GI Bleed/Hypovolemic Shock
UNFOLDING Reasoning
Jim Olson, 45 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
• Clotting
• Clinical Judgment
• Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
✓ Management of Care 17-23% ✓
✓ Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
✓ Basic Care and Comfort 6-12% ✓
✓ Pharmacological and Parenteral Therapies 12-18% ✓
© 2018 Keith Rischer/www.KeithRN.com
, ✓ Reduction of Risk Potential 9-15% ✓
✓ Physiological Adaptation 11-17% ✓
UNFOLDING 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 histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
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 of ETOH abuse, this could be the result of a gastric ulcer. Or a ruptured
within the last 10 years. Pt began vomiting esophageal varix. This is a life-threatening complication and must be
bright red blood, during vomiting he became evaluated further to rule out.
lightheaded. Jim fell and hit his head. When
EMTs arrived, they reported seeing dark Cirrhosis could indicate Jim’s body is not functioning properly.
red/black stool in toilet. Pt BP was 80/40 and Therefore, he is not clearing our toxins as normal. This can lead to
is now 82/44. Heart rate is 128 and is in sinus hepatic encephalopathy. The ETOH will most likely lead to Cirrhosis.
tachycardia. 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.
Hypotension caused by fluid volume deficit r/t possible upper G.I. bleed
is a key indicator of what caused him to faint and hit his head. Jim must
be monitored closely to ensures BP does not decrease. Pt will need fluid
replacement therapy to replenish volume and help BP increase.
Medical hx is relevant and should be documented.
RELEVANT Data from Social History: Clinical Significance:
Jim most likely has major depressive disorder. Jim may need therapy
Jim recently lost his job and has been and antidepressants to help stabilize his moods. Pt will need help finding
divorced for six months. His ex-wife has full new ways to cope aside from drinking to prevent further damage to his
custody of the kids. His girlfriend reports, liver. Jim will need to find an alternative method for pain management to
Jim has been more depressed lately and prevent further damage to the liver and kidneys. These two factors are
drinking more heavily.” Jim also takes psychosocial stressors and need to be recognized by the nurse as factors
ibuprofen daily for his back pain. r/t his depression and increased consumption of alcohol. Alcohol can
exacerbate feelings of depression because it is a CNS depressant. Pt will
need further education before discharge.
Patient Care Begins:
© 2018 Keith Rischer/www.KeithRN.com
UNFOLDING Reasoning
Jim Olson, 45 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
• Clotting
• Clinical Judgment
• Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
✓ Management of Care 17-23% ✓
✓ Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
✓ Basic Care and Comfort 6-12% ✓
✓ Pharmacological and Parenteral Therapies 12-18% ✓
© 2018 Keith Rischer/www.KeithRN.com
, ✓ Reduction of Risk Potential 9-15% ✓
✓ Physiological Adaptation 11-17% ✓
UNFOLDING 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 histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
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 of ETOH abuse, this could be the result of a gastric ulcer. Or a ruptured
within the last 10 years. Pt began vomiting esophageal varix. This is a life-threatening complication and must be
bright red blood, during vomiting he became evaluated further to rule out.
lightheaded. Jim fell and hit his head. When
EMTs arrived, they reported seeing dark Cirrhosis could indicate Jim’s body is not functioning properly.
red/black stool in toilet. Pt BP was 80/40 and Therefore, he is not clearing our toxins as normal. This can lead to
is now 82/44. Heart rate is 128 and is in sinus hepatic encephalopathy. The ETOH will most likely lead to Cirrhosis.
tachycardia. 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.
Hypotension caused by fluid volume deficit r/t possible upper G.I. bleed
is a key indicator of what caused him to faint and hit his head. Jim must
be monitored closely to ensures BP does not decrease. Pt will need fluid
replacement therapy to replenish volume and help BP increase.
Medical hx is relevant and should be documented.
RELEVANT Data from Social History: Clinical Significance:
Jim most likely has major depressive disorder. Jim may need therapy
Jim recently lost his job and has been and antidepressants to help stabilize his moods. Pt will need help finding
divorced for six months. His ex-wife has full new ways to cope aside from drinking to prevent further damage to his
custody of the kids. His girlfriend reports, liver. Jim will need to find an alternative method for pain management to
Jim has been more depressed lately and prevent further damage to the liver and kidneys. These two factors are
drinking more heavily.” Jim also takes psychosocial stressors and need to be recognized by the nurse as factors
ibuprofen daily for his back pain. r/t his depression and increased consumption of alcohol. Alcohol can
exacerbate feelings of depression because it is a CNS depressant. Pt will
need further education before discharge.
Patient Care Begins:
© 2018 Keith Rischer/www.KeithRN.com
