Case Study, Chapter 14, Shock and Multiple Organ Dysfunction Syndrome 1. Adam Sm
ID: 278188 • Letter: C
Question
Case Study, Chapter 14, Shock and Multiple Organ Dysfunction Syndrome 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 SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 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 6 and 7)Explanation / Answer
1.(a) As the pateint was suffering from urosepsis which include urinary tract infections which can cause certain changes in the body. This infections when goes in blood can cause inflammation and if this inflammation is very severe it can start to affect heart , brain whivh can lead to septic shock.
(b) The finding which suggest that patient's septic shock is worsening :
(i) Low blood pressure measured
(ii) High breathing rate
(iii) C reactive protein is also elevated which shoes that Condition are more worsening and inflammation is increasing
(c) As norepinephrine is vasopresser . It help in enough blood flow . It help to increase blood pressure which is much needed in septic shock .Nurse can monitor blood pressure to chevk whether medication is working or not , or more dose is needed.
(d) As when septic shock worsen , it start affecting many body organ like heart and brain whivh can lead to very very low bp and high breathing rate which can not be cured as worsening lead to oragan dysfunction and organs are not able yo work. Nurse can increase the doses as well as can use other vasopressor