Question

Case Study

W.A. is a 70-year-old African American 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 mellitus. She had a left above-the-knee amputation 1 year ago.

Subjective Data

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 complaining of headaches with nausea and dizziness for the past few days.

Goes to hemodialysis 3 days a week

Objective Data

Physical Examination

Blood pressure 178/96, 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

What is MODS? After reviewing W.A.’s presentation, what organ systems do you suspect are involved and why?

What do you think is the origin of W.A.’s septicemia?

What additional tests would you anticipate for W.A.?

What are the interprofessional care goals for W.A.?

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

Answer 1

1st Answer: Multiple Organ Dysfunction Syndrome (MODS). She has a history of Chronic Kidney Disease (CKD) so the renal and endocrine system is involved. It is observed that the patient suffers from diabetes and requires insulin. Nephropathy is one of the complications of diabetes and it leads to CKD.

2nd Answer: Septicemia can occur due to Hemodialysis when the nurse does not follow proper aseptic techniques.

3rd Answer: We would recommend that a liver function test, chest X ray and abdominal scan should be done forn WA;

liver function test and abdominal scan to check for abnormal findings in the liver or stomach since the abdomen is distended with hypoactive bowel sounds in 4 quadrants

chest X ray to check if the septicemia has spread to the lungs since there are crackles in bilateral lower lobes.

4th Answer: The interpersonal care goals for WA would be that she would need to visit a pulmologist, an endocrinologist, a nephrologist and these specialist would need to cooordinate and ensure that WA's septicemia does not spread and also any kind of septicemia shock should be dealt with properly. The impaired gas volume, deficient fluid volume and risk of hyperthermia should be taken care of as and when it arises.

5th Answer: Since WA is suffering from chronic MOD ailments, proper care must be taken and all the specialists that are required for her treatment such as pulmonologist, an endocrinologist and a nephrologist should be available for this patient.