD in Mr. Hall’s case and explain the cause in detail? Explain other risk factors Mr. Hall has that would increase his susceptibility to mucosal injury? (1.75 points)

3. Explain how Mr. Hall’s PUD could cause an abnormal BUN level. (.5 points)

4. Examine Mr. Hall’s hemoglobin (Hgb) and hematocrit (Hct). Based on his acute problem, explain these values. What are normal values for hemoglobin and hematocrit? (.5 points)

5. The gastroenterologist orders: Protonix 8mg/hr IV continuous. What are the action and uses, major adverse effects, and nursing implications for this drug? (1.25 points)

Scenario continued: Mr. Hall’s endoscopic examine showed an actively bleeding duodenal ulcer located just distal to the pyloric sphincter. It is approximately 0.8 cm in size. Repeat blood work reveals a hemoglobin of 8.2 grams/dL and a hematocrit of 40%.

6. As part of the initial assessment, the nurse must evaluate Mr. Hall’s hemodynamic stability. What findings would be concerning to the nurse? (1 point)

7. The Emergency department physician has requested that the patient be transferred to the ICU. What are the guidelines for admission to the ICU and which apply to Mr. Hall? (1.25 points)

8. What is the next priority (following initial assessment) in the management of Mr. Hall’s acute GI bleed? Describe early management (be thorough). (1.25 points)

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