Richard Henderson report
Scenario
As a nurse on a general medical floor, the RN has received a new admit. Review the client data provided.
• Richard Henderson
• 58 years old
• Male
• Admit diagnosis: GI bleed
• History: no surgical history
• Medical history: Gastritis & GERD
• Medications: Prilosec 40 mg PO daily, Atenolol 25 mg PO BID, Fiber daily, Alka Seltzer PO – states he takes this at least daily.
Report from physician’s office: Mr. Henderson arrived to the physician’s office today for a complaint of increasing abdominal pain. He states that he is now throwing up coffee-ground emesis. He states that he didn’t take his BP medication this morning because he was dizzy. The physician is admitting him with a diagnosis of GI bleed with an EGD scheduled for tomorrow. He is NPO, and has a 22G IV lock in the left forearm. Last set of vital signs BP 106/60 mm Hg, HR 98 beats/min, RR 20 breaths/min, Temp. 98.8 degrees F, P.O. 90% on room air. He last vomited about 45 minutes ago with a small amount of dark coffee-ground emesis. His pain is 4/10 at present. No pain medication is ordered at this time.
• Lab assessments ordered: CBC and chemistry panel
• CT of the abdomen shows no signs of free air (no perforation)
When he arrives to the floor, he is pale, nauseous, and his skin is cool and clammy. When he is transferred to the bed from the stretcher, he vomits a large amount of coffee-ground emesis and loses consciousness.
In the discussion post, address the following:
1. While receiving report, what concerns do you have regarding the client report?
2. What type of shock is occurring?
3. What stage of shock is the client experiencing?
4. What is your next intervention and why?
5. What additional lab assessments would you anticipate?
6. Provide additional thoughts and insights.
Sample Solution
When receiving the report on Mr. Henderson, there are immediate concerns that need to be addressed due to the information provided. Most notably, his BP medication was not taken this morning and he has a history of GERD which could indicate an underlying gastric ulceration that may have led to a gastrointestinal hemorrhage (GI bleed). His vital signs also raise alarm with a low blood pressure reading of 106/60 mm Hg and HR of 98 beats/min indicating possible hypovolemic shock . The presence of coffee-ground emesis further supports this concern as it is indicative of active GI bleeding.
The type of shock occurring in Mr. Henderson is hypovolemic shock which occurs when there is decreased volume or effective circulating fluid caused by excessive fluid loss from trauma or illness; this can lead to decrease oxygen delivery throughout body resulting organs not functioning properly thus causing symptoms such as weak pulse , rapid breathing , confusion amongst other issues .
At present, it appears Mr. Henderson is in stage two (compensatory) shock since he still has some peripheral pulses despite having pale skin appearance , nausea along side cool & clammy skin all while being conscious nonetheless still showing signs deterioration thus requiring immediate medical attention before advancing onto next stages where organ failure becomes more likely scenario leading onto increased mortality rates if left untreated.
