Ms. D, a 54-year-old patient, is brought to the emergency department (ED)
by her daughter because of weakness and a decreasing level of
consciousness. The patient responds to brief commands to open her eyes
and move her arms and legs, but she is unable to answer any of your
questions. The daugh...
CASE STUDY Septic shock
Ms. D, a 54-year-old patient, is brought to the emergency department (ED)
by her daughter because of weakness and a decreasing level of
consciousness. The patient responds to brief commands to open her eyes
and move her arms and legs, but she is unable to answer any of your
questions. The daughter tells you that, when she stopped by her mother’s
house today for a visit, Ms. D was complaining about abdominal and back
pain. She also was a little bit nauseated and vomited a small amount twice.
Although usually she is very alert and oriented, today she seemed lethargic
and became increasingly sleepy. Because of her lethargy and nausea, she
has not had anything to eat or drink today.
Her medical history includes hypertension, peripheral arterial disease, and
m
diabetes mellitus type 2. The daughter brings in a list of her usual home
er as
medications, which include enalapril (Vasotec) 40 mg daily, insulin lispro
co
(Humalog) on a sliding scale for elevated glucose levels, metformin
eH w
(Glucophage) 500 mg twice daily, and atorvastatin (Lipitor) 10 mg daily.
o.
rs e
You obtain and document the initial vital sign values as follows:
ou urc
Blood pressure 102/38 mm Hg
o
aC s
vi y re
Heart rate 102 beats/min
O2 saturation 76%
ed d
ar stu
Respiratory rate 40 breaths/min
is
Temperature 102.4° F (39.1° C) (orally)
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1.Based on the initial history and assessment, which action prescribed
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by the health care provider (HCP) will you implement first?
o 1.Insert a Foley catheter and send a urine specimen for culture
and sensitivity testing.
o 2.Start oxygen and titrate to maintain oxygen saturation at 90%
or higher.
This study source was downloaded by 100000822479833 from CourseHero.com on 04-02-2021 07:41:06 GMT -05:00
, o 3.Place the patient on a cardiac monitor.
o 4.Check the blood glucose level.
2.Which method of oxygen administration will be best to increase Ms.
D’s oxygen saturation?
o 1.Nasal cannula
o 2.Nonrebreather mask
o 3.Venturi mask
o 4.Simple face mask
3.Available staffing in the ED includes you and an experienced UAP.
m
Which actions will be best for you to delegate to the UAP? (Select all that
er as
apply.)
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o 1.Measuring vital signs every 15 minutes
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o 2.Attaching the patient to a cardiac monitor
o.
o 3.Documenting a head-to-toe assessment
o rs e
4.Checking orientation and alertness
ou urc
o 5.Inserting an IV line
o 6.Recording urine output hourly
o
aC s
vi y re
4.The cardiac monitor shows atrial fibrillation with a rate of 90 to 114
beats/min. Routine treatment orders for dysrhythmias are included in the
ED protocols. Which action will you prepare to take next?
o 1.Continue to monitor cardiac rhythm.
ed d
o 2.Administer metoprolol (Lopressor) 5 mg IV push.
ar stu
o 3.Prepare to perform cardioversion at 50 J.
o 4.Administer adenosine (Adenocard) 6 mg IV push.
is
Arterial blood gas (ABG) analysis is performed and the following
results are obtained:
Th
Arterial partial pressure of carbon dioxide (PaCO2) 62 mm Hg
sh
Arterial partial pressure of oxygen (Pao2) 50 mm Hg
Bicarbonate (HCO3−) 22 mEq/L
This study source was downloaded by 100000822479833 from CourseHero.com on 04-02-2021 07:41:06 GMT -05:00
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