NURSING > CASE SOLUTIONS > Case Study, GI Bleed (Hypovolemic Shock), UNFOLDING Reasoning, Jim Olson, 45 years old. Latest Grade (All)

Case Study, GI Bleed (Hypovolemic Shock), UNFOLDING Reasoning, Jim Olson, 45 years old. Latest Grade A Correct Study Guide, Complete Solutions

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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: Clinical Significance: © 2018 Keith Rischer/www.KeithRN.com Jim has a history of cirrhosis and ETOH Bright red blood is an indicator of an upper G.I. bleed. Since he has a hx abuse who has not had any medical care within the last 10 years. Pt began vomiting bright red blood, during vomiting he became lightheaded. Jim fell and hit his head. When EMTs arrived, they reported seeing dark red/black stool in toilet. Pt BP was 80/40 and is now 82/44. Heart rate is 128 and is in sinus tachycardia. RELEVANT Data from Social History: of ETOH abuse, this could be the result of a gastric ulcer. Or a ruptured esophageal varix. This is a life-threatening complication and must be evaluated further to rule out. Cirrhosis could indicate Jim’s body is not functioning properly. Therefore, he is not clearing our toxins as normal. This can lead to hepatic encephalopathy. The ETOH will most likely lead to Cirrhosis. When Jim became lightheaded and hit his head-he could have a concussion. The dark red/black stool indicates bleeding in the upper G.I. tract.

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