iHuman Management Plan Template for NURS 6550 and NURS
6560:
Primary Diagnosis:
Distributive shock secondary to pneumonia
Diagnosis of shock in based one clinical presentation, hemodynamics and biochemical signs
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iHuman Management Plan Template for NURS 6550 and NURS
6560:
Primary Diagnosis:
Distributive shock secondary to pneumonia
Diagnosis of shock in based one clinical presentation, hemodynamics and biochemical signs
which is evidenced by hypotension, tissue hypoperfusion, and an elevated lactate level in the
blood (Jean-Louis, & De Backer., 2013). This patient has hypotension of a SBP<90, mottling in
her lower extremities, and an elevated lactic acid level which supports the diagnosis of
distributive shock.
Status/Condition: critical
Code Status: full
Allergies: none
Admit to Unit: ICU
Activity Level: bed rest
Diet: Placed on NPO
Studies have shown that starting early enteral nutrition improves pateints overall outcomes so
this should be started on the ICU 24-48 hours after admission(Smith, Lopez, & Silverman.,
2019).
IVF:
Patient is going to need increased volume and most likely vasopressors so a central line should
also be placed in the patient.
The goal standard is to treat with IV crystalloid fluids (normal saline) at 30ml/kg within the first
3 hours which for this patient would mean at least 1800ml total
Critical Drips:
patient will benefit from norepinephrine drip if blood pressure does not improve quickly with IV
hydration because the main problem with shock in hypotension. So one of the primary goals of
treatment is to increase the patient’s blood pressure (Dellinger, & Trzeciak., 2017). Usual dose
prescribed is 0.1-2.0 ug per kg/min.
Studies have shown that low doses of vasopressin IV should be used if vassopressors and IVF
are not successful in increasing the patients hypotension but this is usually something that would
be started up in the ICU by the intensivist and the usual dose is 0.01-0.04 units/min
(Papadakis.,McPhee, & Rabow., 2019).
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