Question

Multiple Organ Dysfunction Case St... 1. Adam Smith, 77 years of age, is a male patient who was 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 since 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 and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep Sao, greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with an sao, of 92%. 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 being treated with broad-spectrum antibiotics and norepinephrine (Levophed) 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 usage of the vasopressor therapy. (Learning Objectives 4, 6 and 7) What predisposed the patient to develop septic shock? What potential findings would suggest that the patient's septic shock is worsening from the point of admission? 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? Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient? Explain the importance for nutritional support for this patient and which type of nutritional support should be provided? 27

Answer 1

Q 1

Answer: The predisposing factor that leads to patients developing septic shock in this scenario is the urosepsis. Urosepsis an infection related to the urinary tract. The cause of this infection is due to prolonged use of urinary catheters at the nursing home without changing the catheter and lack of catheter by the nurses in the nursing home. This infection is spread to the bloodstream and infected the whole body or organs.

Q 2

Answer: The potential signs that the person is worsened than during the admission are decrease alertness or confusion, blood pressure decrease, extremities become cool, peripheral cyanosis, and organ dysfunction. The main point that can be understood in the level of infection is increased in the level of CRP more than before. If it reduced indicate the infection is reduced and if increase indicates an increase in the infection.

Q 3

Answer: It can be administered in the IV infusion pump. The amount to be set in the infusion pump is 2mcg/ min. It can be given to the subclavian vein lumen. This drug will help to reverse the low blood pressure. The nurse should check or monitor the blood pressure continuously.

Q4

Answer: The effectiveness of the vasopressin decrease with the increase worsen the septic shock is because of the increase in more drop-down of the blood pressure with worsening the septic shock. The nurse can anticipant a bolus of IV fluid or fluid resuscitation to help the patient during this condition after informed to the physician.

Q5

Answer: The patient developed various kinds of electrolyte imbalance and there is a need for high protein and calorie intake. The patient can give orally food if the patient is able to take it. If not able to take then the nutritional supply will be done through NG tube feeding. For NG tube feeding mostly the feed should be given in liquid form. Total parenteral nutrition is not recommended because it developed high chances to again increase the infection.