-Understanding the pathophysiological processes involved in a patient with an active gastrointestinal (GI) bleeding, considering the patient’s individual characteristics and needs.
–  Formulating a person centred, holistic care plan for the management of a person with a gastrointestinal bleed.

Case Study

Mr Barker is a 48-year-oldmale who presented to the Emergency Department (ED) four months ago with an anterior ST segment elevation myocardial infarction (STEMI). He was thrombolysed at your hospital and referred to a tertiary referral hospital for a rescue Percutaneous Coronary Intervention (PCI). He was successfully re-vascularised and discharged home on a regime of aspirin 100mg daily, prasugrel 10mg daily, Atorvastatin 40mg daily, Metoprolol 50mg bd and Lisinopril 5mg daily.

Mr Barker decided to celebrate his successful recovery post MI with a holiday in Bali. All went well until the last couple of days of his holiday, when he became unwell with nausea, vomiting and diarrhoea.  His illness had settled after a week of rest at home. For the past two days Mr Barker has had intermittent chest pain with no radiation but he has felt nauseated. When assessed (using PQRST) he states the pain is scoring 8/10, worse at night, burning in nature and he has slight relief after drinking milk. His vital signs on admission are BP 119/68, heart rate 46bpm, temp 36.8, SpO2 100% on room air and respiratory rate of 16 breaths per minute.

According to the hospital policy, Mr Barker’s pain is treated as chest pain; however, normal ECG’s and negative troponins over the past twenty-four hours have excluded this as a cause of his pain. Mr Barker has been admitted to your ward for management of his pain. On his last admission, Mr Barker’s blood results showed haemoglobin level of 14.4 g/dL, platelets 268× 10⁹/L and normal white cell count. On this admission his haemoglobin is 11.3 g/dL, platelets 204× 10⁹/L and white cell count 12.7× 10⁹/L.

Overnight Mr Barker complains of lower abdominal pain and urgency to move his bowels, but he has not yet been able to pass a stool, just flatus. Approximately 2 hours later your colleague notices he has been missing from his bed for some time. When she checked the bathroom she found Mr Barker slumped on the toilet. He was cool, pale and sweaty but rousable. There was faecal matter in the toilet mixed with a large volume of frank blood.

Mr Barker’s vital signs at this time are BP 67/39, heart rate 100bpm, temp 35.1, SpO2 89% on room air and respiratory rate of 29 breaths per minute. The medical team urgently assesses Mr Barker, a fluid resuscitation is commenced and Mr Barker is taken for an urgent endoscopy. During the endoscopy Mr Barker is found to have two actively bleeding gastric ulcers. During the endoscopy these are injected with adrenaline and the bleeding has now ceased. Mr Barker was also found to have helicobacter pylori present in his gastric ulcers.

Mr Barker’s condition was stabilised, he commenced a regime of antibiotics to treat the helicobacter pylori and discharged home after a few days.

Instructions

There are two parts to this assessment task

Part A:

Develop a concept map using the information from the case study that demonstrates:

a)    Your understanding of the pathophysiological processes associated with active gastrointestinal bleeding;

b)    Integrates your assessment data from Mr Barker’s case study which impact on the patient’s problems; (Mr Barker’s medical and social history for example: lifestyle, culture, age and ethnicity and activities of living should be considered when you assess to identify the patient’s problems).

Part B:

Consider how you will develop a person centred holistic care plan using the information in the case study. Write up the care plan in the form of a report giving a rational for the issues you have chosen to include in the care plan. A minimum of four (4) issues/problems needs to be considered, these should take into account age, socio economic status, patient education needs and pathophysiology (1500 words).

Points to consider:

–         You must use current literature, less than 10 years old, textbooks, journal articles and/or other peer-reviewed resources.

–         No more than three (3) web-based resources are to be used for this assignment.

–     Relevancetopractice– 50%

§  Structure,organisation&presentation–20%

7)    Utilise and evaluate evidence based criteria with which to appraise clinical practice planning and delivery for people with an episodic illness that has resulted in alterations in human functioning across the lifespan.

8)    Demonstrate an ability to assess diversity and to incorporate differences in culture, age, ethnicity, religion in planned care.

Criteria