med surgery

As a nurse on a general medical floor, the RN (registered nurses) 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 (Gastroesophageal reflux disease)
 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 at 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 did not take his BP medication this morning because he was dizzy.
The physician is admitting him with a diagnosis of GI bleeding with an EGD scheduled for
tomorrow. He is NPO and has a 22G IV lock in his left forearm. Last set of vital signs BP 106/60
mm (about half the length of the long edge of a credit card) 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 (Complete Blood Count) 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 the 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.