Case Study: Shock/SIRS/MODS

Case Study: Shock/SIRS/MODS

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Case Study: Shock/SIRS/MODS

Adam
Smith, 77 years of age, is a male client who was admitted from a nursing home
to the intensive care unit with septic shock secondary to urosepsis. The client
has a Foley catheter in place from the nursing home with cloudy greenish,
yellow-colored urine with sediments. The nurse removes the catheter after
obtaining a urine culture and replaces it with a condom catheter attached to a
drainage bag since the client has a history of urinary and bowel incontinence.
The client is confused, afebrile, and hypotensive with a blood pressure of
82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter
reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per
nasal cannula titrated to keep SaO2greater than 90%.
The client responded to 2 L of oxygen per nasal cannula with a SaO2 of
92%. The client has diarrhea. His blood glucose level is elevated at 160 mg/dL.
The white blood count is 15,000 and the C-reactive protein, a marker for
inflammation, is elevated. The client is being treated with broad-spectrum
antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated
to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple
lumen catheter was inserted and verified by chest x-ray for correct placement. An
arterial line was placed in the right radial artery to closely monitor the
client’s blood pressure during the usage of the vasopressor therapy.

Case Study: Shock/SIRS/MODS

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