From his history and assessment, identify five signs and symptoms (S/S) of GI bleeding and loss of ...

From his history and assessment, identify five signs and symptoms (S/S) of GI bleeding and loss of blood volume.
 
  What are they? Anyone can help?

Question 2

R.M. tells you that he knows that exercise will help him to lose weight, which is good, but he does not understand how exercise helps his cholesterol levels.
 
  How do you answer him?

Question 3

The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at 0430. She told the ED triage nurse that he had had diarrhea for the past 3 days and that last night he had a lot of dark red diarrhea.
 
  When he became very dizzy, disoriented, and weak this morning, she decided to bring him to
  the hospital. C.W.'s vital signs (VS) in the ED were 70/ (systolic blood pressure SBP 70 mm Hg, diastolic
  blood pressure DBP inaudible), pulse rate 110 beats/min, 22 breaths/min, oral temperature 99.1  F (37.3
  C). A 16-gauge IV catheter was inserted and a lactated Ringer's (LR) infusion was started. The triage nurse
  obtained the following history from the patient and his wife. C.W. has had idiopathic dilated cardiomyopathy
  for several years. The onset was insidious, but the cardiomyopathy is now severe, as evidenced by an
  ejection fraction of 13 found during a recent cardiac catheterization. He experiences frequent problems
  with heart failure (HF) because of the cardiomyopathy. Two years ago, he had a cardiac arrest that was
  attributed to hypokalemia. He has a long history of hypertension and arthritis. He had atrial fibrillation in
  the past but it has been under control recently. Fifteen years ago he had a peptic ulcer.
  Endoscopy showed a 25-  15-mm duodenal ulcer with adherent clot. The ulcer was cauterized and
  C.W. was admitted to the medical intensive care unit (MICU) for treatment of his volume deficit. You are his
  admitting nurse. As you are making him comfortable, Mrs. W. gives you a paper sack filled with the bottles
  of medications he has been taking: enalapril (Vasotec) 5 mg PO bid, warfarin (Coumadin) 5 mg/day PO,
  digoxin (Lanoxin) 0.125 mg/day PO, potassium chloride 20 mEq PO bid, and diclofenac (Voltaren) 50 mg
  PO tid. As you connect him to the cardiac monitor, you note he is in sinus tachycardia. Doing a quick
  assessment, you find a pale man who is sleepy but arousable and slightly disoriented. He states he is still
  dizzy. His BP is 98/52, pulse is 118, and respiratory rate 26. You hear S3 and S4 heart sounds and a grade II/
  VI systolic murmur. Peripheral pulses are all 2+, and trace pedal edema is present. Lungs are clear. Bowel
  sounds are present, midepigastric tenderness is noted, and the liver margin is 4 cm below the costal margin.
  A Swan-Ganz pulmonary artery catheter and a peripheral arterial line are inserted.
 
  What may have precipitated C.W.'s gastrointestinal (GI) bleeding?

Question 4

You enter R.M.'s room and hear the physician say, There are many options for changing your LDL and triglyceride levels. You need to continue modifying your diet and exercise to enhance your medication regimen.
 
  The physician asks R.M. whether he has any questions, and the patient responds, No.
 
  After the physician leaves the room, R.M. tells you he really didn't understand what the
  physician said. Explain the necessary lifestyle changes to R.M.

Question 5

R.M. tells you that he really does not want to put up with the side effects of the niacin.
 
  Is there an alternative to niacin?

Question 6

What else in R.M.'s history might be contributing to his elevated homocysteine levels?
 
  And you are teaching R.M. about the side effects of niacin. Which effects will you include in your
  teaching? Select all that apply.
  a. Flushed skin
  b. Headache
  c. Gastrointestinal (GI) distress
  d. Pruritus
  e. Dizziness