Problem
GI Bleeding with COPD complications: Edwin Carr's scenario You are a nurse working in a community hospital. Edwin Carr is admitted today. He is a 67 year old male with a history of COPD, hypertension, MI, arthritis, and hiatal hernia who was recently hospitalized and treated for congestive heart failure (CHF). His current medications include: Carafate 1gram PO before meals and at HS; Celexa 40mg PO daily; Colace 100mg PO BID; Ecotrin 325mg PO daily; Lasix 20mg PO BID; Lopressor 50mg PO BID; Prilosec 20mg PO daily; TUMS 1-2 tabs prn; Robitussin DM 5mL PO q6hr; Theodur 200mg PO BID; and Combivent (albuterol + ipratorium) 2 puffs QID.
Ed reports that he has been taking ASA with alcohol at his for stomach pain because he "can't afford the Prilosec". Mr. Carr is a thin gentleman who is slightly short of breath but does not appear in acute distress. He states that his "cough and breathing" have improved since his last hospitalization but that he gets "sharp pains in my gut all the time." He also states that he has noticed feeling "woozy" when he gets out of bed.
Assessment reveals: T 36.7, P 96, R 30, BP 98/52, O2 90%.
Labs reveal: WBC 8400, Hemoglobin 8.4, Potassium 4.2.
Consider the following questions
1) You suspect that Mr. Carr may have an ulcer. Why?
2) What medications should he be taking for his ulcer, and how do they differ?
3) How do these drugs interact with each other and how should they be given?
4) Discuss the meaning of Mr. Carr's labs, BP, pulse, respirations, and, symptoms
5) Reflect on the implications of his combined hemoglobin and 02%
6) What factors are contributing to his alterations in perfusion?
7) What are the nursing implications of his altered perfusion?
8) Share your thoughts on giving Mr. Carr his medications by mouth?
9) What does Mr. Carr's physician need to be told?
10) Discuss specific medication related safety concerns and nursing implications.
11) What specific patient teaching is needed in this scenario?
12) Were there any ethical issues evident in this scenario?