Ateneo de Zamboanga University

College of Nursing
1st Semester S.Y. 2021-2022
RELATED LEARNING EXPERIENCE
CASE SCENARIO:

Lolong is a 45-year-old male patient with acute GI bleeding, uncontrolled diabetes mellitus type
2, type 2 hypertension, and acute liver failure as a result of cirrhosis and hepatitis c; the patient
has been a known alcoholic for 5 years. He was admitted to the ICU two hours ago.
Five days prior to admission, the patient reported severe colicky abdominal pain in the right upper
quadrant region, along with hematemesis and melena. For his abdominal pain, he has been taking
OTC drugs such as mefenamic acid 500 mg 1 capsule. Per day, he consumes 5 bottles of
carbonated drinks daily. He does not seek medical consultation if he is feeling well.
A month ago, he felt numbness in his feet, followed by a tingling sensation, and noticed a small
unhealing wound. He also reported vision blurring, extreme thirst, urination, skin dryness, and
severe headaches.
A day prior to his admission, Lolong was found sleeping unconsciously inside his room, as
reported by his relatives; he was therefore rushed to the emergency room. He had bouts of
melena and hematemesis, severe headache, and abdominal pain several hours after
confinement. His vital signs are as follows; BP: 190/100mmHg, RR: 12br/min, PR: 150b/min,
Temp: 39.5 degree Celsius., oximetry: 90%
Doctor’s orders are as follows.
Admit to the intensive care unit

• IVF: Hook to PNSS1L and regulate at 160 ml/hr/min

• Prepare whole blood or PRBC and transfuse after properly crossmatched and typed
• Monitor Vital signs every 15 minutes and orthostatic BP q4h
• Neuro-vital signs q2H
• Watch out for hypotension, tachycardia
• Hook to cardiac monitor and pulse oximeter
• For RBS monitoring every 4 hours
• Diet: NPO temporarily, stop alcohol, avoid NSAIDs and steroids
• Insert NGT
• Observe for recurrence of hematemesis and melena
• Refer accordingly

Laboratory: CBC with platelet count and blood typing, FBS, BUN, CREA, CT-BT, PTT, Na, K
RBS, SGPT, SGOT , alkaline phosphatase, Total , direct and indirect bilirubin, ECG, CXR,
Upright abdomen x-ray, Urinalysis, Fecalysis, Blood typing, guaiac test, stat CBG, for
colonoscopy and endoscopy once stable.
Medications:

• Nicardipine drip at 10mcgtts/min, titrate for BP=120/80mmHg; 5 mg/hr by slow infusion

(50 mL/hr) initially; may be increased by 2.5 mg/hr every 15 minutes; not to exceed 15
mg/hr
• Cefuroxime (kefox) 500mg IVTT q8h anst( )
• Lactulose 30 ml TID per NGT
• Sucralfate (Iselpin) 1gm, 1 tab QID a.c
• Phytomenadione (konakion) 10mg/ml, 1 amp slow IV BID
• Aminoleban 500 cc IV q12H
• Rebamipide (mucosta) 100 mg 1 tab TID
• Omeprazole (Losec) 80 mg, 1 amp IV once a day
• Tranexamic Acid (Hemostan) 500mg/amp, 1 amp IV q8h
• Phospolipids (Essentiale P Forte) 1 cap once a day
• Humulin-R 15 units SQ q6h defer for RBS=100mg or less

TASK FOR THE WEEK:

1. Formulate an NCP and prioritize each problem

2. Formulate a health teaching plan
3. Conduct a drug study
4. Transcribe all medications to the MAR
5. Conduct an IVF study (calculate the number of drops per minute based on the given rate
above)
6. Briefly discuss the pathophysiology of patient’s disease condition.
7. Prepare a lab/diagnostic analysis
8. Formulate a focused (FDAR) charting based on the presented problems.
9. Simulate a ward endorsement based on the case presented.
10. Conduct an actual health teaching (prepare you slides)
11. Prepare an NSO based on identified nursing procedures from the case study and
present it to the RLE class.