SEPSIS/SEPTIC SHOCK - 2013
Brittney Bonsall
Xavier University
July 27, 2015
Pathophysiology questions (50 points)
Adv Nursing questions (85 points)
Pharmacology (30 points)
CASE PRESENTATION
Emergency Department
Mr. Roberts, a 72-year-old man, arrived in the emergency department unconscious, with stab wounds to the upper-right abdomen and lower-right chest that were sustained in his home while fighting off a burglar. The paramedics secured two large-bore intravenous (IV) catheters in his right and left antecubital spaces and infused Lactated Ringer’s (LR) solution wide open in both sites. An endotracheal tube was inserted, and ventilation with a resuscitation bag with 100% oxygen was begun. Pressure dressings to both wounds were secured.
A 5-cm stab wound to his right lower chest and a 7.5-cm stab wound to his
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Monitor the heart rate and pattern
Mr. Roberts has already developed sinus tachycardia with short runs of ventricular tachycardia, ST-segment elevation, T-wave inversion, and the development of Q waves over most of the anterior V leads on his electrocardiogram.
The ST-segment elevation and the T-wave inversion indicate a possible Myocardial Infarction
The low serum levels of potassium due to fluid shifting back to the intracellular compartments, the myocardium excitability increases resulting in tachycardia and abnormal EKG patterns
Monitor fluid status
Weight the patient daily
This is the most accurate way to determine if the patient is retaining or losing fluid
Strictly record Intake and Output
Patient may develop dehydration due to all the water shifting to the interstitial spaces
Maintain vascular volume
Administer either D5W or hypertonic saline solution in order to pull fluids back into the vascular compartment.
With lactic acidosis, lactated-ringers may be contraindicated.
Monitor blood