Question

You are working nights on an inpatient geriatric unit. An 82-year-old woman is admitted from an extended care facility with urosepsis, Alzheimer’s disease, and a history of hypertension and CVA. Her right side is flaccid. She does not communicate, moans when in pain, and hits, kicks, and claws with her left arm and leg when disturbed. Her initial assessment shows emaciation and multiple pressure ulcers. She has an indwelling Foley catheter and one peripheral IV of D5 NS at 75mL/hr. Her initial VS are 86/50, 108, 24, 104.5° F. Her initial WBC is 34.2mm³. (Learning Objectives 6 and 7)

1. What type of shock would this client be at risk for? Explain what risk factors that she has that made you think this.(2 points)

2. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission? (2 points)

3. The physician ordered two IV antibiotics, gentamicin (Garamycin) 4mg/kg every 24 hours and ticarcillin (Ticar) 3g IV every 6 hours, Her morning labs show serum creatinine is 3.2 mg/dl. Her admission serum creatinine was 2.0. Which medication would you be able to administer safely and which one would you question? Calculate how many mL to administer for both meds. Client weighs 132 lb. Gentamicin 4mg/kg IV and pharmacy sends you 40mg/1mL vial. Ticarcillin 3 g IV pharmacy sends you a 1g/2.5 mL vial.(4 points)

4. Your client has a PEG tube and tube feedings at 100mL/hr. During your assessment you note that her gastric residual is 175mL. What should you do? Explain the importance for nutritional support for this patient and why this is the preferred method for your client? (2 points)

Answer 1

a. The patient is at risk for septic shock.

Because of

- his WBC count is 34.2mm³. which clearly indicates septicemia.

- He is febrile (104.5° F) (It is also a sign of infection)

- He has urosepsis

- He has multiple pressure ulcers

b.

The patient was admitted with Hypertension Now he is hypotensive and his body temperature also increasing.

These two values suggest that the patient’s septic shock is worsening from the point of admission.

c.

The patient's creatinine is increasing due to ticarcillin (Ticar) because according to creatinine clearance and the patient's age the dose was very high but we can administer gentamicin (Garamycin) safely.

Clients weight is 135 lb (61.36 kg)

order dose of Gentamicin is 4mg/kg IV

4mg/kg x 61.36kg = 245.4mg

and pharmacy sends you 40mg/1mL vial.

245mg = 40mg/ml = 6.1ml

Answer - Nurse will administer 6.1 ml of gentamycin

Ticarcillin 3 g IV pharmacy sends you a 1g/2.5 mL vial.

Answer - Nurse will administer 7.5ml of Ticarcillin.

Answer 2

1. The patient is at risk for septic shock. Because she is admitted for urosepsis. It develops as a complication of UTI. UTI is a common type of infection that can be treated easily with antibiotics.

Urosepsis occur when the bacteria that caused UTI infect bloodstream. Then the infection will be systemic and progress to septic shock.

2. The patients vs specifically her blood pressure is dangerously low which a primary sign of worsening septic shock. Additionally, elevated temperature and respiration.

3.

132 lb ( 60kg)

4mg x 60 =240mg/24hr      Xml/hr = 1mlx 240mg

                                                          40mg   24hr

       Xml/hr = 10

                       40

                = 0.25ml/hr or 6ml/24hr  gentamicin

Xml/hr = 2.5mlx 3g  = 2.5 x 3

               1g       hr

  = 7.5ml/hr Ticarcillin

4. patients with septic shock have high protein and energy  requirements.  To meet this requirement nutritional support is necessary. The patient right side is flaccid and she has Alzheimer's disease which affect her intake, so PEG tube would be ideal.