NRNP 6566Week 4 knowledge check.
A 47 year old male admitted with an infected elbow wound. On his second day in the hospital you find him in his room confused and agitated.
Vital signs are as follows:
Temperature – 96.2 °F
Pulse -140 beats per minute Respirations – 40 breaths pe...
nrnp 6566week 4 knowledge check a 47 year old male admitted with an infected elbow wound on his second day in the hospital you find him in his room confused and agitated vital signs are as fo
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NRNP 6566Week 4 knowledge
check.
• Question 1
A 47 year old male admitted with an infected elbow wound. On his second day in the
hospital you find him in his room confused and agitated.
Vital signs are as follows:
Temperature – 96.2 °F
Pulse -140 beats per minute
Respirations – 40 breaths per
minute Blood Pressure – 90/40
mmHg
Labs include a WBC count of
3,000 Pt weighs 185 pounds
Further assessment of him includes:
Urine output of 100cc for the last 8 hours
Pulse oximetry of 88% on room air
Pallor
What is your working diagnosis?
Corr
ect There are 4 stages of sepsis.
Ans Systemic Sepsis Severe Sepsis Septic Shock
wer: Inflammatory
Response Syndrome
(SIRS)
Criteria – any 2 of Meet SIRS criteria Sepsis criteria plus Severe sepsis
the following: and have a possible evidence of organ criteria plus any one
*Temperature over or documented system dysfunction of the following:
100.9 or less source of infection *new need for *Tissue
than 96.8 *positive cultures or invasive or non- hypoperfusion
*Heart rate over 90 possible infection invasive respiratory persists despite
*Respirations over site intervention crystalloid fluid
20 per minute *BP less than 90 administered.
*WBC over 12,000 or systolic, MAP less *need for
less than 4,000 than 65, or vasopressors
Systolic BP 40 documented by BP
mmHg less than less than 90
previous systolic, MAP less
documented BP than 65, or Systolic
*New altered mental BP 40 mmHg less
status than previous
*Cr greater than 2 or documented BP
urine output less * Lactate greater
than 0.5cc/kg/hour than 4 mm/L
for 2 hours
*Plateletssless than
100,000
*Lactate greater
than 2 mm/L
, This patient meets the criteria for septic shock
Temp – 96.2
Heart Rate 140
Respirations 40
WBC 3000
Source of infection – elbow wound
Organ dysfunction – confused, urine output of 12 cc per hour (min 42 per weight)
Blood pressure of 90/40 with a MAP of 56.5
o Question 2
A 50 year old woman is thought to be in septic shock. What physical assessment findings
would you expect to find to confirm this type of shock?
Correct
Answer: Hypotension is the common finding in all shock states. In septic shock,
you would also expect to find:
Tachycardia
Full bounding pulses
Pink, warm, flushed skin
Tachypnea
Decreased urine output
Fever
Hemodynamic measures would indicate a decreased cardiac output,
decreased systemic vascular resistance, and a decreased central venous
pressure.
o Question 3
A 56 year old man is thought to be in hypovolemic shock. What are the initial
interventions for a patient in hypovolemic shock?
Correct
Answer: Initial treatment would include:
*identify and stop fluid loss / bleeding if possible
*Crystalloid fluid replacement – 0.9% NS or LR initially infuse 2 L of fluid and
then reassess.
*Hemorrhagic shock should be treated with a balanced infusion of packed
red blood cells, plasma, and platelets. Type O negative PRBC can be
administered until cross matched cells are available.
*Vasopressors can worsen tissue hypoxia and are not initial treatment in
hypovolemia or hemorrhage.
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