• Darrell Kinsey is a 55-year old, male admitted to the hospital with an upper gastrointestinal bleed
(UGIB). For this admission, he reported epigastric pain, melena, fatigue, dizziness, and mild shortness
of breath with exertion for the past 2 days. His medical history includes arthritis of the right shoulder
and hypercholesterolemia. He has an allergy to nuts which causes hives.
• In addition, he reports a previous hospitalization 4 months ago for UGIB in which he was newly
diagnosed with a duodenal peptic ulcer, but was negative for Helicobacter pylori infection. He was
treated with endoscopic injection therapy and a blood transfusion. He cannot recall his hemoglobin
level or how many units of blood he was given at that time.
• His current medications are Nexium 20 mg/day and Lipitor 20 mg/day. He has discontinued any use of
non-steroidal anti-inflammatory drugs (NSAID), alcohol, and caffeine.
• Vital signs: Temperature 98.5 degrees Fahrenheit (oral); respiratory rate (RR) = 28 breaths/min,
slightly labored; heart rate (HR) = 118 beats/min, sinus tachycardia (ST); blood pressure (BP) = 98/54
mmHg; oxygen saturation = 89% on room air; pain = 4/10 (epigastric).
• Serum results: Hemoglobin (HB) = 7.9 gm/dL; hematocrit (HCT) = 35%; other blood counts,
chemistry, and coagulation results were within normal ranges.
• Other results: Upper endoscopy revealed no active bleeding. Chest x-ray showed clear lungs.
• Treatment: The patient was placed on 2L of oxygen via nasal cannula, intravenous (IV) fluids were
started, and indwelling urinary catheter placed with 250 cc of clear urine output.
Admission to the nursing floor,
• Patient alert, oriented, and cooperative upon admission to the medical-surgical unit. Transfusion of 1
unit of packed red blood cells was started. Within 30 minutes of the transfusion; the patient called the
nurse complaining of chills, dizziness, and nausea. He appeared anxious and restless.
• His immediate vital signs were: Temperature 102 degrees Fahrenheit (oral); RR = 32 breaths/min,
labored; HR = 136 beats/min, ST; BP= 88/50 mmHg; oxygen saturation = 87% on 2L of oxygen via
nasal cannula; pain = 8/10 (epigastric area and extending to lower back).
• Skin, mucous membranes: Oral mucosal membranes pale. Skin and sclera slightly jaundiced.
Sanguineous fluid oozing from the IV access site and other venipuncture sites. • His immediate vital signs were: temperature of 102 degrees Fahrenheit (oral), respiration rate of 32 breaths per minute (labored), heart rate of 136 beats per minute (ST), blood pressure of 88/50 mmHg, oxygen saturation of 87% on 2 liters of oxygen through a nasal cannula, and pain level of 8/10. (epigastric area and extending to lower back).
• Skin, mucous membranes: Oral mucosal membranes pale. Slight yellowing of the skin and eyes.
The IV access site and other venipuncture sites were leaking blood.
• Cardiopulmonary: The sounds of the lungs have gotten quieter in both bases, with small crackles. S1 and S2 were heard.
Cool limbs with a little bit of pedal edema, peripheral pulses of 1 or more, and capillary refill of 2 to 3 seconds.
• Musculoskeletal: Slight bloating, soft, tender, and weak bowel sounds in the abdomen. Very little dark, reddish urine in the bag. Musculoskeletally, all of the limbs had full range of motion (ROM) and strength, except for the right shoulder, which had limited ROM and only 4/5 strength.
• STAT results: The abnormal serum results were HB = 6.8 gm/dL, HCT = 30%, potassium = 5.8 mEq/L, total bilirubin = 2.6 mg/dL, blood urea nitrogen = 34 mg/dL, creatinine = 2.0 mg/dL, direct Coombs test positive for antiglobulin, and increased prothrombin time and partial thromboplastin times.
The urine test showed that there was free hemoglobin. Bibasilar pulmonary infiltrates can be seen on the chest x-ray.
• Cardiopulmonary: Lung sounds diminished in both bases with fine crackles. S1 and S2 auscultated.
Extremities cool with trace pedal edema, peripheral pulses 1+, capillary refill 2-3 seconds.
• Abdomen, musculoskeletal: Slight distention, soft, tender, hypoactive bowel sounds. Minimal dark
reddish urine in collection bag. Musculoskeletal: There was full range of motion (ROM) and strength
in extremities except right shoulder (limited ROM, strength 4/5).
• STAT results: Abnormal serum results were HB = 6.8 gm/dL, HCT = 30%; potassium = 5.8 mEq/L,
total bilirubin = 2.6 mg/dL, blood urea nitrogen = 34 mg/dL, creatinine = 2.0 mg/dL, direct Coombs
test positive for antiglobulin, and increased prothrombin time and partial thromboplastin times.
Urinalysis positive for free hemoglobin. Chest x-ray positive for bibasilar pulmonary infiltrates.
To answer questions 1-3, use the scenario above
1. Identify the likely disorder, the underlying pathophysiology (i.e., cellular and tissue changes), and
relate the changes to abnormal findings to support your interpretation. (20 points) Hint: We are in
the immune system ☺ !
2. Identify all nursing diagnoses labels (just the label!) that apply to this patient (e.g., impaired
swallowing). Identify the priority (#1) nursing diagnosis label; and for the (#1) nursing diagnosis
label, explain the nursing interventions to address the identified problem. Provide evidence-based
rationale to explain the need and/or benefit of each intervention. For interventions, include what
the nurse should “monitor/assess”, “do”, and “teach” to the client. (20 points)
3. Describe 2 medical therapies used to treat the disorder and explain their specific mechanism of
action and intended impact at the cellular and/or tissue level. (15 points)
To answer questions 4-5, choose ONE disorder from this week’s reading
4. For the chosen disorder, identify the disorder and describe the impact on the United States
population including incidence, prevalence, costs, morbidity, mortality, and/or other appropriate
issues. Be sure to identify the disorder, the population associated with the data, and the year(s) of
data. (15 points)
5. For the chosen disorder, locate recommendations in a nursing journal article or professional
nursing organization. Provide a brief summary of the information and specific recommendations
for nursing actions to improve care for patients. (15 points) Hint: To increase the likelihood of
locating a nursing journal or organization, look for some form of the word “nurse” in the journal
or organizational name!
Scholarly Writing: Use correct spelling, grammar, sentence structure, formatting, professional terms,
title page, paraphrasing, citations, and references. Sources current (<5 years old) and professional (15