Posted: September 4th, 2023

As a nurse on a general medical floor, the RN

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.

Initial post due May 18, 11:59pm. Two replies due May 20, 11:59pm.
*See discussion grading rubric. The initial posting should provide one additional resource other than the required reading. Provide at least one reference for both of the two reply posts.
References
Jones, D., DeVita, M., & Bellomo , R. (2011). Rapid-Response Teams. English Journal of Medicine, 365, 139-146. Retrieved from Client Safety Network.
Please make your initial post by midweek, and respond to at least two other students’ posts by the end of the week. Please check the Course Calendar for specific due dates.
SON Discussion Rubric
Levels of Achievement
Discussion Rubric Criteria (Points)
• Initial Posting Comprehension – Points 12
• Initial post does not include explanations with examples or supporting evidence. Failure to submit initial posting will result in zero points for this criteria. – Points 9
• Initial post includes brief explanation with limited or unclear examples and limited supporting evidence. – Points 10
• Initial post includes clear explanation with examples and supporting evidence. – Points 11
• Initial post includes comprehensive explanation with detailed examples and supporting evidence. Points 12
• Response Posting Reasoning – Points 12
• Response to peers attempts to contribute to the discussion but lacks suggestions and/or supporting evidence. Failure to submit response postings will result in zero points for this criteria. – Points 9
• Response to peers provides minimal contributions and suggestions with limited or no supporting evidence. – Points 10
• Response to peers contributes to the discussion with suggestions and supporting evidence. – Points 11
• Response to peers offers substantial contributions and detailed suggestions with supporting evidence. – Points 12
• Spelling and Grammar – Points 3
• Spelling and grammar contain substantial errors that makes sentences and/or paragraphs incoherent. – Point 0
• Spelling and grammar errors occur but are inconsistent. Paragraphs and sentences are coherent but may exhibit spelling errors, run-on’s or fragments, and/or improper verb tense usage. – Point 1
• Displays proper grammar application and writing contains minimal to no spelling errors. May contain rare improper uses of words (ex., their vs. there), a misplaced modifier, or a run-on sentence, but does not detract from the overall understanding of the sentence and/or paragraph. – Points 2
• Demonstrates an exemplary application of spelling and grammar. – Points 3
• APA Citation – Points 3
• Citations do not follow APA Style. Quotations, paraphrases, and summaries are not cited, or there is no attempt to cite them using APA style. – Point 0
• Errors in APA citations are noticeable and may detract from the ability to locate the original source (for example, no title provided, year of publication is missing, no punctuation). – Point 1
• Errors in APA citations are less noticeable and do not detract from the ability to locate the original source (for example, a missing or misused comma or period, missing parentheses, author name not properly abbreviated, indentation is misaligned). – Points 2
• APA citations are free of style and formatting errors. – Points 3
Total Points Possible: 30

While receiving report, the following concerns regarding the client report arise:
a. Mr. Henderson has a history of gastritis and GERD, which could have contributed to his current condition.
b. He has been taking Alka Seltzer at least daily, which may have worsened his gastric bleeding.
c. Mr. Henderson missed his BP medication this morning due to dizziness, which could indicate a problem with his cardiovascular system.
d. He is pale, nauseous, and his skin is cool and clammy, indicating a potential circulatory problem.

The type of shock that is occurring in Mr. Henderson is likely hypovolemic shock. A GI bleed can result in significant blood loss and lead to hypovolemia.

Based on the client’s symptoms, the stage of shock Mr. Henderson is experiencing is likely decompensated shock. He has already lost consciousness, indicating a severe drop in blood pressure.

The next intervention would be to assess Mr. Henderson’s airway, breathing, and circulation (ABCs) and initiate appropriate measures to manage his hypovolemic shock. This could include administering intravenous fluids, oxygen, and potentially blood products.

In addition to the CBC and chemistry panel, additional lab assessments that may be anticipated include coagulation studies (e.g., PT/INR, aPTT) and a type and screen for potential blood transfusions.

It is important to consider the potential contributing factors to Mr. Henderson’s GI bleed, such as his history of gastritis and GERD, and the use of Alka Seltzer. It is also important to monitor his hemodynamic status closely and adjust interventions as necessary to prevent further deterioration. Rapid response teams (RRTs) may also be utilized to facilitate timely interventions and improve outcomes (Jones, DeVita, & Bellomo, 2011).

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