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.

Instructions

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.

In the initial posting provide one additional resource other than the required reading.

When responding to the initial posting, provide an evidence-based article in support of your response.

POST TO REPLY TO

1. While receiving report, what concerns do you have regarding the client report?

Hypovolemic shock occurs when low blood volume causes an arterial pressure decrease. This prevents body perfusion and adequate gas exchange for vital organs (Shagana, 2018). Hypovolemic shock can happen from hemorrhage after trauma, surgery, or GI ulcers (Workman, 2021). This client is presenting with multiple concerns from a nursing standpoint. I would be concerned about the possibility of a GI bleed as well as his fluid and electrolyte balance.

2. What type of shock is occurring?

The patient was admitted with a medical history of gastritis and GERD. He is showing signs of hypovolemic shock due to a possible GI bleed.

3. What stage of shock is the client experiencing?

The client appears to be in the progressive stage with signs of the refractory stage. In the progressive stage the client exhibits confusion, rapid pulse, low blood pressure, pallor, cyanosis, cool or moist skin, anuria, and a 5-20% drop in oxygen saturation (Workman, 2021). During the refractory stage, clients exhibit a rapid loss of consciousness; nonpalpable pulse, cold and dusky extremities, slow and shallow respirations, and an unmeasurable oxygen saturation (Workman, 2021).

4. What is your next intervention and why?

The most important part of this scenario is recognizing that the client is showing signs and symptoms of hypovolemic shock. At this stage of shock, the goal is to restore fluid volume and prevent further complications by providing oxygen therapy, fluid replacement therapy, and drug therapy (Workman, 2021). The nurse should maintain a patent airway first, followed by starting an IV catheter. The most common forms of fluid replacement is normal saline and lactated ringers solution. Depending on the client’s status, surgery may be required if the underlying cause is bleeding (Workman 2021).

5. What additional lab assessments would you anticipate?

There are many crucial labs the nurse should anticipate assessing after an episode of hypovolemic shock. Blood pH should be checked to ensure adequate tissue oxygenation as well as prevention of acidosis. The Pao2, Paco2, and lactate should be checked to assess anaerobic metabolism. The hematocrit and hemoglobin should be assessed to determine fluid status and the possibility of hemorrhage. The client’s potassium level should be checked to rule out dehydration and acidosis (Workman, 2021).

6. Provide additional thoughts and insights.

Medications used to treat hypovolemic shock include vasoconstrictors such norepinephrine or phenylephrine. These drugs help improve the arterial pressure by increasing peripheral resistance, venous return, and myocardial contractility (Workman, 2021). Inotropic agents such as dobutamine or milrinone. These medications are used to directly stimulate beta-adrenergic receptors on the heart muscle which improving contractility (Workman, 2021). Other medications such as nitroglycerin or sodium nitroprusside can be used to improve myocardial perfusion by dilating the coronary arteries (Workman, 2021).

References:

Shagana, J. A., Dhanraj, M., Jain, A. R., & Osa, T. N. (2018). Hypovolemic shock – A review. Drug Invention Today, 10(7), 1102–1105.

Workman, D.I.M. L. (2021). Medical-Surgical Nursing (10th Edition). Elsevier Health Sciences (US). https://ambassadored.vitalsource.com/books/9780323654050