Section 1 Clinical question. Your patient who was admitted withmelaenaand is currently only taking fluids has returned from the bathroom feeling dizzy and short of breath. What will your actions be?...

Section 1
Clinical question
Assessment-
Patient who was admitted with Melaena is on fluids only cu
ently and when came out of bathroom, he is feeling very dizzy and short of
eathe. This must have happened because of iron deficiency caused in his body due to blood loss. As in Melaena, there are much gastrointestinal bleeding causing black ta
y stools. Melena occurs usually due to bleeding in upper gastrointestinal tract; underlying cause behind this may be peptic ulcer disease, gastric cancer or the liver disease. This blood loss causes anemic condition leading to shortness of
eath and dizziness.
Actions-
· First and foremost, I will assist the patient to sit on bed in comfortable positioning which is very important. Breathing can be eased up by making him sit up and lean forward with hands on knees. Also, I will make him sit near window followed by teaching relaxation techniques to calm him down. I will try to be friendly while empathizing his condition and will make him aware about the condition and reason behind this.
· Afterwards, I will start his oxygen supplement equipment; will advise to have nothing by mouth. Avoid NIPPV due to the risk of aspiration with ongoing vomiting.
· IV fluid will be started with normal saline or Lactated Ringer’s solution for Resuscitation.
· Will start diagnostic studies and lab tests to know the risks, extent of disease and bleeding areas. And diagnosis.
· Blood units may be transfused in case of low hemoglobin count based on the reports.
Hypothesis-
The reason behind the dizziness and shortness of
eath is anemia like condition caused by heavy blood loss by gastrointestinal bleeding. Thus, to manage it, patient must be calm and comfortable followed by assistance via oxygen supplement.
Another reason behind this symptom may be anxiety about the disease or not able to cope up with the stress in air of hospital.
Rationale-
To overcome the condition of short
eathless, the first step is to be done is setting up oxygen level in body by starting the oxygen by nasal tube. But in cases, where nasal tube is not helping to soothe or calm the
eathing pattern or in case oxygen saturation is really low, incubation may be required.
Oral intake is to be stopped for while even for fluids as it interferes with the oxygen intake, to cope up this, IV resuscitation is much required side by side. Also, there is need to make patient comfortable and calm which can be done by being friendly, calm and supportive as and when required.
After first line of action to cu
the dizziness and short
eath, there is need to ca
y out the diagnosis of real reasons behind it. The lab tests and other diagnostics must be done at earliest to know the extent and spread of disease along with the actual underlying cause of this melena whether it is peptic ulcer, gastric cancer or liver disease. If required, blood transfusion may also be added to line of treatment.
Section 2
Prioritization
First of all I will consider request of Patient 3 Mrs Jones who has an oxycodone PCA in situ. Overnight her SpO2 dropped so the night staff applied 2L O2/min and left the SpO2 probe in situ. The SpO2 machine is alarming. She needs attention and nursing care at priority reason being there are chances of Respiratory distress, tachypnoea or slow respirations. Impaired oxygenation or cyanosis chances are higher in case of delay. Patient may suffer from hypotension, agitation or confusion if not checked...