For the Last Time.pptx [Autosaved]

7/27/2019 For the Last Time.pptx [Autosaved]

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INTRODUCTION


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DEFINITIONUpper gastrointestinal (GI) bleeding is

hemorrhage in the upper GI tract

includes the esophagus, stomach, andfirst part of the small intestine.


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The common causes for upper GIhemorrhage include the following:

Esophagitis

Gastritis

Esophageal ulcer

Gastric ulcer

Duodenal ulcer Excessive use of NSAID


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Risk factors

Helicobacter pylori infection poor dietary habit

Use of NSAID

Smoking

Drinking alcohol Family history

Stress

Personality A

Blood type O Age between 40 to 60 years old


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Signs and Symptoms

Chronic abdominal pain especially when

stomach is empty

Recurrent vomit

Hematemesis ( vomiting with blood)

Melena (black stool)

Chronic anemia

Abdominal tenderness


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PATIENTS PROFILE

Name: Mr. RJCase no. : 100657

Address: Sitio 5, Santo Angel Central Sta. Cruz (26)

Laguna

Gender: Male

Civil Status: SingleBirthdate: January 24,1972

Age: 41 y/o

Birthplace: Sta. Cruz

Nationality: FilipinoReligion: Aglipay

Occupation: Ice dealer

Admission: August 1, 2013 (4:10 pm)

Admission Diagnosis: UGIB prob secondary to BPUD


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Medical History:

Chief complaint: vomiting x2 weeks

History of present illness:2 weeks prior to admission

+ pallor

+ loss of appetite

+vomiting post prandial

+epigastric pain

+Occasional dizziness

2nd

day prior to admission+ epigastric pain


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Past medical history:

HPN x1month Catapres OD maintenance

s/p appendectomy 2008 @ LPH

Personal / social history:

Alcohol beverage +

Smoking+

Family history: none Allergy: none


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Physical examination:

Vital sign

T 36.7CR 78

RR 21

BP 140/100

General data: conscious and coherentSHEENT: pale looking, ambulatory not in cardio

respiratory distress, anicteric sclerae, pale palpebral

conjunctiva

Heart: NPR, (-) murmurAbdominal: Flat, soft, epigastric tenderness, (+) pale

nail beds, (-) edema


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NUTRITIONAL-METABOLIC PATTERN

Typical daily food intake:AM-bread

NN- rice, meat (e.g kaldereta)

PM- same as nn

appetite change when vomiting occur vomit any food after meal

gnawing, burning sensation at epigastric area

burping, sour taste

Typical daily fluid intake:

5-7 glasses of water, 2 glass of soda x3 a week

Weight: 72 kg to 66kg


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ELIMINATION PATTERN

Void 3-4 times a day Urine color is yellow

No burning sensation felt during urination

Moves bowel ever morning and afternoon

With brown and formed stool but recently he had x2melena 2weeks PTA.

ACTIVITY/EXERCISE

Ice dealer


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ANATOMYAND

PHYSIOLOGY


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PATHOPHYSIOLOGY


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Predisposing factor Precipitating factorAge (40-60) irritating foods

Gender

Alcohol

Smoking

Blood type oConsume caffeinated beverages

Increase HCl acid production

Irritation of lining of stomach

Damage mucosal barrier

Low function of mucosal cell

Low quality of mucus

Loss of tight junction between cells

Further mucosal erosion

ulceration epigastric pain

Bleeding black tarry/ hematemesis

Decrease o2 crrying capacity

Pallor, lightheadness, weakness


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DIAGNOSTIC AND

LABORATORY STUDIES


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Radiology 8-1-13

Chest PA

ROENTENOLOGYMild Cardiomegaly


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BT FROM

Patient blood type : O+

Source of Blood: PRC

Component : PRBC

Amount:For modification (y/N) N

Serial no. 4009-0043690

ABO/ RH type :O+

Extraction date: 7-31-13

Expiration date: 9-4-13

Cross matching method: DiaclonResult of cross matching

Testing: compatible (unit is fit for transfusion)

Cross transfusion done by: lyne M. Aliamirano

Transfusion Started 8-3-13 (4:55 am)

Vital signPrior Post

T- 36.9 36.7

P- 72 83

R- 20 21

BP- 120/80 120/70


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Clinical Chemistry (electrolytes)

8-1-13

Na 133.5 135-145 mmol/L LOW

K 4.21 3.5-5.0 mmol/L NORMAL

Cl 106.8 97-107 mmol/L NORMAL


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URINALYSIS

8-1-13

Physical properties color: yellow

Transparency: hazy

Ph: 6.0 (5-9)

Specific gravity: 1.020 (1.005-1.030)Sugar: negative

Protein: 1+ negative (


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8-2-13

ALT 22.9U/L 4.0-36.0 NORMAL

BUN kinetic UV 40.8 mmol/L 2.5-6.4 HIGH

Crea kinetic 201.1 mmol/ L 35.4-123.8 HIGH


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Hematology 8-5-13

Result normal value

Hbg 8.0 13-18

Hct 24% 40-50%


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Department of radiology 8-6-13

ROENTGENOLOGY REPORT

RU: 7.4X2.7 cm

LU: 7.4X4.2 CM

Small sized right kidney with clearance

Parenchymal change

Normal sized left kidney with clearance

Normal prostate gland/U. bladder


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Fecalysis 8-8-13Color : Brown

Consistency: loose

Occult blood: negativeOva or parasite: no parasite

seen

Others: Blastocystis hominis


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BT FROM 8-5-13



Component : PRBC


Serial no. 4009-00600080

ABO/ RH type :O+






Vital sign

Prior

T- 36.8

P- 98

R- 24

BP- 140/90


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BT FROM 8-5-13



Component : PRBC


Serial no. 4009-0060040

ABO/ RH type :O+



Cross matching method: Diaclon

Result of cross matching



Vital signPrior

T- 36.6

P- 75

R- 21

BP- 120/80


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BT FROM 8-9-13



Component : PRBC


Serial no. 4009-004170-0

ABO/ RH type :O+





Transfusion Started 8-10-13 (1:15 Pm)

Vital sign

PriorT- 37.3

P- 90

R- 23

BP- 140/80


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MEDICATION


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Ranitidine 1 amp IV now

Ranitidine blocks histamine h2- receptors

in the stomach and prevents histamine-

mediated gastric acid secretion

Classification

Histamine2 (H2) antagonist

Adverse effect:

Headache, dizziness, hypersensitivity

Nursing consideration:

Take drug wit meals and at bed time


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Omeprazole 40 mg IV OD 6am 8/2-8/3and shifted to omeprazole 40mg/tab 1tab OD 8/4-8/10An antisecretory compound that is a

gastric acid pump inhibitor. Suppressesgastric acid secretion by inhibiting the H+,

K+-ATPase enzyme system [the acid

(proton H+) pump] in the parietal cells

Classifications:

gastrointestinal agent; proton pumpinhibitor

Adverse effectsHeadache, dizziness, fatigue, Diarrhea,

abdominal pain, nausea, mild transient

increases in liver function tests

Nursing consideration:Give before food, preferably breakfast;

capsules must be swallowed whole (do not

open, chew, or crush).


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Tranxemic acid 500g IV q8 given 8/1 8pm

to 8/3 4am and revised to tranxemic acid

500g q8 x3 more doses

used for the prompt and effective control

of haemorrhage

Classification: Anti-fibrinolytic,

antihemorrhagic

Adverse Effects:

Nausea, vomiting, visual disturbance


The medication can be taken with or

without meals.


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Clonidine 75mcg tab PRN forBP>160/120 given 8/1 8pm and 8/6 5am

stimulates alpha-2 receptors in brain stem

which results in reduced sympatheticoutflow from the CNS and a decrease in

peripheral resistance leading to reduced

BP and pulse rate.

Classification: Antihypertensive

Adverse effect:dizziness, headache, constipation, urinary

retention, itching, fluid or electrolyte

imbalance, GI upset, orthostatic

hypotension, weakness, sedation,

Transient hypertension or profoundhypotension

Nursing consideration:Monitor BP carefully when discontinuing

clonidine; hypertension usually returns

within 48 hr.

Ciprofloxacin 500mg tab BID given 8/2


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Ciprofloxacin 500mg tab BID given 8/26pm to 8/10 6pm

an antibiotic that is used to treat

bacterial infections

Classification:quinolone antibiotics

Side effect:Nausea, vomiting, diarrhea, abdominal,

pain, ras, headache, and restlessness.

Nursing consideration:Instruct patient not to take ciprofloxacin

with dairy products such as milk or yogurt,

or with calcium-fortified juice. He may

eat or drink dairy products or calcium-

fortified juice with a regular meal, but do

not use them alone when taking

ciprofloxacin. They could make

the medication less effective

Amvase( Amlodepine) 5mg tab OD given


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Amvase( Amlodepine) 5mg tab OD given8/2 6pm to 8/10 6am

Inhibits the movement of calcium ions

across the membranes of cardiac and

arterial muscle cells; decreasedcardiac work, decreased cardiac oxygen

consumption

ClassificationCalcium channel-blocker, Antihypertensive

Adverse effect:Dizziness, light-headedness, headache,

fatigue, Flushing, rash,

Nausea, abdominal discomfort

Nursing consideration:Monitor patient carefully (BP, cardiac

rhythm, and output) while adjusting drug

to therapeutic dose

Take with meals if upset stomach occurs.


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Mucosta tab TID pre meals given 8/3 5:30

to 8/10 5:30

is a mucosal protective agent and

is postulated to increase gastric blood

flow,prostaglandin biosynthesis and

decrease free oxygen radicals.

Classification:

Antacid

Adverse Reaction:

Rash, pruritus, constipation, diarrhea,

nausea.


May be taken with or without food


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Diphenhydramine 1amp IV 30 mins prior

BT given 8/6 5:45 , 9:00 and 8/10 12:45

blocks histamine H1-receptors on effector

cells of the GI tract, blood vessels and

respiratory tract. It also causes sedation

and has some anticholinergic action.

Classification:

Antihistamine

Adverse Reactions:

Drowsiness, dizziness, anticholinergic

effects.


Administer with food if GI upset occurs.


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Metronidazole 500 mg/tab 1 tab BID x 7days given 8/10 6pmis used to treat bacterial infections of the

vagina, stomach, skin, joints, and

respiratory tract.

Classification:Anti-protozoals

Adverse effect:

abdominal pain, anorexia, nausea,diarrhea, dry mouth, furry tongue,

glossitis, unpleasant taste, vomiting

Nursing consideration: Take on an emptystomach, at least 1 hour before or 2 hours

after eating a meal. Do not crush, chew,or break an extended-release tablet. Your

symptoms may improve before the

infection is completely cleared. Skipping

doses may also increase your risk of

further infection that is resistant to

antibiotics


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NaHCO3 1tab TID given 8/10 12nn 6pmSodium bicarbonate act as alkalinizing

agent by releasing bicarbonate ions which

capable of neutralizing gastric acid

Classification:Antiulcer agents, alkalinizing agent

Adverse effect:Edema, flatulence, gastricdistension, metabolic alkalosis,

hypernatremia, hypocalcemia,

hypokalemia

Nursing consideration:Assess the clients fluid balance

throughout the therapy, this assessment

includes intake and output, daily weight

Take medication 1 hour after meal and at

bedtime


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CaCO3 1tab TID given 8/10 12nn 6pmDecreases total acid load of GI tract.

Increase esophageal sphincter tone

Classification:Antacid,calciumsupplement, osteoporosis

Adverse effect:Constipation, flatulence, diarrhea, renal

dysfunction

Nursing consideration:Administer as antacid 1 hr after meal and

at bed time


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DISCHARGE PLANNING


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DISCHARGE PLANNINGHealth teaching:

Assist the patient in understanding the condition and factors that

help or aggravate it.

Teach patient about prescribed medications, including

name, dosage, frequency, and possible side effects. Also

identify medications such as aspirin that patient should avoid.

Instruct patient about particular foods that will upset the gastric

mucosa, such as coffee, tea, colas, and alcohol, which have acid

producing potential.

Encourage patient to eat regular meals in a relaxed setting and to

avoid overeating.

Explain that smoking may interfere with ulcer healing; refer

patient to programs to assist with smoking cessation.

Alert patient to signs and symptoms of complications to be

reported. These complications include hemorrhage penetration

and), and pyloric obstruction

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