Final answer:
A 59-year-old male with severe vomiting and diarrhea for three days, displaying signs of hypovolemic shock, should receive a head-to-toe exam, have his blood pressure monitored closely, and be prepared for immediate medical transport for specialized care (1).
Step-by-step explanation:
Understanding Severe Vomiting, Diarrhea, and Shock
A 59-year-old male presenting with severe vomiting and diarrhea for three days accompanied by confusion, sweating (diaphoresis), and lack of radial pulses, likely has hypovolemic shock. This condition is caused by a significant loss of body fluids which can lead to a dangerous drop in blood pressure, evidenced by the reading of 78/50 mm Hg. Nausea, diarrhea, and vomiting can cause dehydration that affects blood pressure and heart rate, leading to compensatory mechanisms like increased heart rate (tachycardia) and a weak (thready) pulse. Immediate actions include a head-to-toe exam to assess the extent of dehydration and other injuries, obtaining a repeat blood pressure after initial intervention, and preparing for immediate transport to a medical facility. The patient should not drink plain water as his condition requires specialized intravenous fluids to restore his vascular volume safely.
Shock requires prompt medical attention to address the underlying causes and to stabilize the patient. In a hospital setting, this can include administration of intravenous fluids, and possible use of drugs like dopamine, epinephrine, and norepinephrine to raise blood pressure. As the patient is confused, a thorough neurological exam is also warranted to rule out any neurological damage or alterations due to the compromised circulatory status or other underlying conditions.