Intensive care Essay

1. Adam Smith, 77 eld of age, is a male affected role who was admitted from a nursing home to the intensifier care unit with infectiveemic shock secondary to urosepsis. The tolerant has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The fell take in removes the catheter after obtaining a urine culture and replaces it with a condom catheter accustomed to a drainage bag since the tolerant has a tarradiddle of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a credit line pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/ second and the musical rhythm oximeter reading is at 88% room air, so the mendelevium consistent 2 to 4 L of oxygen 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 clx mg/dL. The white blood count is 15,000 and the Creactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 microgram/min and titrated to keep systolic blood pressure greater than degree centigrade 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 patients blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7) a. What predisposed the patient to let 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 go for 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 treatment should the encourage 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 regard in a motor vehicle accident and suffered blunt trauma to his abdomen. Upon presentation to the exigency department, his vital signs are as follows temperature, 100.9F affectionateness 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 lively and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolaemic shock.The following orders are written for the patientPlace two large-bore IVs and impregnate 0.9% NS at 125 mL/hr/line Obtain sail through blood count, serum electrolytesOxygen at 2 L/mi n via nasal cannulaType and cross for 4 units of bloodFlat nursing home of the abdomen STAT(Learning Objectives 1, 4, and5)a. Describe the pathophysiologic sequence of events seen with hypovolemic shock. b. What are the major goals of aesculapian management in this patient? c. What is the rationale for placing two large-bore IVs?d. What are advantages of use 0.9% NS in this patient?e. What is the rationale for placing the patient in a change Trendelenburg position? Case Study, Chapter 13, Fluid and Electrolytes Balance and Disturbance 1. Mrs. dean is 75-year-old charwoman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a naso heavy weapontric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg day-after-day and hydromorphone 0.2 mg every 4 hours, as needed for pain. The sunrise electrolytes reveal serum potassium of 3.2 mEq/L.a. Wha t 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 assess 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 attending 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 science labSodium (Na+) 150 honey oil (K+) 5.5Chloride (Cl) 110BUN 42Creatinine 0.8Glucose 86pH 7.32PaCO2 35HCO 3 20PaO2 90O2 Sat 98%a. What is your interpretation of this arterial blood gas sample?b. Explain the high potassium in this patient.c. Calculate the patients anion gapd. What is the interpretation of this anion gap?1. Complete a blueprint of care for a patient with an electrolyte imbalance fluid volume shortage and fluid volume superfluity 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 fourfold organ dysfunction syndrome (MODS).