Nursing

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:

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