7633771142 Rasmussen College Septic Clinical Reasoning Case Study Sepsis/Septic Shock Clinical Reasoning Case StudyJean Kelly, 82 years old Overview Sepsis

7633771142 Rasmussen College Septic Clinical Reasoning Case Study Sepsis/Septic Shock Clinical Reasoning Case StudyJean Kelly, 82 years old
Overview
Sepsis is now the most common reason that a patient is admitted to the hospital. Do not take sepsis lightly because it can
be a killer, especially when it is NOT recognized early. This scenario will sharpen your ability to be that nurse who will
be a lifesaver in practice and rescue a septic patient before it is too late!
Concepts (in order of emphasis)
I. Infection
I. Perfusion
II. Fluid and Electrolyte Balance
III. Thermoregulation
IV. Clinical Judgment
V. Patient Education
VI. Communication
VII. Collaboration After the case study Can you please write a A Reflection Paper of one Page with a cover page. Circulation (Perfusion)
Sepsis/Septic Shock Clinical Reasoning Case Study
STUDENT Worksheet
Jean Kelly, 82 years old
Overview
Sepsis is now the most common reason that a patient is admitted to the hospital. Do not take sepsis lightly because it can
be a killer, especially when it is NOT recognized early. This scenario will sharpen your ability to be that nurse who will
be a lifesaver in practice and rescue a septic patient before it is too late!
Concepts (in order of emphasis)
I.
I.
II.
III.
IV.
V.
VI.
VII.
Infection
Perfusion
Fluid and Electrolyte Balance
Thermoregulation
Clinical Judgment
Patient Education
Communication
Collaboration
Sepsis
I. Data Collection
History of Present Problem:
Jean Kelly is an 82 year old woman who has been feeling more fatigued for the last three days and has had a fever the
last twenty-four hours. She reports painful, burning sensation when she urinates as well as frequency of urination the last
week. It has been >90 degrees this past week. She usually drinks 2-3 glasses of liquid a day and a cup of tea. Her daughter
became concerned and brought her to the emergency department (ED) when she did not know what day it was. She is
mentally alert with no history of confusion.
Personal/Social History:
Jean lives independently in a senior apartment retirement community. She is widowed and has two daughters who are
active and involved in her life. While taking her bath today, she was unable to get out of the tub and used the help button.
When help arrived, she was able to get to the side of the tub and sit. Upon standing to ambulate she became dizzy and lost
her balance. She didn’t get injured while coming down hard on the toilet seat.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
RELEVANT Data from Social History:
Clinical Significance:
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH:
Home Meds:
Pharm. Classification:
Expected Outcome:
Diabetes type II
1.Allopurinol 100 mg bid
1.
1.
Hyperlipidemia
2.Colchicine 0.6 mg prn
2.
2.
Hypertension (HTN)
3.ASA 81 mg daily
3.
3.
Gout
4.Pioglitazone (Actos) 15
4.
4.
mg daily
5.
5.
5.Simvastatin 20 mg daily
6.
6.
6.Metoprolol 25 mg bid
7.
7.
7.Lisinopril 10 mg daily
8.
8.
8. Furosemide (Lasix) 20 mg
daily
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology, (if applicable), which disease likely developed FIRST that then initiated a “domino effect” in
their life?
Circle what PMH problem likely started FIRST
Underline what PMH problem(s) FOLLOWED as domino(s)
II. Patient Care Begins:
Current VS:
T: 101.8 (oral)
P: 110 (regular)
R: 24 (regular)
BP: 102/50
O2 sat: 98% room
air
WILDA Pain Assessment (5th VS):
Words:
Intensity:
Location:
Duration:
Aggravate:
Alleviate:
Ache
5/10
Right flank
Continuous/ongoing
Nothing
Nothing
The nurse recognizes the need to validate his/her concern of fluid volume deficit and performs a set of
orthostatic VS and obtains the following:
Position:
Lying
Standing
HR:
110
132
BP:
102/50
92/42
What VS data is RELEVANT that must be recognized as clinically significant to the nurse?
RELEVANT VS Data: Clinical Significance:
Current Assessment:
GENERAL
APPEARANCE:
RESP:
CARDIAC:
Resting comfortably, appears in no acute distress
Breath sounds clear with equal aeration bilaterally, nonlabored respiratory effort
Pink, warm & dry, no edema, heart sounds regular-S1S2, pulses strong, equal with
palpation at radial/pedal/post-tibial landmarks
NEURO:
Alert and oriented x2-is not consistently oriented to date and place, c/o dizziness when she
sits up
GI:
GU:
Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants
SKIN:
Skin integrity intact
Admits to dysuria and frequency of urination the past week, right flank tenderness to gentle
palpation
What assessment data is RELEVANT that must be recognized as clinically significant to the nurse?
RELEVANT Assessment Data:
Clinical Significance:
III. Clinical Reasoning Begins…
1. What is the primary problem that your patient is most likely presenting with?
2. What is the underlying cause/pathophysiology of this problem?
3. List all relevant nursing priorities. What nursing priority(s) will guide your plan of care? (if more than one-list in
order of PRIORITY)
4. What interventions will you initiate based on this priority?
Nursing Interventions:
Rationale:
Expected Outcome:
5. What body system(s) will you most thoroughly assess based on the primary/priority concern?
6. What is the worst possible/most likely complication to anticipate?
7. What nursing assessment(s) will you need to initiate to identify this complication if it develops?
8. What nursing interventions will you initiate if this complication develops?
Medical Management: Rationale for Treatment & Expected Outcomes
Care Provider Orders:
Chext X-ray (CXR)
Rationale:
Expected Outcome:
Complete blood count (CBC)
Basic metabolic panel (BMP)
Lactate
Procalcitonin
Urine analysis/urine culture
(UA/UC)
Blood cultures x2 sites
Place Foley catheter
0.9% NS 1000 mL IV bolus
Acetaminophen 650 mg
Ceftriaxone 1g IVPB…after
blood/urine cultures obtained
Morphine 2 mg IV push
every 2 hours prn-pain
PRIORITY Setting: Which Orders Do You Implement First and Why?
Care Provider Orders:
1. Place Foley catheter
2 .0.9% NS 1000 mL IV
bolus
3. Acetaminophen 650 mg
4. Ceftriaxone 1g
IVPB…after blood/urine
cultures obtained
5. Morphine 2 mg IV push
every 2 hours prn-pain
Order of Priority:
1.
2.
Rationale:
1.
2.
3.
3.
4.
4.
5.
5.
Medication Dosage Calculation:
Medication/Dose:
Ceftriaxone 1g
IVPB
Normal Range:
(high/low/avg?)
Mechanism of Action:
Volume/time frame to
Safely Administer:
50 mL
Hourly rate IVPB:
Nursing Assessment/Considerations:
Radiology Reports:
What diagnostic results are RELEVANT that must be recognized as clinically significant to the nurse?
RELEVANT Results: Clinical Significance:
CXR: No infiltrates or
other abnormalities. No
changes from last
previous
Lab Results:
What lab results are RELEVANT that must be recognized as clinically significant to the nurse?
Complete Blood Count (CBC):
WBC (4.5-11.0 mm 3)
Hgb (12-16 g/dL)
Platelets(150-450x 103/µl)
Neutrophil % (42-72)
Band forms (3-5%)
Current:
13.2
14.4
246
93
2
High/Low/WNL?
Most Recent:
8.8
14.6
140
68
1
What lab results are RELEVANT that must be recognized as clinically significant to the nurse?
RELEVANT Lab(s):
Clinical Significance:
TREND: Improve/Worsening/Stable:
Basic Metabolic Panel (BMP):
Sodium (135-145 mEq/L)
Potassium (3.5-5.0 mEq/L)
Chloride (95-105 mEq/L)
CO2 (Bicarb) (21-31 mmol/L)
Anion Gap (AG) (7-16 mEq/l)
Glucose (70-110 mg/dL)
Calcium (8.4-10.2 mg/dL)
BUN (7 – 25 mg/dl)
Creatinine (0.6-1.2 mg/dL)
RELEVANT Lab(s):
Current:
140
3.8
98
22
8
184
8.8
15
1.5
High/Low/WNL?
Clinical Significance:
Misc. Labs:
Magnesium (1.6-2.0 mEq/L)
Lactate (0.5-2.2 mmol/L)
Procalcitonin (< 0.05 µg/L) Current: 1.8 3.2 8.4 Most Recent: 138 3.9 102 20 10 128 8.8 14 1.1 TREND: Improve/Worsening/Stable: High/Low/WNL? Most Recent: 1.9 n/a n/a RELEVANT Lab(s): Clinical Significance: Urine Analysis (UA): Color (yellow) Clarity (clear) Specific Gravity (1.015-1.030) Protein (neg) Glucose (neg) Ketones (neg) Bilirubin (neg) Blood (neg) Nitrite (neg) LET (Leukocyte Esterase) (neg) MICRO: RBC’s ( Purchase answer to see full attachment