การพยาบาลผู้ป่วยที่ได้รับการให้ยาระงับความรู้สึก สำหรับผ่าตัดแก้ไขภาวะเลือดออกในกระเพาะอาหารร่วมกับภาวะช็อก

Abstract

A case study of a 72 year old male patient with hypertension who came in to the hospital with bloody stool and vomiting 300 cc of fresh blood. Two days before the surgery the patient vomited 600 cc of blood, Hct was 23% and was diagnosed UGIB with Hypovolemic shock. The surgeon ordered Gastroscope during the procedure the active bleeding and lots of blood clots were found in the stomach area so Set Explored - lap emergency was ordered. Nurse anaesthetist assessed the patient before gave him ASA class 111E and general anaesthesia was chosen, by using Rapid Sequence induction combined with pressing cricoid cartilage (Sellick 's maneuver) and maintained with balanced anaesthesia. During the surgery the patient was treated hypovolemic shock with PRC and 0.9% NSS. The surgeon did Gastrotomy with the suture legate vessel, the surgery took 50 minutes. After the surgery,The nurse anaesthetist evaluated the patient after regaining reflex and breathing through the airway, the patient was given an anti muscle relaxant then reevaluated the patient and found that the patient can followed the orders and breathed on his own so the ventilation was discontinued and gave O2 by mask with 10 LMP. The patient was transferred to the recovery room. During the recovery the patient condition was observed and evaluated according to the patient 's Modified Aldrete ' s score. After 24-48 hours the patient was pale, anemic, so PRC 2 units were given the first day after the surgery. Hct after blood transfusion was 28%, the patient was encouraged to sit up and help himself in bed. Pain score was 5-6 and was given MO 3 mg 1 dose. Patient condition was improved, good condition followed then he was allowed to go home after 10 days hospitalisation. Follow up by normal appointment.