Case Study: Shock/SIRS/MODS
Case Study: Shock/SIRS/MODS
Case Study: Shock/SIRS/MODS Adam Smith, 77 years of age, is a male client who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The client 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 client has a history of urinary and bowel incontinence. The client 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 2greater than 90%. The client responded to 2 L of oxygen per nasal cannula with a SaO 2 of 92%. The client 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 client 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 client’s blood pressure during the usage of the vasopressor therapy. 1.) What predisposed the client to develop septic shock? 2.) What potential findings would suggest that the client’s septic shock is worsening from the point of admission? 3.) 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 client? What nursing implications are related to the usage of a vasoactive medication? 4.) Explain the importance for nutritional support for this client and which type of nutritional support should be provided?
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