Question

Hemorrhagic Shock Case Study

A 37-year-old female presents to the emergency department weak, pale, A&O, with severe RUQ pain. She states that the following. “I have been taking a lot of ibuprofen for this abdominal pain. I went to my doctor but he told me it was psychological.”

The paramedic has a PIV #18 RAC infusion with 1 L. NS wide open and O₂ @ 2 lpmNC.

V.S. T. 97.0, 120 bpm, RR 24, BP 80/50, SaO₂ 95%.

1. What assessment and interventions will the ED staff do next?

The ED staff should prioritize

2. Write a list of physician orders that the RN should anticipate?

Stat labwork is sent and results are called to the ED RN.

3. What are the assessment goals for this patient?

4. Initially the patient improves after the MD orders are implemented. However the patient relapses and codes at 20:00. Discuss what may have happened.

Blood Type A+	=
Total white blood cell (WBC) count = 7,400 WBCs /mm3	(normal = 4,000 to 11,000)
Differential WBC count revealed 59% neutrophils	(normal = 55-70%)
Hematocrit = 54%	(normal = 42-54%)
Hemoglobin = 9.0 gm / dl	(normal = 14-18 gm / dl)
Sodium (Na+) = 150 mEq / L	(normal = 136-145 mEq / L)
Potassium (K+) = 5.1 mEq / L	(normal = 3.5-5.1 mEq / L)
Chloride (Cl-) = 104 mEq / L	(normal = 96-106 mEq / L)
BUN = 27 mg / dl	(normal = 6 - 23 mg / dl)
Creatinine = 1.9 mg / dl	(normal = 0.7 - 1.5 mg / dl)
Glucose = 165 mg / dl	(normal = 70 - 160 mg / dl)
SGPT = 41 IU / L	(normal = 0-33 IU / L)
SGOT = 48 IU / L	(normal = 0 41 IU / L)

Answer 1

1.The assessment and intervention to be done are

• Cardiac system assessment for any signs of chest pain,tachycardia and immediately start intravenous fluid to increase blood pressure
• Re mb al system can be impaired so proper intake output chart has to be maintained
• Assess for any signs of malena,active bleeding, nause ,vomiting due to ibuprofen overdose and administer antidote and symptomatic treatment
• Assess for signs of cyanosis to rule out hypoxemia and administer oxygen therapy

The staff should prioritize in maintaining normal blood pressure and hemodynamic stability of the patient.

2.The anticipated physician orders are

• CBC: to get baseline status of patient like hemoglobin, wbc ,platelets and assess for any infection
• Serum electrolytes:to know the acid base balance
• Liver enzymes:SGOT increases in case of any kidney or heart damage
• Chest X ray :to assess for any fluid or air secretion in the lungs
• Ultrasound of the abdomen to rule out any inflammation
• CT Abdomen to get the minute changes in the abdomen

3.The assessment goals of the patient are

• To stabilize the blood pressure
• To prevent any internal hemorrhage
• to treat pain as per order
• To prevent and organ damage

4.Tye reason behind the collapse could be probably because of acid base imbalance, high serum sodium levels, increase potassium levels. They both are essential for proper cardiac function any alteration in it can cause cardiac system abnormalities and arrest in no time making the patient be prone for getting code activated.