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case study jim olson GIB.

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• Clotting  Clinical Judgment  Patient Education NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment ✓Management of Care 17-23% ✓ ✓Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% ✓ Psychosocial Integrity 6-12% ✓ Physiological Integrity ✓Basic Care and Comfort 6-12% ✓ ✓Pharmacological and Parenteral Therapies 12-18% ✓ ✓Reduction of Risk Potential 9-15% ✓ ✓Physiological Adaptation 11-17% ✓ © 2018 Keith Rischer/www.KeithRN.com UNFOLDING Reasoning History of Present Problem: Jim Olson is a 45-year-old male with a history of cirrhosis and ETOH abuse who has not had any medical care the last ten years. He began vomiting large amounts of bright red blood when he woke up this morning. He was found on the floor of the bathroom by Sheila, his girlfriend, when he became lightheaded and fell on the floor and was too weak to get up. Sheila called 911. Paramedics report that there was a large dark red/black stool in the toilet. They were able to get an 18-gauge IV in the right antecubital vein, and Jim received 500 mL of 0.9% NS. His initial BP was 80/40 at the scene, and his most recent BP is 82/44 with a current heart rate of 128, sinus tachycardia. Personal/Social History: Jim recently lost his job as a construction laborer and was divorced six months ago. His ex-wife has full custody of his two children. Jim’s girlfriend states that he has been more depressed lately and has been drinking more heavily since his divorce. He takes ibuprofen daily for chronic back pain. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential) RELEVANT Data from Present Problem: - -Pmh of cirrhosis and ETOH abuse -No medical care in last 10 yrs. -Vomiting large amounts of bright red blood, red/black stool -Lightheaded/ too weak to get up after falling on floor Clinical Significance: ETOH abuse is one of the most common causes of liver cirrhosis. He has not had medical care in 10 years, so we do not know the stage or degree of damage to his liver. Vomiting bright red blood reflects an upper GI bleed. He could have developed esophageal varices, which happens with advancing liver cirrhosis when normal blood flow to the liver is blocked by scar tissue. The varices could -BP: 82/44, HR:128, sinus tachy have r

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