ARELLANO UNIVERSITY

COLLEGE OF NURSING
2600 Legarda St. Sampaloc, Manila
www.edu.ph.com

CAP 1 ACTIVITY
SEMIFINALS

Brief Patient History:

Mrs. Arellano, 70 who has a long history of chronic back pain. She has been taking
nonsteroidal anti-inflammatory drugs (NSAIDs) for several years now. She was recently
prescribed warfarin for his atrial fibrillation.

Clinical Assessment:
Mrs. Arellano was currently admitted to the intensive care unit for vomiting bright red blood. She
is pale and diaphoretic, and complains of epigastric pain.

Diagnostic Procedures/VS:
Blood pressure (BP), 70/40; heart rate (HR), 130 (sinus tachycardia); respiratory rate (RR), 30;
temperature (T), 101.3° F; urine output, 15 mL/hr; hemoglobin, 9 g/dL; international normalized
ratio (INR), 5.3.

Medical Diagnosis:
Upper gastrointestinal bleeding

Answer the following questions:

1. What major outcomes do you expect to achieve for this patient?

- The major outcomes expected for this patient includes hemodynamic and hemostasis.

2. What problems or risks must be managed to achieve these outcomes?

- Maintenance of tissue perfussion, volume resuscitation, and airway protection must be
managed.

3. What interventions must be initiated to monitor, prevent, manage, or eliminate the

problems and risks identified?
- Patients VS should be monitored. The bleeding source should be identified and
arrested. Laboratory values should be assessed and blood product replcement should be
administered.

4. What interventions should be initiated to promote optimal functioning, safety, and well-
being of the patient?
- Adherance to policy on blood product administration. Prompt recognition of transfusion
reactions and assessment of complications.

5. What possible learning needs would you anticipate for this patient?
- Patient should be educated on the effect of NSAIDS use on GI tract, monitoring of
coagulations and an action plan in the event of further bleeding.

6. What cultural and age-related factors might have a bearing on the patient’s plan of
care?
- Patient may gave difficulty complying with a treatment plan due to potential memory
impairment, financial issues and transportations.