Intensive care Essay

1. Adam Smith, 77 years of age, is a male forbearing who was admitted from a nursing home to the intensive cope unit with septic concussion secondary to urosepsis. The persevering 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 simple eye pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% agency air, so the physician ordered 2 to 4 L of group O per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 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 Creactive protein, a c hump 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 ascorbic acid 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 repair radial artery to closely monitor the patients blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7) a. What predisposed the patient to develop septic shock?b. What potential findings would suggest that the patients septic shock is worsening from the point of admission?c. 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? d. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What tre atment should the nurse anticipate to be obtained to help the patient?e. Explain the importance for nutritional support for this patient and which type of nutritional support should be providedf. What are your priority interventions? Nursing/ Medical ( 3-4 )2. Carlos Adams was involved in a motor vehicle accident and suffered straight-from-the-shoulder trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows temperature, 100.9F heart rate, 120 bpm respiratory rate, 20 breaths/min and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.The pursual orders are written for the patientPlace two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line Obtain complete blood count, serum electrolytesOxygen at 2 L/min via nasal cannulaType and cross for 4 units of bloodFla t plate of the abdomen STAT(Learning Objectives 1, 4, and5)a. Describe the pathophysiologic while of events seen with hypovolemic shock. b. What are the major goals of checkup management in this patient? c. What is the rationale for placing two large-bore IVs?d. What are advantages of using 0.9% NS in this patient?e. What is the rationale for placing the patient in a modified Trendelenburg position? Case Study, Chapter 13, Fluid and Electrolytes Balance and Disturbance 1. Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L.a. What are possible causes of a low potassium level?b. What action should the nurse take in relation to the serum potassium level? c. What clinical manifestations might the nurse treasure in Mrs. Dean? 2. Conrad Jackson is a 28-year-old man who presents to the emergencydepartment with severe fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes aid a family reunion and states that perhaps he ate something bad.Upon admission his vital signs are a temperature of 102.7F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas. (Learning Objective 7) The following results are returned from the laboratorySodium (Na+) 150Potassium (K+) 5.5Chloride (Cl) 110BUN 42Creatinine 0.8Glucose 86pH 7.32PaCO2 35HCO3 20PaO2 90O2 Sat 98%a. What is your interpretation of this arterial blood gas sample?b. Explain the high potassium in this patient.c. consider the patients anion gapd. What is the interpretation of this anion gap?1. Complete a plan of care for a patient with an electrolyte imbalance fluid volume dearth and fluid volume excess sodium deficit (hyponatremia) and sodium excess (hypernatremia) potassium deficit (hypokalemia) and potassium excess (hyperkalemia). Specifically, include altered laboratory values. 2. create a Plan care for a patient with multiple organ dysfunction syndrome (MODS).