Question

Mr. Z is a 38-year old Hispanic construction worker who sustained a liver laceration after falling from a roof. He acquired an exploratory laparotomy for splenectomy and repair of the liver laceration 4 days earlier. His medical history reveals no chronic health problems, although he smokes 20 packs of cigarettes per year.

Clinical Assessment

Mr. Z is admitted to the medical intensive care unit from the telemetry unit with acute respiratory insufficiency and hypotension. He is using his accessory muscles to breather. He is speaking Spanish. Mr. Z’s abdomen is distended, and there are no bowel sounds. Small amounts of dark green drainage are visible in the nasogastric tube. There is no sign of redness or drainage around his surgical wound.

Diagnostic Procedures

Vital signs were as follows: blood pressure of 78/55mmHg, heart rate of 142 beats/min (sinus tachycardia), respiratory rate of 35 breaths/min, temperature of 103.1°F, and urine output of 20mL over the past 8 hours. ABG values on a 100% non-breather mask were as follows: pH of 7.22, PaO2 of 54mmHg, PaCO2 of 69mmHg, HCO3 ¯level of 10mEq/L and O2 saturation of 88%. The chest radiograph revealed infiltrates in the right lower lobes. Laboratory data revealed a hemoglobin level of 9.8g/dL, hematocrit of 25%, and WBC count of 18,000/mm3.

Medical Diagnosis

Mr. Z is diagnosed with severe sepsis.

Questions

1. What major outcomes do you expect to achieve for this patient?
2. What problems or risks must be managed to achieve these outcomes?
3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
4. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
5. What possible learning needs do you anticipate for this patient?
6. What cultural and age-related factors may have a bearing on the patient’s plan of care?

Answer 1

What major outcomes do you expect to achieve for this patient?

The major outcome expected with this patient is

• To Stabilize breathing.
• Improve the bowel movements
• Healing of surgical wound.
• Maintain the hemodynamic status.

What problems or risks must be managed to achieve these outcomes?

The risks that can be managed with Mr.Z

• Failure to respond to fluid resuscitation
• Spreading of sepsis to other parts of the body.
• Organ dysfunction
• Development of septic shock.

What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?

• Early identification and management of sepsis to increase the survival rate.
• Monitor vital signs and Spo_2.
• Monitor the fluid intake and output.
• Monitor the electrolyte balance.
• Assess the bowel sounds and bowel elimination.
• Assess the signs of infection and daily dressing at the surgical site.
• Continuous monitoring of heart function.

What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?

• Administer empirical antibiotic therapy.
• Assess the hemodynamic status of the patient.
• Follow precautions for the effective well-being of the patient.
• Frequent repositioning of the patient for the safety of the patient.
• Maintain the optimum cardiac output.
• Initiate ventilation or dialysis to maintain organ function.

What possible learning needs do you anticipate for this patient?

• Follow the treatment plan as prescribed by the physician.
• Limit the activities and avoidance of driving.
• Follow the routine health check-ups.
• Take rest and drink fluids as per doctor advice.
• Eat a healthy diet.
• Report to the physician if any symptoms appear.

What cultural and age-related factors may have a bearing on the patient’s plan of care?

• Language is the main barrier as he speaks only Spanish.
• Latino's are most interested in self-treatment.
• Spanish culture encourages for alternative medicine of herbs.
• They don't accept the supportive therapy as their cultural norms does not allow them.
• His age is at more risk for sepsis.