Intensive care Essay

1. Adam Smith, 77 days of age, is a male unhurried who was admitted from a nursing home to the intensive disturbance unit with septic appal supplementary to urosepsis. The enduring has a Foley catheter in posture from the nursing home with cloudy greenish, yellow-colored piss with sediments. The give removes the catheter after obtaining a peeing culture and replaces it with a condom catheter affiliated to a drainage bag since the tolerant has a story of urinary and gut incontinence. The patient role role is confused, afebrile, and hypotensive with a family compress of 82/44 mm Hg. His respiratory rate is 28 breaths/ hour and the pulse oximeter reading is at 88% room air, so the doctor coherent 2 to 4 L of group O per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of atomic number 8 per nasal cannula with a SaO2 of 92%.The patient has diarrhea. His extr sue glucose level is elevated at 160 mg/dL. The white profligate count is 15 ,000 and the Creactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) starting line at 2 mcg/ arcminute and titrated to keep systolic course pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and nutriment by chest x-ray for even off placement. An arterial line was placed in the right radial artery to tight monitor the patients blood pressure during the habitude of the vasopressor therapy. (Learning intentions 6 and 7) a. What dispose the patient to develop septic shock?b. What potential findings would suggest that the patients septic shock is worsening from the file of main course? c. The norepinephrine concentration is 16 mg in 250 mL of radiation diagram saline (NS). Explain how the nurse should look at the medication. What nursing implications are related to the usage of a vasoactive medication? d. Explain wherefore the effectiveness of a va soactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient?e. Explain the importance for nutritional financial support for this patient and which type of nutritional support should be providedf. What are your priority interventions? treat/ Medical ( 3-4 )2. Carlos Adams was involved in a motor vehicle accident and suffered un piecenerly trauma to his abdomen. Upon presentation to the emergency department, his critical signs are as follows temperature, 100.9F nucleus rate, 120 bpm respiratory rate, 20 breaths/min and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising roughly the umbilicus. He is alert and oriented, but complains of lightheadedness when changing positions. The patient is admitted for management of guess hypovolemic shock.The following orders are scripted for the patientPlace two large-bore IVs and transfuse 0.9% NS at 125 mL/hr/line Obtain complete blood count, serum ele ctrolytesOxygen at 2 L/min via nasal cannula eccentric and cross for 4 units of blood horizontal plate of the abdomen STAT(Learning Objectives 1, 4, and5)a. Describe the pathophysiologic era of events seen with hypovolemic shock. b. What are the major goals of medical management in this patient? c. What is the rationale for placing two large-bore IVs?d. What are advantages of using 0.9% NS in this patient?e. What is the rationale for placing the patient in a modified Trendelenburg position? model Study, Chapter 13, Fluid and Electrolytes Balance and Disturbance 1. Mrs. doyen is 75-year-old woman admitted to the hospital for a crushed bowel obstruction. Her medical history includes hypertension. Mrs. dean is NPO. She has a naso ordnancetric (NG) tube to low ceaseless suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as required for pain. The morning electrolytes reveal serum green of 3.2 mE q/L.a. What are possible causes of a low chiliad level?b. What action should the nurse take in comparison to the serum potassium level? c. What clinical manifestations might the nurse assess in Mrs. Dean? 2. Conrad Jackson is a 28-year-old man who presents to the emergency department with severe wear off and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunification and states that perhaps he ate something bad.Upon admission his vital signs are a temperature of 102.7F, pump rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas. (Learning Objective 7) The following results are returned from the laboratory atomic number 11 (Na+) 150Potassium (K+) 5.5Chloride (Cl) 110 axial rotation 42Creatinine 0.8Glucose 86pH 7.32PaCO2 35HCO3 20PaO2 90O2 Sat 98%a. What is your interpretation of this arterial blood gas sample?b. Explain the high potassium in this patient.c. Calculate the patients anion gapd. What is the interpretation of this anion gap?1. peg a plan of care for a patient with an electrolyte imbalance fluid meretriciousness deficit and fluid volume redundancy sodium deficit (hyponatremia) and sodium intemperanceiveness (hypernatremia) potassium deficit (hypokalemia) and potassium excess (hyperkalemia). Specifically, include altered laboratory values. 2. lay down a Plan care for a patient with multiple organ disfunction syndrome (MODS).