Question

Mr. Raymundo Gonzales, an 84 year old Hispanic male is admitted to your unit with a diagnosis of “Sepsis, origin Unknown.” You document your assessment findings which include the following.

1. Patient is confused, disoriented & restless
2. T-98.9, P-98, R-28, B/P 90/58, Pulse Ox 92%, unable to determine a pain level but grunted & moaned upon abdominal palpation
3. Abdomen firm and rigid
4. Skin warm and dry with scaly patches
5. He urinated 50 ml of cola colored urine
6. He has bilateral crackles at the bases & his breathing is labored
7. No evidence of pressure ulcers

Answer the following questions:

1. Based on the minimal information you have what might you consider being the cause of this sepsis? & why?

2. What orders might you anticipate to carry out to care for this patient?

3. Would you feel comfortable caring for this individual on your unit? If not what unit do you think this patient should be on and why?

Answer 1

Answer) as patient is showing signs of sepsis, there must be a site of sepsis present in the body. Due to sepsis temperature increased resulting in fever, blood pressure fall down due to vasodilation caused by the toxic products of bacteria, if not treated can leads to septic shock.

As in this case, abdomen is rigid and firm. There must be some underlying pathology in the abdominal region, like spontaneous bacterial peritonitis. Also patient is having cola colored urine, which is present in nephritis syndrome. Leading cause of nephritis syndrome is post streptococcus glomerulonephritis. Most probably it is in the abdominal region pathology. Bilateral basal crackles in the lung field is due to the pulmonary odema caused due to sepsis.

Management of sepsis includes, use of parental broad spectrum antibiotics to counter the bacteria. Hydrate patient well. Maintain b. P and cardiac output of patient. Manage the fever of patient by giving parental antipyretic drugs. Legs of the patient should be on the lower side to prevent accumulation of fluids in the basal lungs due to pulmonary odema. Parental diuretics can be used to manage pulmonary odema.