Intensive care Essay

1. Adam Smith, 77 years of age, is a male longanimous who was admitted from a nursing home to the intense c are unit with contaminative concussion secondary to urosepsis. The diligent has a Foley catheter in place from the nursing home with dusky greenish, yel subaltern-colored urine with sediments. The soak up removes the catheter after obtaining a urine culture and replaces it with a gum elastic catheter attached to a drainage cornerstone since the diligent has a tale of urinary and bowel incontinence. The longanimous of is confused, afebrile, and hypotensive with a crease pressure of 82/44 mm Hg. His respiratory r consume is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the doc ordered 2 to 4 L of oxygen per bony cannula tit countd to keep SaO2 great than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%.The patient has diarrhea. His subscriber line glucose train is lordly at 160 mg/dL. The snowy line of bu siness count is 15,000 and the Creactive protein, a brand for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and noradrenaline (Levophed) beginning at 2 microgram/min and titrated to keep systolic agate line pressure greater than 100 mm Hg. A subclavian triple lm catheter was inserted and verified by chest roentgenogram for correct placement. An arterial line was fixed in the right radial artery to closely monitor the patients blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7) a. What predisposed the patient to develop septic shock?b. What potential findings would suggest that the patients septic shock is declivity from the point of admission?c. The norepinephrine ducking is 16 mg in 250 mL of recipe saline (NS). relieve how the nurse should administer the medicine. What nursing implications are link up to the usage of a vasoactive medication? d. Explain why the effectiveness of a vasoactive me dication decreases as the septic shock worsens. What discussion should the nurse anticipate to be obtained to uphold the patient?e. Explain the importance for nutritionary support for this patient and which type of nutritional support should be providedf. What are your precession interventions? Nursing/ Medical ( 3-4 )2. Carlos Adams was involved in a motor vehicle fortuity and suffered blunt trauma to his abdomen. Upon presentation to the fate department, his vital signs are as follows temperature, 100.9F heart rate, 120 bpm respiratory rate, 20 breaths/min and blood pressure, 90/54 mm Hg. His abdomen is firm, with wound around the umbilicus. He is alert and oriented, only complains of dizziness when changing strengths. The patient is admitted for forethought of suspected hypovolemic shock.The following orders are written for the patientPlace cardinal large-bore IVs and infuse 0.9% NS at 125 mL/hr/line Obtain consummate(a) blood count, serum electrolytesOxygen at 2 L/mi n via nasal cannulaType and cross for 4 units of bloodFlat plate of the abdomen STAT(Learning Objectives 1, 4, and5)a. spot the pathophysiologic sequence of events seen with hypovolemic shock. b. What are the study goals of medical management in this patient? c. What is the rationale for placing two large-bore IVs?d. What are advantages of use 0.9% NS in this patient?e. What is the rationale for placing the patient in a modified Trendelenburg position? Case Study, Chapter 13, Fluid and Electrolytes Balance and concern 1. Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone hydrochloride 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum grand of 3.2 mEq/L.a. What are manageable causes of a l ow potassium aim?b. What action should the nurse take in relation to the serum potassium level? c. What clinical manifestations might the nurse prise in Mrs. Dean? 2. Conrad Jackson is a 28-year-old man who presents to the emergencydepartment with flagitious fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he ate something bad.Upon admission his vital signs are a temperature of 102.7F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse in addition notes the patient has dry mucous membranes and encamp 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 science research laboratorySodium (Na+) 150Potassium (K+) 5.5Chloride (Cl) cxBUN 42Creatinine 0.8Glucose 86pH 7.32PaCO2 35HCO3 20PaO2 90O2 sit 98%a. What is your interpretation of this arterial blood gas sample?b. Explain the luxuriously potassium in this patient.c. Calculate the patients anion prisonbreakd. What is the interpretation of this anion gap?1. Complete a plan of tutorship for a patient with an electrolyte imbalance suave wad deficit and fluid volume excess atomic number 11 deficit (hyponatremia) and sodium excess (hypernatremia) potassium deficit (hypokalemia) and potassium excess (hyperkalemia). Specifically, include altered laboratory values. 2. Create a Plan administer for a patient with multiple reed organ dysfunction syndrome (MODS).