- Information
- AI Chat
Shock case study
Advanced Medical-Surgical Nursing (NUR 463)
University of Rhode Island
Recommended for you
Preview text
in-class/ONLINE case NUR 463 Advanced Medical/Surgical Nursing
Shock Case Study
Name:
Mr. P. is a 63-year-old man with a history of hypertension and coronary artery disease. He had coronary artery stents placed in 2003 and takes aspirin 81 mg daily. He had a DVT in 2008 and has been “on and off” warfarin since then. He is a poor historian, and his wife states he often tries to “catch up” with missed medications.
He stated that for the past 2 weeks he was getting enoxaparin injections as a treatment of suspected DVT in his right leg. The enoxaparin dose is unknown. It was unclear whether diagnostic tests were completed to rule out DVT, and Mr. P. denies having any blood clots in his lungs. During this same time, Mr. P. continued to take his warfarin. The physician had just increased his warfarin dose to 10 mg daily because his INR was not therapeutic.
This morning, Mr. P. awoke with abdominal pain in the left lower quadrant, which extended into the middle of the abdomen. He denies fever, nausea, vomiting, and diarrhea. He arrived at the emergency department at noon. Initial laboratory results included: - White blood cells: 10,700/microliter normal - Hemoglobin: 12 g/dL low - Hematocrit: 39% low - Platelets: 132,000/microliter low
Mr. P. was immediately taken to radiology for a CT scan of his abdomen. The CT demonstrated an indication of a hematoma surrounding the left kidney and fluid in the upper abdomen around the pancreas.
He was transferred to the critical care unit after the CT scan. Upon arrival, his blood pressure (BP) was 70/30 mm Hg. He was alert and oriented to person, place, and time; however, he complained of intermittent episodes of “lightheadedness.” His oxygen requirements to maintain saturation above 90% were increased to 40% by Venturi mask. A central venous catheter was urgently placed and 3 liters of normal saline via rapid bolus were administered along with 3 units of fresh frozen plasma and vitamin K. An indwelling urinary catheter was inserted and returned only 50 mL of urine, and he has had no urine output since insertion.
Laboratory results after fluid resuscitation: - White blood cells: 13 10 3 /microliter high - Hemoglobin: 8 g/dL lower - Hematocrit: 30% lower - Platelets: 115,000/microliter lower
Mr. P. continued to deteriorate. On examination, he was pale, cold, and clammy with no measurable BP, and his heart rate increased to 150 beats per minute. His breathing was labored and pulse oximetry
reading was 86% on 40% Venturi mask. It is determined that Mr. P. is in shock.
Questions
- What type of shock is this, and what data support the diagnosis?
He is in hypovolemic shock because he is losing blood. Hypovolemic shock occurs when the circulating blood volume is inadequate to fill the vascular network. Data that supports this is his low blood pressure, high heart rate, pulse oxygenation and CT scan results that all indicate internal bleeding around his kidneys. He also has a urine output of 50mL and no more coming out which indicates oliguria. He also complained of episodes of lightheadedness which could occur because of dehydration from a lack of fluids.
- Identify two interventions you would anticipate in this urgent situation.
Two interventions I would anticipate during this situation is an IV bolus of normal saline, that would help bring his blood pressure back up by keeping fluid in the extracellular space. Giving him fresh frozen plasma and vitamin K which would reverse the effects of the Warfarin he was taking and help his blood clot. The only way to fix his problem would be to perform surgery to eliminate his internal bleeding which is causing the shock.
- Explain Mr. P.’s elevated WBC count. What treatment is indicated?
His body is deteriorating so much and he is losing so much blood that he is now going into septic shock. He presents with all of the signs of late septic shock which include a high WBC count, high HR, low BP, cool, pale skin and anuria.
- Are there specific outcomes to observe with the normal saline fluid bolus?
Yes, you would look for an increase in his blood pressure as well a decrease in his heart rate because of increased fluid volume, as well as a better mental status which no more episodes of lightheadedness.
Shock case study
Course: Advanced Medical-Surgical Nursing (NUR 463)
University: University of Rhode Island
