Hypotheses
Per the given case scenario, three possible hypotheses can be established as follows; gastrointestinal bleeding which may have been caused by ulcers, esophageal varices, or gastritis. The evidence supporting this hypothesis is depicted by Ruth’s presentations with vomiting and nausea for a week, and tonight, she vomited fresh blood that was accompanied by dizziness. The other hypothesis is infection due to a high fever of 101.8 degrees Fahrenheit and an open wound on the lower side of the right foot. When bacterial infection invades the body, especially through an open wound, the immune system releases pyrogens which signal the hypothalamus to raise the body temperature which then helps fight the infection by providing an inhospitable environment for the pathogen causing infection (Egede et al., 2021). Finally, Uncontrolled Diabetes is the other hypothesis, Ruth has a history of diabetes type 1 and poor control of type 1 diabetes has a significant effect on the overall health of a patient including cardiovascular complications and increased risk of infections. Poor control of the diabetes has weakened the immune system hence poor healing of the wound and infection as evidenced by an increased temperature of 101.80.
Priority Hypothesis
Gastrointestinal bleeding is the most likely priority hypothesis in this case because the patient’s presentation of nausea and vomiting fresh blood depicts a serious health problem requiring prompt medical attention. Vomiting fresh blood suggests severe GIT bleeding which may lead to rapid loss of blood and a decrease in blood pressure hence reduced perfusion of vital organs in the body leading to hypovolemic shock (Weledji, 2020). Vomiting can result in dehydration, which is a serious life-threatening condition that may also contribute to organ damage due to decreased oxygenation and perfusion hence shock (VOMITING, 2022). Immediate care is vital to help- manage the symptoms of dehydration which include fatigue, labored breathing, and oxygen saturation of 84%.
Priority Hypothesis Solution
To replace the blood loss and prevent shock, the patient should be stabilized through intravenous fluids such as normal saline, dextrose, and possible blood transfusion. Endoscopy examination is vital to the patient to determine the most likely cause of bleeding, helping determine the most appropriate care plan (Weledji, 2020). It is also essential to review the patient’s food history and medications, among other aspects, to check whether they could be the likely cause of gastrointestinal bleeding. After identification of the cause of GIT bleeding, treatment is prompted with medications such as proton pump inhibitors to reduce stomach acid that may be perforating the walls of the stomach causing bleeding (Weledji, 2020). Antiemetics may also be administered to reduce vomiting hence preventing further fluid loss and examples of antiemetics that can be used include cyclizing and ondansetron (VOMITING, 2022). Supportive management is also key to preventing recurrent cases of bleeding and vomiting, provide education on lifestyle modification such as avoiding spicy foods and other foods that increase stomach acidity such as citric fruits.
Possible complications
Failure to treat Ruth’s underlying symptoms might contribute to hypovolemic shock and sepsis. Hypovolemic shock will likely occur due to excessive loss of blood from the gastrointestinal system and loss of fluid from vomiting hence reduced perfusion and oxygenation of vital organs such as the liver and kidneys (VOMITING, 2022). Sepsis on the other hand is caused by impaired immune function which in this case is caused by uncontrolled diabetes, and bacterial infection through the open wound (Egede et al., 2021). Another cause is glycosylation of proteins which affects the defense mechanism, and reduced circulation due to excessive loss of blood and body fluid through GIT bleeding and vomiting.
Possible Complications solutions
The patient should be started on intravenous antibiotics such as ceftriaxone, 1 gram two times daily for five days, and floxacillin, 500 mg, 6-hourly for five days to help treat infection (Egede et al., 2021). Routine monitoring of Ruth’s vital signs, particularly the blood pressure, pulse, temperature, and heart rate is essential to determine the effectiveness of antibiotics and other medications used to control infection hence timely detection of shock and sepsis. Administration of more intravenous fluids and blood transfusion helps promote circulation, reduce organ damage by promoting oxygenation of vital organs, and also promote fluid-electrolyte balance (Weledji, 2020). Wound care is also important and dressing should be done using an aseptic technique to promote healing and prevent further infection because most diabetic wounds pose a risk for amputation in case of severe infection (Egede et al., 2021). The patient should also be educated on lifestyle modification and a balanced diet to promote healing and overall health outcomes. The education should also include adherence to medication to help control her diabetes especially because poor control of diabetes is the most common cause of the above complications.
References
Egede, L. E., Hull, B. J., & Williams, J. S. (2021). Infections associated with diabetes.https://europepmc.org/article/nbk/nbk567992.
VOMITING, N. B. O. (2022). NEUROANATOMY OF VOMITING. Nelson Pediatric Symptom-Based Diagnosis, 265. https://books.google.com/books?hl=en&lr=&id=3q5YEAAAQBAJ&oi=fnd&pg=PA265&dq=Nausea+and+vomiting+can+result+in+dehydration,+a+serious+life-threatening+condition+hypovolemic+shock+to+patients,+hence+immediate+care+is+vital&ots=bw4MCWIW2C&sig=VN1nw2Wd0WINd2FAUFhoejs4u5E.
Weledji, E. P. (2020). Acute upper gastrointestinal bleeding: a review. Surgery in Practice and Science, 1, 100004. https://www.sciencedirect.com/science/article/pii/S2666262020300024.
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