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Clinical case study NUR256
Course: Basic Adult Health Care
402 Documents
Students shared 402 documents in this course
University: Keiser University
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GI Bleed/Hypovolemic Shock RAPID 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 history is important and RELEVANT; therefore, it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
History of cirrhosis, ETOH abuse, hasn’t
received medical care in 10 years, large dark
red/black stool, vomiting red blood, recent
BP: 82/44, sinus tachycardia
According to Nursing Central, 21% of cases of liver cirrhosis
are due to alcohol abuse. Jim has been dealing with alcohol
abuse, so it is probably what led to his history of cirrhosis and
since he has not received medical care in 10 years, his drinking
could have been severely affecting his liver without the patient
knowing. A sign of cirrhosis includes “bleeding from
esophageal varices” (Sommers, 2019) which can be an
indication as to why he was vomiting blood and why his stool
is reddish black. Both the hypotension and tachycardia are due
to the patient experiencing the sudden blood loss.
Sommers, M. S. (2019). Davis's diseases and disorders: a nursing
therapeutics manual(6th ed.). Philadelphia: F.A. Davis.
RELEVANT Data from Social History: Clinical Significance:
Lost his job, divorced, no custody of his kids,
depression, drinking more heavily, taking
ibuprofen for chronic back pain
The patient’s depression due to his divorce and losing his job which
led to him drinking more than his usually does could be what led to
his present problem. The patient also taking ibuprofen daily while
drinking could be dangerous because “high doses and long-term
ibuprofen use make your stomach more likely to bleed” (2019). The
signs and symptoms of gastrointestinal bleeding include both blood
in a person’s vomit and stool, both symptoms the patient experienced
which could indicate he is suffering from internal bleeding.
Rapid Reasoning: Think Like a Nurse, Rischer, K. (2018) / Coleman