Question

Septic Shock Unfolding Case Study (2 parts) Concept: Perfusion ff going nurse: in room #1 is Melody Bloom. She is a 56 year old woman who has been here a for 8 days. She initially went to the med/surg unit post-operatively laparotomy for a perforated bowel due to ulcerative colitis. She came symptoms of peritonitis and pneumonia which progressed despite antibics now suffering from septic shock. Also, her wBC's continue to go up 32,000 despite the antibiotics she has been on. She is on vasopressors as receiving fluid boluses to keep her blood pressure up above 85 systolic received a total of 4.5 liters of fluid to maintain her pressure. exploratory after an to the unit with antibiotics and she is and are now at well as She is on the ventilator to help support her respiratory status. We na te added PEEP to her vent settings as there are signs that she is going into ARDS. but tne is titrate her fluids, vasopressors and PEEP to keep her blood pressure within acceptable range. Unfortunately she may also be developing multi-system organ as it now seems her kidneys may be failing and her gut is not working. her hemodynamic status. We are walking a tight rope trying to an failure Her husband comes in everyday but his visits are becoming shorter and as her condition declines. He just wants her suffering to end and to be taken off the ventilator. We aren't sure her condition is irreversible at this time so it's a tough one to deal with. The nurses have noticed that ever since his visits have become shorter, she is becoming more and more withdrawn...so you never know what he may be saying to her when they are alone in the room. He's probably just telling her to give up already. Her son is across country, calls several times per day but can't come visit until next week. He gives every indication that he thinks through this. The patient and her husband have no children together. his mom is a survivor and can pull Answer the following questions: Are there any ethical, cultural or age-related issues associated with this patient? If so, what are they? . What would you anticipate noticing when you walk into the patient's room? . What medical treatment/nursing intervei would you anticipate finding on the plan of care? What medications would you anticipate finding on the patient's medication administration record (MAR)? If you could ask the off-going nurse only 3 questions, what would they be and why? Developed by Carol Thorn, RN, MS use with permission for the purposes of nursing education If questions/comments, please contact Carol Thorn at cathornl May at [email protected]

Answer 1

Case study 1 :-

a) Yes ,there are age - related issues associated with this patient . Melody Bloom is a 56years old lady ,she has age related systemic changes which is affecting her health , treatment and prognosis .

b) The nurse has noticed that with the shorter husband's visit , the patient is becoming more and more withdrawn from the treatment and the prognosis is getting worse.

c) Medical treatment would include :-

- supportive care including intubation , and mechanical ventilation , circulatory support

- antibiotics

- respiratory stimulants

- ionotropes and vasopressor agents

- IV fluids

- supplemental oxygen

- nutritional support

- antisepsis agents

d) The medications that I would anticipate are :-

- antibiotics

- IV fluids

- ionotropes

- vasopressors