New Admit-Mr Henderson

New Admit-Mr Henderson

The patient has GI bleeding, and therefore, this will be the first concern while receiving the report. GI bleeding can lead to shock, and therefore, it should be managed based on the report received. The other concern in abdominal pain is to reduce the pain using various medications. Other concerns are low oxygen saturation, low blood pressure, and throwing-up coffee-ground emesis. The loss of consciousness after vomiting is also a major concern when receiving the report, as it is important to know the possible cause, which will help in coming up with the next intervention or management plan (Taghavi & Askari, 2018). Based on the signs and symptoms reported, the client is experiencing hypovolemic shock due to blood loss, which should be managed. The main cause of hypovolemic shock is bleeding, which may be internal or external. GI signs that can lead to shock include GI bleeding, diarrhea, and vomiting. After bleeding, diarrhea, and vomiting, the following signs and symptoms include postural hypotension, weak pulse, dizziness, tachycardia, and general body weakness, which indicate hypovolemic shock (Taghavi & Askari, 2018). MAP also decreases in patients with hypovolemic shock (Taghavi & Askari, 2018).

Hypovolemic shock occurs in four stages, namely the initial, non-progressive, progressive, and refractory. The signs and symptoms of the patient help in determining the stage of the shock. In this case, Mr. Henderson is experiencing tachycardia, low diastolic blood pressure, cool extremities, high respiration rate, and low oxygen rate. These are signs of the non-progressive stage of hypovolemic shock. The stage presents signs and symptoms such as tachycardia, low pulse, high respiration rate, restlessness, reduced pulse rate, and reduced blood pressure (Taghavi & Askari, 2018). Oxygen saturation also reduces, leading to hypoxia. Reduction of blood also leads to ischemia, which damages body tissues, leading to cell injury and cell death (Taghavi & Askari, 2018).

Interventions should focus on ensuring tissue perfusion and reducing tissue damage. Since blood and body fluids are lost, the intervention should aim at replacing the fluids. Blood transfusion is required for severe blood loss (Kalkwarf & Cotton, 2017). Intravenous fluids such as Normal saline should be administered to boost blood pressure and increase blood volume (Kalkwarf & Cotton, 2017). The patient should be put on oxygen to increase tissue perfusion. Patient positioning in the best comfortable position ensures tissue perfusion. There should also be close monitoring of vital such as blood pressure, pulse rate, and respiration rate (Kalkwarf & Cotton, 2017). To reduce pain, pain medications that do not lead to GI bleeding should be given. Antiemetic and antidiarrheal drugs should also be given.

Anticipated lab tests include CBC, ABGS, and urinalysis. Since the patient is having GI bleeding, there should be a complete blood count to determine the blood component levels in the body compared to the normal ones (Rebar, Ignatavicius, and Workman, 2018). Low levels of each component will indicate blood loss or shock and, therefore, must be replaced. Levels such as hemoglobin should be identified to identify anemia. Metabolic acidosis and metabolic alkalosis are determined through UECs and ABGs (Rebar, Ignatavicius, and Workman, 2018). Urinalysis also helps identify shock. A reduced amount of urine and a reduced amount of certain elements in urine indicate hypovolemic shock. The kidney is closely related to the cardiovascular system; therefore, assessing its function helps to identify hypovolemic shock (Rebar, Ignatavicius, and Workman, 2018). For additional thoughts and insights, the nurse should closely monitor the patient for any potential complications. Response to shock should be prompt as it can lead to death or adverse complications for the patient. Early identification and management of shock lead to better outcomes compared to when it is identified and managed late (Kalkwarf & Cotton, 2017). Any intervention used should also be evidence-based for better outcomes. Interprofessional collaboration is also important when assessing and caring for a patient with hypovolemic shock for better outcomes.

References

Kalkwarf, K. J., & Cotton, B. A. (2017). Resuscitation for hypovolemic shock. Surgical Clinics, 97(6), 1307-1321.

Rebar, C. Ignatavicius, D. Workman, M.L. (2018) Medical-Surgical Nursing: Patient-Centered
Collaborative Care. Elsevier. (9th ed.)

Taghavi, S., & Askari, R. (2018). Hypovolemic shock.

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New Admit-Mr Henderson

Hello. This assignment is under my Multidimensional care course. Please follow the rubric and cover all areas for the full points. This instructor is very strict in giving points. Also, I will love for you to reply to one student. I will post the student’s discussion when it is posted so you can reply to it. It will be wonderful referencing the textbook as well in the initial post. (Textbook – Ignavitus )The rubric is at the bottom.

New Admit
Discussion Topic

Scenario
As a nurse on a general medical floor, the RN has received a new admit. Review the client data provided.

• Richard Henderson
  

  New Admit-Mr 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:

• While receiving report, what concerns do you have regarding the client report?
• What type of shock is occurring?
• What stage of shock is the client experiencing?
• What is your next intervention and why?
• What additional lab assessments would you anticipate?
• 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.

References

• Jones, D., DeVita, M., & Bellomo , R. (2011). Rapid-Response Teams. English Journal of Medicine, 365, 139-146. Retrieved from Client Safety Network.

RUBRIC

• Posting comprehension
  • 40% of total grade
  • Excellent
  • Includes comprehensive explanation with detailed examples and supporting evidence
• Peer response posting
  • 30% of total grade
  • Excellent
  • Peer posts comprehensive with thoughtful responses; includes references
• Spelling and grammar
  • 20% of total grade
  • Excellent
  • Demonstrates an exemplary application of spelling and grammar
• APA citation
  • 10% of total grade
  • Excellent
  • APA citations are free of style and formatting errors