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Nursing Diagnosis is Risk for bleeding related to esophageal varices as evidenced by prolonged prothrombin time Create NCP for this patient. Thank you!

Nursing Diagnosis is Risk for bleeding related to esophageal varices as evidenced by prolonged prothrombin time Create NCP for this patient. Thank you!

An Illustrated Guide To Vet Med Term
An Illustrated Guide To Vet Med Term
4th Edition
ISBN:9781305465763
Author:ROMICH
Publisher:ROMICH
Chapter18: Like Cats And Dogs
Section: Chapter Questions
Problem 1.3CS
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Nursing Diagnosis is Risk for bleeding related to esophageal varices as evidenced by prolonged prothrombin time

Create NCP for this patient.

Thank you!

Peritoneal fluid examination showed 40 cells/mm3 and a very high protein level of 8g/dL with negative acid-fast bacilli (AFB). Peritoneal fluid cytology was negative He had negative hepatitis B and C serology. Retroviral screening, Mantoux test and sputum AFB were negative. Ultrasonography of the abdomen revealed a hepatomegaly of 18.2cm with an enlarged caudate lobe and an architecture characteristic of chronic parenchymal liver disease. There was moderate ascites and bilateral pleural effusions. There was evidence of early portal hypertension. The initial colour doppler studies failed to show any abnormalities. Liver biopsy revealed effaced architecture with the liver parenchyma was separated into nodules by thick fibrous septae. Hepatocytes showed ballooning and degeneration. There was no steatosis, bile stasis, necro-inflammation or interphase hepatitis. These findings were compatible with established liver cirrhosis. The health provider places orders for the following: Kеep Spo2> 92% Кеep HOB > 30 degrees Insert 2 large bore Parenteral IV lines (PIV's) 500 mL NS IV bolus STAT 100 mL/hr NS IV continuous infusion Hydrocodone/Acetaminophen 5-500 mg 1-2 tabs q4h PRN moderate to severe pain Diphenhydramine 25 mg PO q8h PRN itching Ondansetron 4 mg IV q6h PRN nausea Lactulose 20 mg PO qồh After 24 hours upon admission patient experienced vomiting 2 times of fresh blood moderate in amount. Repeat laboratory done, result patient's hemoglobin is 7 g/dL, the hematocrit is 12%, and the platelets are 75,000. The patient has a prolonged PT and PTT. EGD was requested, which later revealed esophageal varices. The physician placed a right subclavian triple lumen catheter and there is NS infusing at 100 mL/hr. The iCú nurse administered vitamin K. Additional orders on the chart from the gastroenterologist include the following: Octreotide (Sandostatin) 5-mcg bolus followed with continuous infusion 500 mcg in 250 mL D5NS at 25 mcg/hr. Type and cross of 6 units of PRBCS STAT and transfuse 2 units of PRBCS over 2 hours each and administer furosemide (Lasix) 20 mg IVP in between each unit. Repeat CBC 1 hour after the transfusion is completed.
Transcribed Image Text:Peritoneal fluid examination showed 40 cells/mm3 and a very high protein level of 8g/dL with negative acid-fast bacilli (AFB). Peritoneal fluid cytology was negative He had negative hepatitis B and C serology. Retroviral screening, Mantoux test and sputum AFB were negative. Ultrasonography of the abdomen revealed a hepatomegaly of 18.2cm with an enlarged caudate lobe and an architecture characteristic of chronic parenchymal liver disease. There was moderate ascites and bilateral pleural effusions. There was evidence of early portal hypertension. The initial colour doppler studies failed to show any abnormalities. Liver biopsy revealed effaced architecture with the liver parenchyma was separated into nodules by thick fibrous septae. Hepatocytes showed ballooning and degeneration. There was no steatosis, bile stasis, necro-inflammation or interphase hepatitis. These findings were compatible with established liver cirrhosis. The health provider places orders for the following: Kеep Spo2> 92% Кеep HOB > 30 degrees Insert 2 large bore Parenteral IV lines (PIV's) 500 mL NS IV bolus STAT 100 mL/hr NS IV continuous infusion Hydrocodone/Acetaminophen 5-500 mg 1-2 tabs q4h PRN moderate to severe pain Diphenhydramine 25 mg PO q8h PRN itching Ondansetron 4 mg IV q6h PRN nausea Lactulose 20 mg PO qồh After 24 hours upon admission patient experienced vomiting 2 times of fresh blood moderate in amount. Repeat laboratory done, result patient's hemoglobin is 7 g/dL, the hematocrit is 12%, and the platelets are 75,000. The patient has a prolonged PT and PTT. EGD was requested, which later revealed esophageal varices. The physician placed a right subclavian triple lumen catheter and there is NS infusing at 100 mL/hr. The iCú nurse administered vitamin K. Additional orders on the chart from the gastroenterologist include the following: Octreotide (Sandostatin) 5-mcg bolus followed with continuous infusion 500 mcg in 250 mL D5NS at 25 mcg/hr. Type and cross of 6 units of PRBCS STAT and transfuse 2 units of PRBCS over 2 hours each and administer furosemide (Lasix) 20 mg IVP in between each unit. Repeat CBC 1 hour after the transfusion is completed.
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