Clinical Case Scenario #1
Health Education for a Male Inpatient with Esophageal Varices
Forty five year old G.K. is admitted to the hospital’s Emergency Department. He is vomiting large amounts of blood. He is mildly intoxicated but alert. His pulse is fast and thready. An IV of normal saline 0.9% is started; he is given oxygen by mask, and is prepared to receive multiple units of packed red blood cells as needed (blood transfusions). He is transferred to the endoscopy lab for an immediate procedure to investigate the source of the bleeding.
In the Endoscopy lab it will be determined that he has bleeding esophageal varices, and a procedure will be performed to stop the bleeding. He will then be admitted to the hospital for observation.
Nursing goals include explanation of all procedures he is to undergo, given his level of comprehension, and written handouts for review later when fully conscious.
Searching in Patient Education Reference Center (PERC)
The nurse uses PERC to gather the handout she will need for Mr. K.
From the Home page, she searches for esophageal varices
She chooses the Conditions source type
She reads #1: Esophageal varices and checks the paper to glean meaningful information to share with Mr. K. She prints the hospital-customized handout.
The nurse searches Procedures & Lab Tests and finds Blood Transfusion for Mr. K.
The nurse returns to the results list and chooses the Procedure source type. She prints Upper GI Endoscopy and shares the paper with Mr. K before he is sedated, answering his questions and providing reassurance.
The gastroenterologist performs the endoscopy and locates the bleeding site. He uses Endoscopic Band Ligation to stop the bleeding. M. K. recovers quickly and is returned to his room.
Mr. K. is visited by the hospital’s social worker to discuss the potentiality of alcoholism and is referred to a community services program for follow up. The Social worker uses PERC to search for alcoholism. She prints Alcoholism and Alcohol Abuse and reviews the paper with Mr. K.
Following his hospital stay, Mr. K is discharged home with Social Services support. The nurse chooses the Discharge Instructions source type and prints both Discharge Instructions for Upper GI endoscopy and Discharge Instructions for Endoscopic Band Ligation. She discusses his instructions which include important follow up instructions such as seeing his doctor within 2 days and avoiding alcohol.
Following Mr. K.’s discharge, the nurse adds all patient education papers to folders and their related subfolders in PERC, to make available to the other members of the multidisciplinary team.
Handouts for Acute Care Folders in PERC
Blood and Blood Products
GI: esophageal varices
Upper GI Endoscopy, Upper Band Ligation
GI: Discharge info
Discharge Instructions for Upper GI endoscopy, Discharge Instructions for
Endoscopic Band Ligation.