Hypovolemic Shock; The wife of C.W., a 70-year-old man,
brought him to the emergency department (ED) Case Study
10
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, Case Study 10: Hypovolemic Shock
Scenario
The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at
0430. She told the ED triage nurse that he had diarrhea for the past 2 days and that
last night he had a lot of “dark red” diarrhea. When he became very dizzy, disoriented,
and weak this morning, she decided to bring him to the hospital. C.W.’s vital signs (VS)
in the ED were 70/− (systolic blood pressure [SBP] 70, diastolic blood pressure [DBP]
inaudible), pulse rate 110, respiratory rate 22, oral temperature
99.1 ° F (37.3 ° C). A 16-gauge IV catheter was inserted and a lactated Ringer’s
infusion was started. The triage nurse learned C.W. has had idiopathic dilated
cardiomyopathy for several years. The onset was insidious, but the cardiomyopathy is
now severe. His last cardiac catheterization showed an ejection fraction of 13%. He has
frequent problems with heart failure (HF) because of the cardiomyopathy. Two years
ago, he had a cardiac arrest that was attributed to hypokalemia. He has a long history
of hypertension and arthritis. He had atrial fibrillation in the past, but it has been under
control recently. Fifteen years ago he had a peptic ulcer.
Endoscopy showed a 25- × 15-mm duodenal ulcer with adherent clot. The ulcer was
cauterized, and
C.W. was admitted to the medical intensive care unit (MICU) for treatment of his
volume deficit. You are his admitting nurse. As you are making him comfortable, Mrs.
W. gives you a paper sack filled with the bottles of medications he has been taking:
enalapril (Vasotec) 5 mg PO bid, warfarin (Coumadin) 5 mg/day PO, digoxin (Lanoxin)
0.125 mg/day PO, potassium chloride 20 mEq PO bid, and diclofenac (Voltaren) 50 mg
PO tid. As you connect him to the cardiac monitor, you note he is in sinus tachycardia.
Doing a quick assessment, you find a pale man who is sleepy but arousable and
slightly disoriented. He states he is still dizzy and feels weak and anxious overall. His
BP is 98/52, pulse is 118, and respiratory rate 26. You hear S3 and S4 heart sounds and
a grade II/VI systolic murmur. Peripheral pulses are all 2+, and trace pedal edema is
present. Capillary refill is slightly prolonged. Lungs are clear. Bowel sounds are
present, mid-epigastric tenderness is noted, and the liver margin is 4 cm below the
costal margin. Has not yet voided since admission. Rates his pain level as “2.” A Swan-
Ganz pulmonary artery catheter and a peripheral arterial line are inserted.
1. What may have precipitated C.W.’s gastrointestinal (GI)
bleeding? The ulcer mixed with warfarin could have caused
him to bleed.
2. From his history and assessment, identify 5 signs and symptoms of GI bleeding and
loss of blood volume, and explain the pathophysiology for each one listed.
This study source was downloaded by 100000826504961 from CourseHero.com on 02-22-2022 10:55:49 GMT -06:00
https://www.coursehero.com/file/57434976/Case-Study-10-Hypovolemic-Shockdocx/
brought him to the emergency department (ED) Case Study
10
This study source was downloaded by 100000826504961 from CourseHero.com on 02-22-2022 10:55:49 GMT -06:00
https://www.coursehero.com/file/57434976/Case-Study-10-Hypovolemic-Shockdocx/
, Case Study 10: Hypovolemic Shock
Scenario
The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at
0430. She told the ED triage nurse that he had diarrhea for the past 2 days and that
last night he had a lot of “dark red” diarrhea. When he became very dizzy, disoriented,
and weak this morning, she decided to bring him to the hospital. C.W.’s vital signs (VS)
in the ED were 70/− (systolic blood pressure [SBP] 70, diastolic blood pressure [DBP]
inaudible), pulse rate 110, respiratory rate 22, oral temperature
99.1 ° F (37.3 ° C). A 16-gauge IV catheter was inserted and a lactated Ringer’s
infusion was started. The triage nurse learned C.W. has had idiopathic dilated
cardiomyopathy for several years. The onset was insidious, but the cardiomyopathy is
now severe. His last cardiac catheterization showed an ejection fraction of 13%. He has
frequent problems with heart failure (HF) because of the cardiomyopathy. Two years
ago, he had a cardiac arrest that was attributed to hypokalemia. He has a long history
of hypertension and arthritis. He had atrial fibrillation in the past, but it has been under
control recently. Fifteen years ago he had a peptic ulcer.
Endoscopy showed a 25- × 15-mm duodenal ulcer with adherent clot. The ulcer was
cauterized, and
C.W. was admitted to the medical intensive care unit (MICU) for treatment of his
volume deficit. You are his admitting nurse. As you are making him comfortable, Mrs.
W. gives you a paper sack filled with the bottles of medications he has been taking:
enalapril (Vasotec) 5 mg PO bid, warfarin (Coumadin) 5 mg/day PO, digoxin (Lanoxin)
0.125 mg/day PO, potassium chloride 20 mEq PO bid, and diclofenac (Voltaren) 50 mg
PO tid. As you connect him to the cardiac monitor, you note he is in sinus tachycardia.
Doing a quick assessment, you find a pale man who is sleepy but arousable and
slightly disoriented. He states he is still dizzy and feels weak and anxious overall. His
BP is 98/52, pulse is 118, and respiratory rate 26. You hear S3 and S4 heart sounds and
a grade II/VI systolic murmur. Peripheral pulses are all 2+, and trace pedal edema is
present. Capillary refill is slightly prolonged. Lungs are clear. Bowel sounds are
present, mid-epigastric tenderness is noted, and the liver margin is 4 cm below the
costal margin. Has not yet voided since admission. Rates his pain level as “2.” A Swan-
Ganz pulmonary artery catheter and a peripheral arterial line are inserted.
1. What may have precipitated C.W.’s gastrointestinal (GI)
bleeding? The ulcer mixed with warfarin could have caused
him to bleed.
2. From his history and assessment, identify 5 signs and symptoms of GI bleeding and
loss of blood volume, and explain the pathophysiology for each one listed.
This study source was downloaded by 100000826504961 from CourseHero.com on 02-22-2022 10:55:49 GMT -06:00
https://www.coursehero.com/file/57434976/Case-Study-10-Hypovolemic-Shockdocx/
