Case Study: A 25-year-old presented to the labor and delivery unit with complaints of uterine cramping and lower back pain. The client denied any vaginal bleeding and had a history of preterm birth at 32 weeks (about 7 and a half months) gestation with her last pregnancy. The baby from that pregnancy is three years old has no developmental issues. The client’s gestational age is 30 weeks (about 7 months). She is O+, and all other lab values are normal. No evidence of sexually transmitted infections (STI’s).

(Group Beta Strep is missing from the labs and most often is obtained at 35 – 37 weeks (about 8 and a half months) gestation. Without this information, it is often determined to treat the patient anyway, to protect a premature baby from the risk.)

• What additional information should the nurse obtain from the client?
• What nursing intervention is most appropriate in this situation?
• What screening tests should be obtained to determine the risk for preterm labor?
• If the client is in preterm labor, what medications would the nurse expect to be ordered, and what are the priorities for the nurse to assess post-administration? (Include dose, side effects and expected outcomes of the medication).

Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. 

GASTROINTESTINAL TRACT BLEEDING

Patient Profile

Maria, a 48 year-old woman was transferred from emergency department (ED) to transitional care unit (TCU) with a diagnosis of probable gastrointestinal (GI) tract bleeding and abdominal pain. Patient c/o nausea and vomiting blood x2 weeks.

Subjective Data:

-Has a history of alcohol abuse

-Has a history of poorly controlled peptic ulcer disease due to non-compliance with treatment

-Is overweight, but recently lost 10 pounds

-Work as an admission coordinator at local junior college

-Live with her spouse, who was recently diagnosis with prostate cancer

-Recently experienced the death of a her mother from cardiac arrest

  Physical Examination:

                        B/P = 77/41 HR 49 RR 16 T (tympanic) 37.9 (100.2) O2 Sats 98% RA

                        Lungs clear to auscultation, S-3 heart sound to auscultation

Diaphoretic, short of breath, anxious

  
Laboratory Studies

NA 157 Serum K (potassium (3.0)

Hgb 7.6 HCT: 22.8 PLTs 138

RBC 3.32 WBC 11.6

Critical Thinking Questions:

1. Briefly explain the pathophysiology of the development of GI tract bleeding. What is the etiology associated with acute GI tract bleeding?

2. Identify common causes of GI tract bleeding and list predisposing factors specific to Maria.

3. Discriminate between the characteristics of upper and lower GI tract bleeding.

4. What complications did Maria experience?

5. Which factors determine whether blood products will be administered to a patient with GI tract bleeding?

6. Maria Hgb and Hct values dropped. Discuss the drop in Hgb and Hct values in relation to Maria blood loss.

7. If Maria continues to have active bleeding from the GI tract despite conservative management, what other medical procedures might be implement and why?

You will conduct a professional interview with a staff nurse and a staff nurse leader ( charge nurse, shift lead, house supervisor, etc) to discover their intra/inter-professional communications styles. It will be important to incorporate learning objectives regarding therapeutic communication styles including their method of caring, assertive, and responsible communication in your discussion/analysis of the interview.

The paper should utilize APA 7th format using Times New Roman 12pt font and include a title page. There should be less than 10% of direct quotations used in your paper, sources should be paraphrased and cited appropriately. The use of headings should be incorporated in the paper design. Additionally, provide citation for the personal communication with the interviewees (use initials only). Support from at least 3 peer reviewed journal articles in addition to your textbooks must be used. Use initials and avoid the use of patient names, staff names, and facility names for HIPPA compliance. Complete the Contact Information Form for Experiential Learning for all individuals interviewed and submit with your completed assignment to the drop box Sunday by 11:59pm.

You should use headings and subheadings from the Instructions to set up your paper

The following information should be included in your interview:

Description the facility i.e.: a large metropolitan hospital, rural nursing home or urban clinic

Staff Nurse Interview

Interview a staff nurse regarding:

· What (s)he perceives are the main communication issues/barriers

· how they communicate with patients,

· how they communicate with colleagues

· how they communicate with leadership/administration.

Describe your findings in no more than 2 pages using terms and vocabulary from course learning. Relates each interview question to content learned in the class by providing analysis and synthesis of question and response and includes minimum of one citation per question- you may cite the texts & or other peer reviewed journal articles.

Please watch videos to be able to answer questions. Please click links