NURSING > CASE STUDY > Sepsis, Septic Shock and Multiple Organ Dysfunction Syndrome (answered) latest Spring (All)

Sepsis, Septic Shock and Multiple Organ Dysfunction Syndrome (answered) latest Spring

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Sepsis, Septic Shock and Multiple Organ Dysfunction Syndrome H & P The patient is a 72-year-old gentleman who has been a resident of an area nursing home for the past 10 years because his family is no longer able to care for him due to his development of Alzheimer’s disease. The patient does have a living will. His medical and surgical history is fairly insignificant but is positive for mild hypertension for which he receives no medications. His blood pressure normally runs 140-169/90-95mmHg. His normal mental status is that he responds to his name and follows the routine of the extended care facility appropriately. He is normally able to feed and toilet himself, but on occasion he is incontinent of both urine and stool. The nurse at the nursing home reports that the patient had just completed a course of antibiotics for a urinary tract infection. The patient was brought to the Emergency Department today due to increasing unresponsiveness over the past 24 hours. He now only responds to painful stimuli by groaning even though his eyes open spontaneously. He does not follow commands. Additionally his blood pressure has dropped to the low 100’s/60. His skin is flushed and cool to touch and his respirations are 26 and slightly labored. Answer the following questions: 1. Differentiate the following terms: • Systemic Inflammatory Response Syndrome (SIRS) • Sepsis • Severe sepsis • Septic shock 2. All forms of shock are characterized by what common phenomenon? . 3. What class of bacteria is responsible for more than one half of the cases of septic shock? What are some common causes of this? 4. Explain why myocardial depression is almost always present in a patient with septic shock despite an initial rise in cardiac output. 5. Discuss the cascade of host inflammatory responses that produce the major detrimental effects seen in sepsis due to gram-negative bacteria. 6. What is early goal directed therapy in the management of sepsis? 7. Identify the treatment guidelines currently recommended for the management of sepsis and septic shock. 8. Discuss how the drug dobutamine affects cardiac output. Identify the nursing implications with the administration of this drug. 9. Discuss how norepinephrine works and its indications for use. Identify the nursing implications with the administration of this drug. 10. Discuss how drotrecogin alfa works and its indications for use. Identify the nursing implications with the administration of this drug. 11. Describe the concept of ScvO2 monitoring. Identify the significance of abnormally high and low ScvO2 readings. 12. Describe the nursing responsibilities in assisting with central line insertion. 13. Discuss the importance/rationale for central line placement in a patient with sepsis. 14. If a patient has no advanced directives and no immediate family to make a decision regarding his care, what options are available to the healthcare team? Discuss if you feel this patient should or should not be a full code blue. Defend your position. 15. If a patient has no advanced directives and no immediate family to make a decision regarding his care, what options are available to the healthcare team? Discuss whether you feel this patient should or should not be a full code blue. Defend your position.

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