Intervention

Question 1

1. Airway

Answer 1

I would make sure that Phil is moved to a bed where he is highly visible. This is to ensure that he is closely monitored as his conscious levels are impaired due to his hypovolemia. He is at risk of his conscious levels deteriorating further due to a build up of lactic acid caused by anaerobic respiration. Acidosis can cause CNS depression therefore impairing conscious levels and leading to potential airway compromise

Question 2

2. RR

Answer 2

I would an arterial blood sample is obtained and analysed. The results would indicate an accurate pH level, CO2 and oxygen partial pressures as these would indicate the state of his acidosis and hypoxaemia based on impaired gaseous exchange caused by his oesophageal varices bleed.

Question 3

3. Sats

Answer 3

I would ensure that I would put Phil on 15litres high flow oxygen via a non re breathe mask. When he stabilises I would reduce this to maintain oxygen saturations of 94-98% (BTS, 2017). His hypovolemia has led to a reduced hypovolemia and less oxygen to bind to haemoglobin therefore the increase of oxygen concentration will provide enough oxygen to bind to haemoglobin

Question 4

4. Heart Rate

Answer 4

I would ensure that Phil is connected to a 3 lead cardiac monitor as he is at risk of developing arrhythmias due to his oliguric state which has caused a build up of potassium due to reabsorption of water and sodium by angiotensin 2 and the anti diuretic hormone

Question 5

5. BP

Answer 5

I would ensure that Phil has an arterial line inserted to ensure his BP is monitored continuously. Thus is because he is at risk of further hypotension due to loss of blood from his oesophageal varices bleed. He is also at risk of coagulopathy due to his liver’s inability to produce clotting factors

Question 6

6. CRT

Answer 6

I would ensure that Phil is cannulated with 2 size 16 cannulas in order to for him to receive IV fluids and blood products due to his hypovolemia as this would increase stroke volume, cardiac output and circulatory volume which would help to maintain his BP

Question 7

7. Urine Output

Answer 7

I would administer Terlipressin (2mg via IV) every 4hours for Phil as this would help to retard the oesophageal varices bleed hence reducing a further decrease in cardiac output

Question 8

8. Temperature

Answer 8

I would ensure that blood samples are obtained from Phil for blood cross match so that he would be transfused with the appropriate blood type since he is at risk of a reduction in haemoglobin due to his oesophageal varices bleed

Question 9

9. Glucose

Answer 9

I would ensure that Phil is commenced on a 20% IV glucose infusion as he is at further risk of of hypoglycaemia due to his depleted glycogen stores and poor oral intake due to his liver failure

Question 10

10. Conscious Levels

Answer 10

I would conduct neuro observations on Phil every 15 minutes using the Glasgow Coma Scale since he is at risk of his conscious levels deteriorating further and due to his encephalopathy which has resulted from high levels of ammonia which have crossed his blood brain barrier due to his liver failure