Reference no: EM133909983

Question

Shock and MODS Case Study 4

Patient Profile

W.A. is a 70-year-old woman 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 vital signs on admission were Blood pressure 172/92, pulse 110, temperature 101.5°F, respirations 28. 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 162/86, pulse 114, temperature 101.2°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

Questions

1. What is multiple organ dysfunction syndrome (MODS)? After reviewing W.A.'s presentation, what organ systems (list three) do you suspect are involved and why?

2. What do you think is the origin of W.A.'s septicemia? Based on W.A. current assessment (i.e. objective data) what complication are you concerned about and why?

3. What three additional tests would you anticipate for W.A.? Include rationale for test

4. Describe three priority nursing interventions and outcomes that would be appropriate for W.A.