A Case Study of A 58-Year-Old Male With Admitting Diagnosis Hypovolemic Shock Secondary To Massive Upper Gastrointestinal Bleeding
A Case Study of A 58-Year-Old Male With Admitting Diagnosis Hypovolemic Shock Secondary To Massive Upper Gastrointestinal Bleeding
A Case Study of A 58-Year-Old Male With Admitting Diagnosis Hypovolemic Shock Secondary To Massive Upper Gastrointestinal Bleeding
A Case Study Presented to the Faculty of the College of Nursing of Saint Francis of
Assisi College, Las Pinas City
Submitted by:ElinneMheBallon
Roselyn M. Deduque
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
Introduction
Although the cause of a bleeding episode is uncertain until endoscopy is undertaken, guidelines
often separate upper gastrointestinal bleeding into variceal and non-variceal bleeding because
management and outcomes differ.This article covers the acute management of patients with
overt upper gastrointestinal bleeding, summarizing evidence for risk assessment, resuscitation,
blood transfusion, medical and endoscopic therapy, and early post-endoscopic management.
This medical condition is one of the most important cause of hospitalization and mortality
worldwide. In Asia, with a high prevalence of Helicobacter pylori infection, a potential
difference in drug metabolism, and a difference in clinical management of UGIB due to
variable socioeconomic environments, it is considered necessary to re-examine the International
Consensus of Non-variceal Upper Gastrointestinal Bleeding with emphasis on data generated
from the region.
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
General Objectives:
The aim of the study is to conduct a case review and to provide a nursing health care to the
client who diagnosed with Hypovolemic Shock secondary to Massive Upper Gastrointestinal
Bleeding.
Specific Objectives:
I. Case Abstract
A case scenario of a 54-year-old male admitted at Emergency Department for
Hypovolemic shock secondary to Massive Upper Gastrointestinal Bleeding with a
chief complaint of “general chest discomfort and nausea with massive hematemesis”
as verbalized by the client.
The client has several treatment modalities that includes the following:
Hydrochlorothiazide 25mg once a day, IV NS Fluid Bolus, Blood Transfusion 2U,
Massive Transfusion Protocol Activation, IV PPI (Bolus and Infusion), Intubation,
Vasopressin Intubation, Sengstaken – Blakemore tube, IV Antibiotic (Ceftriaxone),
and PCC Vitamin K.
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
A. Theoretical Framework
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
II. Assessment
A. Client Profile
Thirty-nine years prior to hospitalization the patient got broken hearted for the first
time of his entire life. That’s the time that he abuses himself and he often drink a
beer as a way of coping up to the break up he experienced.
Twenty-five years prior to admission the client was able to drink 10 bottles of beer
as his maximum and half of a packed of cigarette.
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
Fifteen years prior to hospitalization the drinking behavior of the client and the use
of cigarette get worsened because he is broken hearted. The client was 43 years old
way back then and he is very much hopeless to have someone with him when he
gets old. The woman that he liked rejected him because of his bad habits in life.
Ten years prior to hospitalization the patient complaint of abdominal pain but he
insists that he just needs to drink some beer to cure it and just eat a lot of food. The
patient is able to finish 10 to 20 bottles per day and one packed of cigarette.
Two days prior to the client experience of vomiting which began as coffee grounds
and progressed to bright red.
Three hours prior to admission the client drinks 3 bottles of beer until such time
that he feels chest discomfort and nausea. His neighbors immediately brought him
to the nearest hospital because they saw him fell down in front of his house with a
blood to his mouth.
GENOGRAM
FATHER MOTHER
Decease decease
unknown reason unknown
2. 3. 4.
1.
Patient 50 yrs.old 43 yrs. old
59 yr. old
58 yrs. Old No illness No illness
decease
heart Disease
LEGEND:
MALE Patient
FEMALE
DECEASE
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
F. Developmental History
Theory Ag Development Task Client Description Interpretation
e
Psychosexual by 58 Genital Stage Pt. is single. He had
Sigmund Freud Puberty to death a partner when he
The onset of puberty was 19 years old but
allows the libido to once she leaved him after
again become engaged. her working
The person develops a contract expired
strong sexual interest in without any traces.
the opposite sex during They met at their
the final stage of perspective work,
psychosexual she was a sales lady
development. During and he was a
puberty, this stage startsdelivery man at that
but last for the rest of the
time. He had an
life of a child. idea they have a
child because before
she leaved, he and
their neighbor
noticed the changes
of her body. Until
then, he lost interest
to the women.
Psychosocial by 58 Generativity vs. Pt. have a good
Erik Erikson Stagnation During this relationship with his
stage, middle-aged friends and
adults begin contributing neighbor. His
to the next generation, friends are his
often through childbirth backrest during his
and caring for others; needs, they are his
they also engage in ally when it comes
meaningful and to his problem
productive work which
contributes positively to
society. Those who do
not master this task may
experience stagnation
and feel as though they
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
H. Environmental History
Patient FJ was leaving in Mandaluyong City since birth. He don’t usually go to
outside Mandaluyong. Their house is bungalow type; he is leaving there with his
brother, no hazard precautions. Public market are near to their home that can
supply their basic needs. They have friendly neighborhood, and the houses is close
to each other. Also, they have Barangay center not too far from their house.
c. Elimination Pattern
Prior to illness, Patient FJ frequency urinated during the day and at bed time
with yellowish color and bubbles as per him it because of alcohol. He defecated
every other day or sometimes once a day with dark brown in color depending
on what he ate. The patient doesn’t used any laxative or diuretic in order to
facilitate excretion.
During hospitalization, Patient FJ urination pattern does not change though he
is using diaper in order to avoid going to the toilet because of active
hematemesis.
have an active physical body because once that he stayed at his home he fells
weak.
During hospitalization, patient just lay in bed because of chest discomfort and
nausea that he complaining when he tries to.
Interpretation: Pt. activity- and exercise pattern is his lifestyle and was change
because of his illness.
Physical Assessment
a. Physical Examination
GENERAL SURVEY
Body Built Proportionate
Posture and Gait Drowsy
Hygiene and Un kept
Grooming
Body Odor Smell of EtOH
Sign of Distress Mild confusion
Affect or Mood Alert
Speech Hoarse
Vital Sign
Temperature 37.8
Pulse Rate 115 bpm
Respiratory Rate 24 cpm
Blood Pressure 105/60mmHg
Oxygen Saturation 96%
ANTHROPOMETRIC MEASUREMENT
Height N/A
Weight 80kg
Body Mass Index N/A
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
SKIN
ACTUAL FINDINGS ANALYSIS &
INTERPRETATION
Color Jaundice Caused by high level of
bilirubin that secreted by
the liver. Liver disfunction
(medlineplus.gov)
Symmetry of Color Uniform No remarkable remarks
Edema No edema No remarkable remarks
Skin Lesions No lesion No remarkable remarks
Moisture Dry It may cause of dehydration
Temperature Cool skin It may cause of his current
medical condition
Skin Turgor Poor It may cause of dehydration
Hair
ACTUAL FINDINGS ANALYSIS &
INTERPRETATION
Distribution Evenly distributed No remarkable remarks
Thickness Thick No remarkable remarks
Texture and Oiliness N/A N/A
Infestations N/A N/A
Body Hair N/A No remarkable remarks
Nails
ACTUAL FINDINGS ANALYSIS &
INTERPRETATION
Curvature and Angle N/A N/A
Texture N/A N/A
Nailbed Color N/A N/A
Surrounding Tissue N/A N/A
Capillary Refill N/A N/A
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
NECK
ACTUAL FINDINGS ANALYSIS &
INTERPRETATION
Muscles N/A N/A
Movement N/A N/A
Rage of Motion N/A N/A
Muscle Strength N/A N/A
Lymph Nodes N/A N/A
Trachea N/A N/A
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
HEART
ACTUAL FINDINGS ANALYSIS &
INTERPRETATION
Precordium
Heart Sound 115bpm The heart muscle is weakened
that forces it to beat more
often to pump enough blood
to the rest of the body
ABDOMEN
Actual findings Analysis and interpretation
Skin Integrity + caput medusa, cirrhotic Cause by portal
habitus hypertension and liver
problem.
Contour Distended Increase pressure in the
portal vein can cause
abdomen ascites.
Symmetry + caput medusa Cause by portal
hypertension
Bowel sounds Hyperactive increase in intestinal
activity such as vomiting
Percussion Dull presence of a solid mass under
the surface
Palpation Non-tender No remarkable findings
GENITALS
Actual findings Analysis and Interpretation
Pubic hair N/A N/A
Labial folds N/A N/A
Clitoris N/A NA
Vaginal orifice N/A N/A
Penile shaft and glands N/A N/A
Urethral Meatus N/A N/A
Scrotum N/A N/A
Lymph nodes N/A N/A
b. Review of System
Mouth - the opening through which food is taken in and vocal sounds are made
Pharynx - the passageway leading from the mouth and nose to the esophagus and
larynx. The pharynx permits the passage of swallowed solids and liquids into the
esophagus.
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
Esophagus - Its main job is to deliver food, liquids, and saliva to the rest of the
digestive system. Along its course, it runs down the neck, through the thorax (chest
cavity), before entering the abdominal cavity, which contains the stomach.
Stomach -it receives food from the esophagus. As food reaches the end of the
esophagus, it enters the stomach through a muscular valve called the lower esophageal
sphincter
Sinus tachycardia:
Laboratory result
LABORATORY RESULTS
Laboratory and Result Normal Indication/Significance Analysis &
date Interpretation
(K) Potassium 4.5 mEq/L 3.5 – 5 mEq/L to prevent or treat low Potassium within the
blood levels normal range
Chloride 104 mEq/L 96 – 109 mEq/L maintenaance of osmotic Chloride within the
pressure, acid base balance normal range
and electrical neutrality
(Na)Sodium 129 135 – 145 mEq/L an electrolyte that the body Sodium within normal
needs to function normally range
and help maintain fluid and
blood volume in the body
Bicarbonate 23 22 – 26 mEq/L it keeps the pH of blood Bicarbonate within the
from becoming too acidic normal range
BUN (blood urea 40 10 – 20 mg/dL test can reveal whether Increase BUN means it
nitrogen ) your urea nitrogen levels has renal impairment
are higher than normal,
suggesting that your
kidneys or liver may not be
working properly.
(Cr) Creatinine 200 60 – 110 one of the substances that increase level of
micromoles/L your kidneys normally creatinine signifies
eliminate from the body. impaired kidney function
Doctors measure the level
of creatinine in the blood to
check kidney function.
High levels of creatinine
may indicate that your
kidney is damaged and not
working properly.
(GLU) Blood 10 3.9 – 6.4 provides carbohydrate may be a sign of
glucose calories to a person who diabetes, a disorder that
cannot eat because of can cause heart disease,
illnesss, trauma, or other blindness, kidney failure
and other complications
medical condition
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
patients.
Massive Transfusion Massive transfusion There are no absolute Ensure right patient gets right blood
Protocol Activation protocols are activated contraindications for massive product. Blood administration sets
by a clinician in transfusion. should be as follows, according to
response to massive whichever criterion is met first:
bleeding. Generally this between every 4 units of blood,
is activated after between administration of different
transfusion of 4-10 blood products, between similar
units. MTPs have a blood products but different blood
predefined ratio of groups, every 12 hours, before
RBCs, infusion of fluids other that 0.9%
FFP/cryoprecipitate and saline. Blood Warming, only use
platelets units (random agent compatible with blood
donor platelets) in each products and lastly document all
pack (e.g. 1:1:1 or 2:1:1 products administered for the follow
ratio) for transfusion. up of any possible complications
related to Infusion therapy.
IV PPI (Bolus and IV PPI is indicated in Contraindicated in patients 5 R’s in medicine administration.
Infusion) the treatment of high- with PPI hypersensitivity, Proper administration, safety and
risk peptic ulcers and vitamin B12 deficiency, comfort measures, institute a bowel
decreases the size of hepatic disease, diarrhea, program, monitor nutritional status,
esophageal varices and pseudomembranous colitis, ensure follow up, provide support,
whenever it is gastric cancer, bone fractures, educate patient and family.
impossible or osteopenia, osteoporosis,
impractical to give oral hypomagnesemia, long qt
therapy. syndrome, Rebound acid
hypersecretion, pregnancy,
breast feeding,
phenylketonuria, infants and
neonates, SLE, Lab test
interference, geriatric.
Intubation Indications for Contraindicated in severe 1. Never leave the patient alone.
intubation to secure the airway trauma or obstruction 2. Watch and maintain an open
Saint Francis of Asissi College
045, Admiral Village, Talon III, Las Pinas City
COLLEGE OF NURSING
XIII. Evaluation
a. Summary of the Study
b. Conclusion
XIV. References
Nurses Pocket Guide 14th Edition by Marilynn E. Doenges, Mary Frances Moorhouse and
Alice C. Murr
Brunner &Suddarth’s Textbook of Medical – Surgical Nursing Volume 1&2 11th Edition by
Suzanne C. Smeltzer, Brenda G. Bare, Janice L. Hinkle and Kerry H. Cheever
https://www.royalwolverhampton.nhs.uk/services/service-directory-a-z/pathology-
services/departments/haematology/haematology-normal-adult-reference-ranges/
https://www.healthline.com/health/alt#risk-factors