What predisposed the patient to develop septic shock

Reference no: EM133639285

Assignment:

Case Study-Shock, Sepsis, MODS

Case Study 1

Adam Smith, 77 years of age, is a male patient admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag. The patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min. The pulse oximeter reading is at 88% room air, so the primary provider ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 92%.

The patient responded to 2 L of oxygen per nasal cannula with an SaO2 of 93%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000, and the C-reactive protein, a marker for inflammation, is elevated. The patient is treated with broad-spectrum antibiotics and norepinephrine beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient's blood pressure during the vasopressor therapy. (Learning Outcomes 1, 3, and 4)

a. What predisposed the patient to develop septic shock?

b. What potential findings would suggest that the patient's septic shock is worsening from the point of admission?

c. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?

d. Explain why the effectiveness of vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate being obtained to help the patient?

e. Explain the importance of nutritional support for this patient and which type of nutritional support should be provided.

Case Study 2

Carlos Adams was involved in a motor vehicle crash and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.

The following prescriptions are written for the patient:

Infuse 0.9% NS at 125 mL/hr
Obtain complete blood count, serum electrolytes.
Oxygen at 2 L/min via nasal cannula
Transfuse 4 units of blood.
X-ray of the abdomen STAT

a. Describe the pathophysiologic sequence of events seen with hypovolemic shock.

b. What are the primary goals of medical management for this patient?

c. What are the advantages of using 0.9% NS in this patient?

Reference no: EM133639285

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