Please read the following case study and answer the following questions
In-Depth Case Study:
Mr. Carmel is a 70-year-old male who traveled with his wife for a family reunion but upon arrival to their destination, he was taken from the airport to the emergency Department because he had fainted in the parking lot of the airport. Mr. Carmel is 5’9” and weighs 204 pounds.
Mr. Carmel is brought from the airport to the ER by the ambulance accompanied by his wife. On arrival, Mr. Carmel is alert, and oriented to all stimuli.
His vital signs are:
blood pressure one 110/78
temperature 36.8 Celsius
A nurse practitioner initiates the assessment. The sclera of both eyes is almost white, but his skin is dry and warm. His wife reported that he has not been eating as he usually does, and he has slept much more than usual for the past three weeks. She also reported that his steps have been much lower than normal, and he has not been as “jovial” as he usually is. Mr. Carmel reports loss of appetite and a decrease in bowel movement, with only one bowel movement every other day. He denies past medical or surgical history but informs the nurse that he has noticed that his bowel movement has been black and tarry, but he did not think anything of it. He reported taking aspirin for arthritic pain during the past six months.
His heart sounds are normal, bilateral breath sounds are clear, and respirations are normal. His abdomen is soft and non-tender to the touch and bowel sounds are hyperactive. On rectal examination, there is a dark coloured blood and tarry stool. Stool for occult blood is done and it is positive. There are no other abnormalities on the rectal examination. A blood specimen is drawn and sent to the lab for haematocrit, hemoglobin, red blood cell count, partial thromboplastin time, activated partial thromboplastin time, serum iron, transferrin, and blood for type and cross match. A 12-lead electrocardiogram is done and reveals normal sinus rhythm. An 18-gauge intravenous catheter is inserted in 0.9% normal saline and is initiated at 100 ml/hr. A nasogastric tube is inserted, and aspirate is analyzed for bleeding but is negative for the presence of blood.
Results of the labs reveal:
hemoglobin 10 mg/dL
red blood cell count 4.5/mm3
partial thromboplastin time 48 seconds
activated partial thromboplastin time 48 seconds
serum iron 50 mg/dL
transferring 230 mg/dL
Mr. Carmel is transferred to the surgical unit where he receives 2 units of packed red blood cells. Mr. Carmel is prepared for a virtual colonoscopy by receiving two cleansing enemas before the procedure. After the transfusion, Mr. Carmel reported feeling much better. The colonoscopy is done and reveals hemorrhoids and small gastric ulcers in the area of the lower GI tract. The multi disciplinary team discusses the findings of the diagnostic studies with Mr. Carmel and make plans to do a proctosigmoidoscopy at a later time.
Post transfusion labs reveal:
hemoglobin 12 mg/dL
Post transfusion vital signs are:
blood pressure 110/74
temperature 36.7 Celsius.
Mr. Carmel is discharged to home with referral to his family physician for a proctosigmoidoscopy, further evaluation to rule out diverticular diseases and benign anorectal diseases, and to re-evaluate hematologic and GI status. A diagnosis of lower GI bleeding is confirmed by clinical symptoms and the colonoscopy.
The following has been prescribed for Mr. Carmel:
Aluminum hydroxide (Amphogel) 60 mL one to three hours after meals
Ferrous Sulfate (Feosol) 325 mg by mouth three times per day
Misoprostol 200 mcg/50mg
Answer the guided, reflective questions within your assigned In-Depth Case Study. Make sure that your answers are meaningful, and provide details with rationale or examples to justify your answers:
1. Discuss common causes for lower GI bleeding in adults.
Answer In-Depth Case Study Question #1 in three complete paragraphs. The answer to this question must be succinct, meaningful, and with clear examples. (for this assignment, each paragraph must have, exactly, 7 complete sentences).
2. Discuss the potentially severe transfusion related complications and the nursing implications.
Answer In-Depth Case Study Question #2 in three complete paragraphs. The answer to this question must be succinct, meaningful, and with clear examples. (for this assignment, each paragraph must have, exactly, 7 complete sentences).
3. a) What is Diabetes Mellitus
b) Write in details about pertinent goals and interventions to be carry out for a Diabetes patient. ( Pertinent Goals And Interventions)