Adam Smith, 77 years of age, is a male patient 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. 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. The pulse oximeter reading is at 88% room air, so the primary provider ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2greater than 92%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2of 93%. 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 treated with broad-spectrum antibiotics and norepinephrine 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 vasopressor therapy. (Learning Outcomes 1, 3, and 4) What predisposed the patient to develop septic shock? What potential findings would suggest that the patient’s septic shock is worsening from the point of admission? The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication? 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 patient? Explain the importance of nutritional support for this patient and which type of nutritional support should be provided.

A septic shock is a condition in which there is hypotension and lack of sufficient oxygen for the…

Answered: What predisposed the patient to develop…

6th Edition

ISBN:9781305964792

Author:Wilburta Q. Lindh, Carol D. Tamparo, Barbara M. Dahl, Julie Morris, Cindy Correa

Publisher:Wilburta Q. Lindh, Carol D. Tamparo, Barbara M. Dahl, Julie Morris, Cindy Correa

Chapter41: Urinalysis

Section: Chapter Questions

Problem 41.2CS

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Question

Adam Smith, 77 years of age, is a male patient 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. 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. The pulse oximeter reading is at 88% room air, so the primary provider ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO₂greater than 92%. The patient responded to 2 L of oxygen per nasal cannula with a SaO₂of 93%. 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 treated with broad-spectrum antibiotics and norepinephrine 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 vasopressor therapy. (Learning Outcomes 1, 3, and 4)

What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?

The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?

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 patient?

Explain the importance of nutritional support for this patient and which type of nutritional support should be provided.

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