A nurse is assisting with the care of a client on a medical surgical unit who was admitted from the emergency department.

Exhibits

For each assessment finding on Day 2 click to specify if the finding is due to lisinopril, carvedilol, or furosemide. Each finding may be related to more than 1 medication.

A. Diminished pulses on the affected extremity. Reduced pulses suggest impaired circulation, which may indicate compartment syndrome, a serious complication where increased pressure restricts blood flow. Without prompt intervention, this can lead to tissue damage or limb loss. The nurse should assess for additional signs such as pallor, paresthesia, and unrelieved pain and notify the provider immediately.
B. One fingerbreadth of space between the cast and the skin. This is an expected finding, as having a small space between the cast and skin allows for proper circulation and prevents excessive pressure that could lead to skin breakdown. The cast should be snug but not too tight to allow for swelling that may occur after injury or surgery. However, this does not require immediate intervention.
C. Client report of muscle spasms of the left leg. Muscle spasms are common in clients with immobilized limbs due to muscle fatigue, positioning, or nerve irritation. While uncomfortable, they do not indicate an emergency. The nurse can suggest gentle repositioning, relaxation techniques, or prescribed muscle relaxants to alleviate discomfort.
D. Ecchymosis on the inner left thigh. Bruising is a normal response to trauma and does not necessarily indicate a severe complication. It should be monitored for changes such as increasing size, pain, or signs of infection, but it does not take priority over assessing circulation and preventing limb-threatening complications.

• Endoscopy is the most appropriate diagnostic tool to visualize the gastrointestinal tract directly when gastrointestinal bleeding is suspected. Given the client’s symptoms of gnawing abdominal pain, radiation of pain to the back, and a positive Hemoccult stool test Endoscopy will help confirm this diagnosis and allow for appropriate treatment.
• Positive Hemoccult stool indicates the presence of occult blood, which is a hallmark sign of gastrointestinal bleeding. In this case, the presence of blood in the stool aligns with the client’s symptoms of abdominal pain and possible peptic ulcer disease, often linked with H. pylori infection. The positive Hemoccult stool test justifies the need for endoscopy to identify the source of bleeding and guide further management.

• Barium swallow. A barium swallow can detect structural abnormalities like strictures, tumors, or achalasia in the esophagus but is not as effective as endoscopy in diagnosing peptic ulcers or evaluating gastrointestinal bleeding. In this case, endoscopy is the preferred diagnostic method as it provides direct visualization of ulcers or other lesions in the stomach or duodenum.
• CT scan. While a CT scan can be helpful in assessing for abdominal issues like perforation or obstruction, it is not the first choice for diagnosing peptic ulcers or gastrointestinal bleeding. Endoscopy provides a more targeted and effective approach for visualizing the gastrointestinal tract and identifying the source of the bleeding.
• Surgical intervention.Surgical intervention is typically reserved for severe cases where there is gastrointestinal perforation or uncontrollable bleeding. In this case, the client has not yet shown signs of perforation or hemorrhagic shock that would require immediate surgery. Initial diagnostic tests, such as endoscopy, are needed before surgical consideration.

• WBC count of 6,700/mm³. The client’s WBC count is within the normal range (5,000 to 10,000/mm³), suggesting no current acute infection. While inflammation could be indicated in cases of ulcers or gastritis, the normal WBC count in this case does not raise immediate concern for infection. It is unlikely to directly influence the need for endoscopy, which is guided primarily by the clinical presentation and positive Hemoccult stool result.

• Hemoglobin of 9.1 g/dL, Hematocrit of 27%. The low hemoglobin and hematocrit levels indicate anemia, which is often caused by chronic blood loss. This aligns with the positive Hemoccult stool test, which suggests that the client is losing blood through the gastrointestinal tract, possibly due to a peptic ulcer. This finding supports the need for endoscopy to investigate the cause of the bleeding and assess the need for treatment such as blood transfusions or iron supplementation.