PA6 – Sprains and strains – Practical Assessment 6 Scenario:

Sally McGuire, 46, is a female client admitted with complaints of abdominal pain, multiple loose dark colored stools, and two episodes of dark bloody emesis. Her current vitals are: BP 96/66, HR 102, RR 22, Sp02 91%, on RA. She is slow to respond to questions. You note normal S1,$2 heart sounds, and +1 pulses on both her upper extremities and lower extremities. Her Abdomen is slightly distended and tender to touch, in her LUQ. Her skin is pale. Her past medical history includes Type 2 diabetes and atrial fibrillation. Her current medications include Apixaban, PO, 2.5 mg bid; Empagliflozin, PO, 10 mg daily, and Dofetilide, PO, 500 mcg bid. Her Hemoglobin/Hematocrit is 8.2/28.2. What elements of Sally’s story are critical to your evaluation of her present status? (Select all that apply) Her current vitals and clinical assessments indicate possible hemodynamic instability Her reporting of multiple stools and hematemesis possibly indicate active bleeding Her lab results may be indicative of active bleeding Her current medications and Co-morbidities put her at higher risk for both bleeding and an unfavorable outcome Her report of hematemesis and melena may be indicative of a lower GI bleed

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