[Expert Solution]: Case Study for Complex Health Nursing A 76…

Case Study for Complex Health Nursing A 76 y/o patient with PMH significant for HTN, DM Type II, and BPH presents to the ED from a managed care facility with new onset confusion and lethargy. Physical exam reveals the patient to be Oriented to person only, and he is intermittently restless and lethargic. VS reveal the following: BP 75/40mmHG (MAP 52), HR 130 (ST), RR 30, Temp 39C. A stat blood glucose level is obtained due to the patient’s altered mentation (80mg/dl), and STAT Head CT is negative for any acute findings. On physical exam, the RN notes the patient’s bladder to be firm and distended, after obtaining orders for foley catheter placement, 1.5L foul-smelling urine was drained from the bladder immediately. In addition to pyuria, the patient’s labwork is significant for an elevated WBC count (26K), elevated serum creatinine (2mg/dl), and elevated lactic acid level (9mmol/L). 1.) Please discuss pathophysiology of septic shock. Does this patient display any risk factors or s/s of this condition? 2.) Please discuss the stages of shock. At what stage does this patient present? 3.) Please discuss the initial management of septic shock, as well as implications for nursing care. Despite fluid resuscitation with 3L LR bolus (30ml/kg IBW over 1hr), the patient remains hypotensive (BP 80/50mmHg, MAP 60). The patient is initiated on a norepinephrine infusion with goal SBP > 90/ MAP > 65, and preparations are made for admission to ICU and placement of central line. 4.) What are important nursing implications for the care of the patient receiving an intravenous fluid bolus? 5.) Please discuss nursing implications for the care of patients receiving vasopressor medications in the ICU. A Swan-Ganz Catheter is placed upon arrival to the ICU, revealing a CVP of 1 mmHg, Cardiac Output of 9L/Min, and SVR 500. The patient receives an additional 2L LR bolus with improvement in his vasopressor requirements (Norepinephrine infusion decreased from 8mcg/min to 4mcg/min), lactic acid level (repeat 2mmol/L), and AKI (repeat serum creatinine 1.7mg/dl). The patient’s STAT blood cultures (obtained in ED) reveal gram-negative bacteremia (e. coli) and broad-spectrum coverage is adjusted per the recommendations of the infectious-disease specialist. 6.) Please discuss the findings of this patient’s hemodynamic monitoring, and implications for his care.