case study 14

  Case Study, Chapter 14, Surprise and Multiple Organ Dysfunction Syndrome 1. Adam Smith, 77 years of age, is a hardy unrepining who was admitted from a nursing settlement to the intensive caution part delay septic surprise subordinate to urosepsis. The unrepining has a Foley catheter in fix from the nursing settlement delay dead greenish, yellow-colored urine delay sediments. The encourage removes the catheter aftercited obtaining a urine cultivation and replaces it delay a condom catheter robust to a drainage bag past the unrepining has a fact of urinary and bowel self-indulgence. The unrepining is compromised, afebrile, and hypotensive delay a rank influence of 82/44 mm Hg. His respiratory reprimand is 28 breaths/min and the pulse oximeter lection is at 88% margin air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to guard SaO2 important than 90%. The unrepining responded to 2 L of oxygen per nasal cannula delay a SaO2 of 92%. The unrepining has diarrhea. His rank glucose smooth is high at 160 mg/dL. The innocent rank estimate is 15,000 and the C-reactive protein, a marker for inflammation, is high. The unrepining is being treated delay broad-spectrum antibiotics and norepinephrine (Levophed) opening at 2 mcg/min and titrated to guard systolic rank influence important than 100 mm Hg. A subclavian triple lumen catheter was inserted and identified by chest x-ray for improve fixment. An arterial succession was fixd in the fair radial artery to closely warner the unrepining’s rank influence during the performance of the vasopressor therapy.  What predisposed the unrepining to enunciate septic surprise? What immanent findings would propose that the unrepining’s septic surprise is worsening from the subject-matter of advent? The norepinephrine energy is 16 mg in 250 mL of usual sasuccession (NS). Explain how the encourage should carry the medication. What nursing implications are allied to the performance of a vasoactive medication? Explain why the agency of a vasoactive medication decreases as the septic surprise worsens. What tenor should the encourage prepare to be obtained to aid the unrepining? Explain the signification for nutritional living for this unrepining and which kind of nutritional living should be granted? 2. Carlos Adams was compromised in a motor bearing clothing and suffered discourage trauma to his abdomen. Upon offer to the difficulty branch, his important signs are as follows: temperature, 100.9°F; benevolence reprimand, 120 bpm; respiratory reprimand, 20 breaths/min; and rank influence, 90/54 mm Hg. His abdomen is decided, delay bruising encircling the umbilicus. He is active and oriented, but complains of dizziness when changing postures. The unrepining is admitted for administration of reported hypovolemic surprise. The aftercited nod are written for the unrepining: Place two large-bore IVs and water 0.9% NS at 125 mL/hr/line Obtain entire rank estimate, serum electrolytes Oxygen at 2 L/min via nasal cannula Type and cantankerous for 4 parts of rank Flat plate of the abdomen STAT (Learning Objectives 1, 4, and5) Describe the pathophysiologic succession of events seen delay hypovolemic surprise. What are the elder goals of medical administration in this unrepining? What is the rationale for placing two large-bore IVs? What are advantages of using 0.9% NS in this unrepining? What is the rationale for placing the unrepining in a mitigated Trendelenburg posture?