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Peptic Ulcer Disease Case Study (60 min)

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Mrs. Baker is a 54 year old female who presented to the ED complaining of nausea and severe epigastric pain x 3 days. She reports a history of osteoarthritis and reports taking ibuprofen 400 mg 3-4 times a day regularly for the last few months since her “arthritis has gotten really bad”.

Critical Thinking Check
Bloom's Taxonomy: Application

What initial nursing assessments should be performed?

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Patient demonstrates guarding when palpating epigastric region, no tenderness to palpation over RLQ, LLQ, or LUQ. Some tenderness over RUQ.  Bowel sounds are hyperactive, lungs are clear to auscultation, S1 and S2 heard clearly with no murmurs. As you finish your assessment, Mrs. Baker reports she is going to be sick and vomits approximately 300 mL of coffee-ground emesis.

Critical Thinking Check
Bloom's Taxonomy: Comprehension

Explain the significance of coffee-ground emesis.

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You notify the provider of the coffee-ground emesis, administer Ondansetron 4 mg IV per provider orders, and assist Mrs. Baker with oral care.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What further diagnostic testing do you expect to be performed for this patient?

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Mrs. Baker is now weak and drowsy. Her fecal occult test is positive and her CBC shows a Hemoglobin of 10 g/dL and a Hematocrit of 31%.  Per provider orders, you insert an NG tube to evaluate stomach contents and decompress the stomach. You connect the NG tube to intermittent low wall suction.


Critical Thinking Check
Bloom's Taxonomy: Analysis

What is likely going on with Mrs. Baker physiologically?

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Critical Thinking Check
Bloom's Taxonomy: Comprehension

What is the benefit to decompressing the stomach via NG tube?

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The UAP notifies you that Mrs. Baker’s blood pressure has dropped to 96/60. You enter the room and see that the suction canister is over halfway full of bright red blood.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What is your priority assessment at this time?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What may be happening to Mrs. Baker?

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Mrs. Baker is pale, diaphoretic, and drowsy. Her heart rate is up to 122. You notify the provider who orders to transfuse 2 units of PRBC’s and calls the Gastroenterology team for a STAT EGD. Within 30 minutes the patient is taken to the GI lab for an EGD, where they find two slow-bleeding gastric ulcers, which they cauterize, and 1 arterial bleed which they repair as well.  Mrs. Baker returns to the unit post-procedure for observation.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What are nursing priorities for Mrs. Baker after this procedure?

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