John Adams, 55 years of age, is admitted to the intensive care unit with the diagnosis of acute esophageal varices bleed. The patient has a long-standing history of alcoholism and cirrhosis of the liver. Six months ago, the patient received an EGD, which diagnosed the esophageal varices. The patient has quit drinking alcohol for the past 6 months and has been active in Alcoholics Anonymous. The patient has a history of coronary artery disease and angina. The patient has been taking nadolol (Corgard) and isosorbide (Isordil). The admission vital signs include: BP, 88/50; P, 110; R, 26; and T, 99°F. The supplemental oxygen is on room air and the patient is placed on 2 L/min of oxygen per nasal cannula with supplemental oxygen. The patient’s hemoglobin is 6 g/dL, the hematocrit is 12%, and the platelets are 75,000. The patient has a prolonged PT and PTT. The liver profile shows a mild elevation of the aspartate aminotransferase (AST) and the alanine aminotransferase (ALT). The BUN and serum creatinine are also elevated. The patient has in place from the emergency department a nasogastric tube to low wall suction. The emergency department physician placed a right subclavian triple lumen catheter and there is NS infusing at 100 mL/hr. The emergency department 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. (Learning Objective 4)
a.In what order should the nurse institute the physician orders that are listed above? Perform dosage calculations and state how to administer the medications.
b.The nurse observes the nasogastric secretions and, upon admission to the ICU, there was 200 mL of dark red-colored drainage. The nurse continues to monitor the drainage and, as the nurse hangs the first unit of PRBCs, 200 mL of bright red bloody drainage is dumped into the collection canister. What should the nurse do?
c.The gastroenterologist orders for the nurse to increase the octreotide to 50 mcg/hr and the endoscopy nurse and the physician will be up shortly to perform a vertical band ligation (VBL). What does the nurse need to do in preparation for this procedure?
11 Dec '14339964.5/5 Brush with death GuidesorSubmit my paper for investigation By Nicholas Klacsanzky GanpatipuleI was on an excursion in Ganapatipule, which is a town on the coast on the west side of India, arranged right on the Indian Ocean. I was with my long-term companion, Janu, and his mom, remaining in an inn for a couple of days. The get-away so far was the epitome of unwinding: eating crisp mangoes, getting up late, feasting out constantly (for the most part fish curry), swimming a couple of times each day in the Indian sea, and kidding around with old buddies. Around three toward the evening on a cloudless day, the sea shore on our side was vacant of individuals other than my companion, his mom, and I. It was liberating to be distant from everyone else on this immense sea shore, known to be a blessed spot among Hindus. Ganapatipule is named after the god Ganesh, and there is a popular Ganesh hallowed place close there where a swayambhu (a model raised from the earth itself as a divine being) is venerated. Washing in the sea around this region should scrub individuals of their pessimism and visiting the place of worship decontaminates people also. Your paper is practically all set? Let a specialist have a last perused your paper before giving it in. The Sure Way to Getting a Higher Grade. SEE YOUR GRADE BEFORE Submitting YOUR PAPER. FREE EXPERT HELP As I began to swim in the warm sea, hopping over waves, I abandoned my companions. I was wearing a white kurta, or a conventional clothing for men in India, which was overwhelming in the water, however my feet was effectively contacting the sea floor consistently. I generally washed my garments by swimming in the sea when I was there. In any case, at one moment, I felt that my feet couldn't contact the sea floor any longer and I dove into the water, weighted somewhere near my garments. The waves continued coming and now they were threatening, as I was getting sucked into the profundities each opportunity they came—regardless of whether I emerged from the water and attempted to swim back to the piece of the sea where I could get an a dependable balance. I had been sucked into a riptide, truth be told, and was stuck in a plunging valley, in spite of my hard endeavors to arrive at security and my hollering to my companions out yonder. In the wake of battling intensely for a couple, long minutes to conflict with the suction of the riptide, and yelling to my companions out there close to the shore without much of any result, I started to unwind, tolerating my destiny. I never again battled to arrive at the edge of the sea valley to get a decent footing, and during the time spent being maneuvered into the sea and returning up to the surface, I conversed with God so anyone can hear. I talked about what I had fouled up in my life and what I did well. I closed in reflection that my life was satisfying generally speaking, and I felt prepared to bite the dust, tolerating the current condition as the real world. However as soon I gave up myself to the circumstance, a gigantic wave came and pushed me out of the riptide and the profound valley I was sucked into. On the float of the wave, I arrived close to my companions, who appeared to be bewildered at my demeanor and my expressions of depiction. They were ignorant that I experienced been difficulty. However, it didn't make a difference at that point—I was glad to arrive at land again and felt my life was reestablished. I later took in the time I swam was foreboding for swimming at Ganapatipule, as the locals accept the god Ganesh washes around three in evening in the sea there. Maybe Ganesh pardoned me for the interruption, and discharged me from the resentment of the sea against divine convention.>GET ANSWER