[Verified Answer]: A 68 y/o patient with PMH significant for…

A 68 y/o patient with PMH significant for hepatitis C infection, widely metastatic hepatocellular carcinoma, and ongoing chemotherapy presents to the ED with acute shortness of breath and a syncopal episode. Stat head CT is negative for any acute intracranial pathology, but CTA chest reveals a large central pulmonary embolism and associated right-ventricular dilation (confirmed on STAT echocardiogram). The patient’s VS are as follows: BP 60/40mmHg (MAP 47), HR 140 (ST), RR 40, Temp 38C. Labwork is significant for the following: WBC 90, MAP > 65), and the patient is taken for emergent suction thrombectomy by the IR team. Following the procedure, the patient return to the ICU for continued management. Despite successful thrombectomy and improved right-heart function on repeat echocardiogram, the patient’s vasopressor requirements fail to improve, and his LFTs/ renal function testing indicate worsening orgain failure and progression to multiple organ dysfunction syndrome (MODS), requiring initiation of CRRT. 1.) What is another factor potentially contributing to this patient’s refractory shock? 2.) Please define MODS. What are nursing considerations for caring for the patient suffering from refractory shock/ MODS?