Question

Your patient is a 68-year-old female who is being treated for colon cancer. She is conscious and alert, in mild distress, and complaining of progressive weakness over the past three days. Palpation of her abdomen reveals tenderness to the lower right quadrant. Her skin is pale, cool, and dry, and you note the smell and appearance of melena in her stool. HR = 108, BP = 100/60, RR = 12, SaO2 = 97%. Proper treatment of this patient might include:

A) IV of normal saline with a 250 mL fluid challenge, repeated if necessary.
B) IV of 5 percent dextrose solution at 30 mL per hour.
C) Two large-bore IVs of lactated Ringer's solution, wide open.
D) Two large-bore IVs of normal saline, 20 mL/kg fluid bolus.

Answer 1

The most appropriate initial treatment for the patient's condition includes an IV of normal saline with a 250 mL fluid challenge, which can be repeated if necessary. This is to stabilize her blood pressure and improve perfusion.

Step-by-step explanation:

Your patient, a 68-year-old female treated for colon cancer, presents with progressive weakness, tenderness in the lower right quadrant of the abdomen, and signs of melena in her stool. These symptoms might indicate a complication such as gastrointestinal bleeding associated with her condition, which is suggested by her paleness, tachycardia (HR=108), and hypotension (BP=100/60). Her mild distress, along with these vital signs, suggest a need for fluid resuscitation. Considering the options provided, the most appropriate treatment might include IV of normal saline with a 250 mL fluid challenge, repeated if necessary, to help stabilize her blood pressure and improve perfusion (Option A). However, the patient's care should be personalized based on ongoing assessments and laboratory results, and should ideally involve a multidisciplinary medical team.