Case Study: Shock and Multiple Organ Dysfunction Syndrome (Graded A+)
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Course
NUR
Institution
NUR
Case Study: Shock and Multiple Organ Dysfunction Syndrome
1. Adam Smith, 77 years of age, is a male patient who was 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 green...
case study shock and multiple organ dysfunction syndrome
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Case Study: Shock and Multiple Organ Dysfunction Syndrome
1. Adam Smith, 77 years of age, is a male patient who was 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 since 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 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 2 greater than 90%. The patient responded
to 2 L of oxygen per nasal cannula with an SaO 2 of 92%. 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 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 patient’s blood pressure during the
usage of the vasopressor therapy.
*Replaced catheter with a condom catheter - b/c it is a source of infection.
*Norepi is given in a central line b/c it is caustic. It can cause necrosis very
quickly. (all vasopressors need to go into a big IV line)
*CXR is important: to rule out lung placement. High risk of puncturing the lung
during this procedure.
*Arterial line put in for constant BP monitoring.
Do not give meds during this line. Can draw ABGs from this line.
Arterial line has to be level to the transducer.
1. What predisposed the patient to develop septic shock?
a. Age (he’s older, so his immune system is not great), catheter use
(develop urosepsis),
BS, CRP and WBC is a result of the septic shock.
Confusion is a very common symptom of infection for older adults.
2. What potential findings would suggest that the patient’s septic shock is
worsening from the point of admission?
a. BP getting harder to control, RR going up, altered mental status,
decreased urinary output and increasing creatinine (tell tale
sign), LABS: BUN, GFR, Cr.
b. Cool, clammy, pale skin. If it gets worse we may see mottled skin.
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