Question

In: Nursing

You review EPIC for Mr. Smith and find that he was admitted to the hospital last...

You review EPIC for Mr. Smith and find that he was admitted to the hospital last night with the diagnosis of bleeding esophageal varices. He is 38 years old, 6’ tall, and weighs 155 lbs. He has a history of alcohol abuse and bipolar disorder. He is on bedrest with bathroom privileges, NPO, and has an IV with lactated ringers running at 125mL/hr. He is a bit confused and has been shivering. His temp is 100.6° F. He is scheduled for a variceal ligation.

Medications: IV octreotide 50 mcg/hr x 3 days

Thiamin 100 mg PO every morning

MVI tablet each morning

Propranolol 20 mg PO BID

Lithium 900 mg PO each morning

Labs:

Alanine aminotransferase (ALT) – 80 Units/L

Aspartate aminotransferase (AST) – 250 Units/L

Hgb 6.8 Hct 21 Potassium – 3.3 mEq/L

Folate – 3 nmol/L (7-36 nmol/L)

Thiamine – 55 nmol/L (70-180nmol/L)

Vit B12 – 100 ng/L (130-700 ng/L)

1. The patient has a Ringers Lactate IV hanging – is this compatible with octreotide IV piggyback?

2. What vital signs would be important to monitor for this patient?

3. Consider the history of alcohol abuse.  What are possible causes for confusion and shivering for this patient?

4. Discuss the use of a Clinical Institute Withdrawal Assessment (CIWA) scale. Your patient has a score of 12 on the CIWA scale.  

Solutions

Expert Solution

1. No, octreotide is not compatible with ringer lactate .

Compatible with sodium chloride 0.9% or dextrose 5% in water.

Stable in sodium chloride 0.9% for 24 hours

2. The vital signs that would be important to monitor for this patient :-

- Temperature

- SPO2

- PR

- RR

3. The possible causes for confusion and shivering for this patient are :-

- alcohol withdrawal

- fever

- low hemoglobin

- NPO

4. The Clinical Institute Withdrawal Assessment for Alcohol, commonly abbreviated as CIWA or CIWA-Ar (revised version), is a 10-item scale used in the assessment and management of alcohol withdrawal. Each item on the scale is scored independently, and the summation of the scores yields an aggregate value that correlates to the severity of alcohol withdrawal.

Categories :-

Less than 10 is mild

Between 11-15 is moderate

Equal to or greater than 16 is severe

Nightingale answered 2 years ago
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