Homework #1

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Summer

Homework 1

Case study

• 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.

Emergency department,

• 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.

• 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.

Summer

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

points)

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