Question

J.G., a 49-year-old man, was seen in the emergency department 4 days ago, diagnosed with alcohol intoxication, and released after 8 hours to his brother's care. He was brought back to the ED 12 hours ago with an active gastrointestinal (GI) bleed and is being admitted to the intensive care unit (ICU); his diagnosis is upper GI bleed and alcohol intoxication.

You are assigned to admit and care for J.G. for the remainder of your shift. According to the ED notes, his admission vital signs (VS) were 84/56, 110, 26, and he was vomiting bright red blood. He was given IV fluids and transfused 6 units of packed red blood cells (PRBCs) in the ED. On initial assessment, you note that J.G:s VS are blood pressure 154/90, 110, 24; he has a slight tremor in his hands, and he appears anxious. He complains of a headache and appears flushed. You note that he has not had any emesis and has not had any frank red blood in his stool or melena (black tarry stools) over the past 5 hours. In response to your questions, J.G. denies that he has an alcohol problem but later admits to drinking approximately a fifth of vodka daily for the past 2 months. He reports that he was drinking vodka when he got home from the ED the first time. He admits to having had seizures while withdrawing from alcohol in the past. He tells you that he "just can't help it" and has strong urges to drink, but that he never means "to drink very much." He has had trouble keeping a job over the past several months.

Chart View

Admission Lab Work

Hgb 10.9 g/dL

Hct 23%

ALT (formerly SGPT) 69 units/L

AST (formerly SGOT) 111 units/L

GGT 75 units/L

ETOH 291 mg/dL

1.Choose one lab and present the normal range and complications if abnormal ranges

2. two nurse diagnostics (two acute diagnostics), include 2 interventions for each diagnostic,

3.Create discharge education applicable to the client's condition, and discharge summary.

Answer 1

1.

Hgb 10.9 g/dL

• Normal results for adults : Male: 13.8 to 17.2 grams per deciliter (g/dL)

Complication

• Low hemoglobin levels lead to anemia, which causes symptoms like fatigue and trouble breathing

2

Nursing diagnosis

- Deficient fluid volume related to blood loss from hemorrhage

Interventions:

• Review Hgb and Hct levels to determine the effectiveness of treatment or worsening of the patient’s condition.
• Administer colloids as ordered to restore intravascular volume.
• Monitor fluid volume status. Measure intake and output hourly to evaluate renal perfusion.

-Ineffective Individual Coping related to Personal vulnerability

Interventions:

• Determine understanding of current situation, previous, and other methods of coping with life’s problems.
• Encourage verbalization of feelings, fears,anxiety.
• Assist patient to learn and encourage use of relaxation skills, guided imagery, visualizations.

3.

Discharge education

• Decrease the amount you drink.
• Plan weekly alcohol use
• There are many consequences of drinking that include :

-Excessive alcohol consumption is a leading preventable cause of death

-Drinking alcohol increases the risk of traffic accidents, suicide, drowning, and other serious injuries.

-Alcohol use continues to be the leading cause of injuries treated in trauma centers and emergency departments

-Alcohol-related liver disease may lead to end-stage liver disease and death.

-Alcohol increases the risk of certain cancers of the mouth, esophagus, throat, liver, and breast.

-Other consequences of prolonged, heavy alcohol consumption include heart failure and several types of dementia, some of which are irreversible.