Nursing care plan for gastro intestinal bleed due to gastric ulcer

Paper instructions:
Mr Beto is a 49 year old Hungarian gentleman who presented to Emergency Department (ED) four months ago with an anterior ST segment elevation myocardial infarction (STEMI). He was thrombolysed at your hospital and referred to a tertiary referral hospital for a rescue Percutaneous Coronary Intervention (PCI). He was successfully revascularised and discharged home on a regime of aspirin 100mg daily, prasugrel 10mg daily, atorvastatin 40mg daily, metoprolol 50mg bd and lisinopril 5mg daily.

Mr Beto decided to celebrate his successful recovery post MI with a holiday in Bali. All went well except he became unwell with nausea, vomiting and diarrhoea in the last couple of days of his holiday. His illness had settled after a week of rest at home. For the past two days Mr Beto has had intermittent chest pain with no radiation but he has felt nauseated. When assessed (using PQRST) he states the pain is scoring 8/10, worse at night, burning in nature and he has slight relief after drinking milk. His vital signs on admission are BP 119/68, heart rate 46bpm, temp 36.8, SpO2 100% on room air and respiratory rate of 16 breaths per minute.

According to the hospital policy, Mr Beto’s pain is treated as chest pain, however, normal ECG’s and negative troponins over the past twenty four hours have excluded this as a cause. Mr Beto has been admitted to your ward for management of this pain. On his last admission, Mr Beto’s blood results showed a haemoglobin of 144, platelets 268 and normal white cell count. On this admission his haemoglobin is 113, platelets 204 and white cell count 12.7.

Overnight Mr Beto complains of lower abdominal pain and urgency to move his bowels, but he has not yet been able to pass a stool, just flatus. Approximately 2 hours later your colleague notices he has been missing from his bed for some time. When she checked the bathroom she found Mr Beto slumped on the toilet. He was cool, pale and sweaty but rousable. There was faecal matter in the toilet mixed with a large volume of frank blood.

Mr Beto’s vital signs at this time are BP 67/39, heart rate 72bpm, temp 35.1, SpO2 89% on room air and respiratory rate of 29 breaths per minute. Mr Beto is urgently assessed by the medical team, a fluid resuscitation is commenced and Mr Beto is taken for an urgent endoscopy. During the endoscopy Mr Beto is found to have two actively bleeding gastric ulcers. During the endoscopy these are injected with adrenaline and the bleeding has now ceased. Mr Beto was also found to have helicobacter pylori present in his gastric ulcers.

Mr Beto’s condition was stabilised, he commenced a regime of antibiotics to treat the helicobacter pylori and discharged home after a few days.

Mr Beto is a 49 year old Hungarian gentleman who presented to Emergency Department (ED) four months ago with an anterior ST segment elevation myocardial infarction (STEMI). He was thrombolysed at your hospital and referred to a tertiary referral hospital for a rescue Percutaneous Coronary Intervention (PCI). He was successfully revascularised and discharged home on a regime of aspirin 100mg daily, prasugrel 10mg daily, atorvastatin 40mg daily, metoprolol 50mg bd and lisinopril 5mg daily.

Mr Beto decided to celebrate his successful recovery post MI with a holiday in Bali. All went well except he became unwell with nausea, vomiting and diarrhoea in the last couple of days of his holiday. His illness had settled after a week of rest at home. For the past two days Mr Beto has had intermittent chest pain with no radiation but he has felt nauseated. When assessed (using PQRST) he states the pain is scoring 8/10, worse at night, burning in nature and he has slight relief after drinking milk. His vital signs on admission are BP 119/68, heart rate 46bpm, temp 36.8, SpO2 100% on room air and respiratory rate of 16 breaths per minute.

According to the hospital policy, Mr Beto’s pain is treated as chest pain, however, normal ECG’s and negative troponins over the past twenty four hours have excluded this as a cause. Mr Beto has been admitted to your ward for management of this pain. On his last admission, Mr Beto’s blood results showed a haemoglobin of 144, platelets 268 and normal white cell count. On this admission his haemoglobin is 113, platelets 204 and white cell count 12.7.

Overnight Mr Beto complains of lower abdominal pain and urgency to move his bowels, but he has not yet been able to pass a stool, just flatus. Approximately 2 hours later your colleague notices he has been missing from his bed for some time. When she checked the bathroom she found Mr Beto slumped on the toilet. He was cool, pale and sweaty but rousable. There was faecal matter in the toilet mixed with a large volume of frank blood.

Mr Beto’s vital signs at this time are BP 67/39, heart rate 72bpm, temp 35.1, SpO2 89% on room air and respiratory rate of 29 breaths per minute. Mr Beto is urgently assessed by the medical team, a fluid resuscitation is commenced and Mr Beto is taken for an urgent endoscopy. During the endoscopy Mr Beto is found to have two actively bleeding gastric ulcers. During the endoscopy these are injected with adrenaline and the bleeding has now ceased. Mr Beto was also found to have helicobacter pylori present in his gastric ulcers.

Mr Beto’s condition was stabilised, he commenced a regime of antibiotics to treat the helicobacter pylori and discharged home after a few days.

In the essay you are to comprise a plan of care for Mr Beto including patient problem / nursing diagnoses, goals, strategies to be implemented and how you would evaluate the outcomes.