Question

Sepsis and MODS

Patient Profile

W.A. is a 70-year-old female who presented to the emergency department with fever, severe nausea, vomiting, and diarrhea. She is admitted to the intensive care unit (ICU) with a diagnosis of kidney failure and septicemia. Her previous medical history includes glaucoma, chronic kidney failure, hypertension, and insulin-dependent diabetes. She had a left above-the-knee amputation 1 year ago.

Subjective Data

• W.A.’s daughter states she was able to do her daily chores at home independently, but for the last few days it was getting difficult for her to get around and that she needed to take frequent breaks because of shortness of breath and no energy. Her daughter also reports that W.A. had been having headaches with nausea and dizziness for the past few days.
• Goes to hemodialysis 3 days a week

Objective Data

Physical Examination

• Blood pressure 172/92, pulse 110, temperature 101.5°F, respirations 28
• Oxygen saturation 86% on 15 LPM via mask
• Oriented to name only
• Crackles in bilateral lower lobes
• 2+ edema bilateral lower extremities and hands
• Abdomen is distended with hypoactive bowel sounds x4 quadrants

Diagnostic Studies

• CBC: Hemoglobin 7 g/dL, hematocrit 23.8%, RBC 2.57 million/mm³, WBC 14.8 mm³
• Chemistry Panel: Serum sodium 132 mEq/L, serum potassium 6.0 mEq/L, calcium 9.3 mg/dL, phosphorus 6.0 mg/dL, glucose 197 mg/dL, albumin 2.4 U/L, serum blood urea nitrogen 77 mg/dL, serum creatinine 7.30 mg/dL, eGFR African American 10, BNP 182 pg/mL
• Urinalysis: Dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones
• Blood cultures pending

Discussion Questions

5) Describe interprofessional care that would be appropriate for W.A.

6) W.A.’s urine output over the past 4 hours is 20 mL, and her latest potassium level is 7 mEq/L. The provider is ordering a continuous renal replacement therapy machine (CRRT). Why would a CRRT be ordered for W.A.?

7) Outline a care plan for W.A., describing nursing interventions that would be appropriate for promoting oxygenation, maintaining fluid volume, and promoting tissue perfusion.

Answer 1

5.The interprofessional care that can be provided for W.A includes first upon a nephrology doctor,because she has renal failure,endocrinologist because she is diabetic and insulin dependent,dialysis technician(CRRT),diatician to manage the diet plan,an intensivist,respiratory therapist and a physiotherapist .These are are the people for the interprofessional care for W A for her comprehensive care.

6.CRRT is recommended for patients who has the need of removing large volume of fluid gradually,hemodynamicaly very unstable and hypotension.patient who is oliguric and anuric,severe metabolic acidosis etc .For WA we need to remove the fluid from her body in a large amount.But if we prefer dialysis it causes drastic change suddenly which cannot be tolerable by the vital organs.Other thing is that,due to CRRT it removes the waste products and the water gradually by taking more time .So it doesnot affect the heart and other vital organs in the body .For example if there is sudden change in the amount of potasium found in the blood for W A it can cause arrythmia.So the doctor prefered for CRRT though the potasium value is too high.

7. Assess fo the signs and symptoms of breathing difficulty

*connect the patient to the cardiac monitor

*continuous monitoring of the oxygen saturation

*Administer oxygen as required

* position the patient in the up right position

*Encourage for coughing and deep breathing exercise

For maintaing the fluid volume

Monitor the intake and output

Daily weight checking

Follow the advice of the dietician

To maintain the tissue perfusion

Ecourage the patient to maintain the intake and out put

Maintain the oxygen level in blood by administering oxygen,chest physiotherapy and ambulation.

Monitor the use of anticoagulant during the dialysis (CRRT)