Reference no: EM133309364

Assignment: CHIEF COMPLAINT: "I'm passing black stool" and lightheadedness - 3 days.

HISTORY OF PRESENT ILLNESS: Teal Howell is a 45 year old nonbinary advertising executive who presents to the emergency room complaining of the passage of black stools x 3 days (see photo below) and an associated lightheadedness. They also relates that they cannot keep up with their usual schedule because of fatigability. Upon further questioning they state that their stools are not only black, but are sticky and malodorous. They further complain of recent worsening of a chronic epigastric burning which had been a problem off/on for years. They have 2-3 martinis at lunch and another cocktail before dinner. They take NSAIDS as needed for back pain and recently started on one aspirin per day for cardiac prophylaxis. They smoke two packs of cigarettes per day and an occasional cigar. They were told of an ulcer in the distant past but had no specific evaluation or treatment for same.

Their weight is stable and he claims to have an excellent appetite. They have had normal bowel habits in the past and has not had prior black stools. They have had no abdominal surgery and denies bleeding tendencies or prior transfusion.

PHYSICAL EXAMINATION: Examination reveals an alert, oriented, overweight male. He appears anxious and somewhat restless. Vital sips are as follows. Blood Pressure 90/60 mmHg, Heart Rate 115/min thready, Respiratory Rate - 20 /minute; Temperature 98 F.

SKIN: Facial pallor and cool, moist skin are noted.

CHEST: Lungs are clear to auscultation and percussion. The cardiac exam reveals regular rhythm with an S4. No murmur is appreciated. Peripheral pulses are present but are rapid and weak.

ABDOMEN/RECTUM: The abdomen reveals a rounded abdomen. Bowel sounds are hyperactive. There is moderate tenderness in the epigastrium. Rectal examination revealed black, tarry stool.

LABORATORY TESTS: Hemoglobin 9gm/dL, Hematocrit 27%, X-ray of abdomen (kidney, ureter, bladder - KUB) is unremarkable.

Alternations in Digestive Function

Question 1: what is the cause of their discomfort? What is the underlying pathophysiology?
Question 2: What are the contributing factors Teal has in his history?
Question 3: As the nurse caring for Teal how will you teach him about each of the treatment options?
Question 4: Break it down to him in a way that they will understand.
Question 5: What is the is the evidence of the effectiveness of each option?