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Clinical Case Study: Shock and Multiple Organ Dysfunction Syndrome
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Clinical Case Study: Shock and Multiple Organ Dysfunction Syndrome
Case Study Questions:
1. Explain the pathophysiology of septic shock and MODS.
• Septic shock is a “subset of sepsis in which underlying circulatory and cellular
metabolism abnormalities are profound enough to substantially increase mortality” (p.
313).
• MODS can be a complication from any form of shock and is a result of inadequate
tissue profusion. It usually occurs at the end of the continuum of septic shock when
tissue perfusion cannot be adequately restored.
2. How can clinical presentations for bacterial sepsis differ between the
gerontologic population as compared to the adult non-Geri population?
• The early signs and symptoms in the gerontologic population are blunted or even
absent. The initial inflammatory response that usually produce the signs and
symptoms is what is usually not present. Another reason is other signs of sepsis are
thought to be part of the normal aging process. Signs such as altered mental status,
delirium, weakness, anorexia, malaise, falls and urinary incontinence. Lastly
sometimes it is hard to get a clear history from the gerontologic patient making it hard
to diagnose.
3. Which clinical findings indicate that the patient has developed sepsis
and/or MODS? Provide rationales.
• Clinical findings that indicate the patient has developed sepsis and/or MODS are:
o RR 36 and shallow – increases because there is a need for oxygen to the cells
o Has a build up of lactic acid since his lab came back as 5.9 mmol/L
o Heart rate increase at 136 bpm – due to lack of adequate blood supply
o WBC 21K – is elevated so indicates an infection
o Admitted with ALOC – due to lack of blood flow to the brain
o Extremities cool to the touch – beginning stages due to lack of adequate blood
flow
o Elevated glucose level of 298 – sign of hypermetabolic state
o Elevated BUN 1347 – indicates kidney failure
o Elevated bilirubin 4.8 – sign of hepatic dysfunction
4. Explain the significance of each of the patient’s lab results.
• ABG’s – show the patient is in Respiratory acidosis which means the lungs
cannot remove all the CO the body is producing.
• Serum lactate 5.9 mmol/L – is elevated since it is > 4 mmol/L indicating there is
lactic acid in the blood and will continue to increase with the progression of
sepsis due to hypoxemia.
• K 3.3 – is low and is significant to the patient’s low blood pressure. Can also cause
EKG changes such as prominent U waves, ST depression, and prolonged PR
interval.
• BUN/Cr 58/1.9 –normal range BUN 20 mg/dL. Normal range Cr 0.7 – 1.4 mg/dL.
Sepsis can increase these factors and these labs used to diagnose acute or chronic
Clinical Case Study: Shock and Multiple Organ Dysfunction Syndrome
, 2
Clinical Case Study: Shock and Multiple Organ Dysfunction Syndrome
Case Study Questions:
1. Explain the pathophysiology of septic shock and MODS.
• Septic shock is a “subset of sepsis in which underlying circulatory and cellular
metabolism abnormalities are profound enough to substantially increase mortality” (p.
313).
• MODS can be a complication from any form of shock and is a result of inadequate
tissue profusion. It usually occurs at the end of the continuum of septic shock when
tissue perfusion cannot be adequately restored.
2. How can clinical presentations for bacterial sepsis differ between the
gerontologic population as compared to the adult non-Geri population?
• The early signs and symptoms in the gerontologic population are blunted or even
absent. The initial inflammatory response that usually produce the signs and
symptoms is what is usually not present. Another reason is other signs of sepsis are
thought to be part of the normal aging process. Signs such as altered mental status,
delirium, weakness, anorexia, malaise, falls and urinary incontinence. Lastly
sometimes it is hard to get a clear history from the gerontologic patient making it hard
to diagnose.
3. Which clinical findings indicate that the patient has developed sepsis
and/or MODS? Provide rationales.
• Clinical findings that indicate the patient has developed sepsis and/or MODS are:
o RR 36 and shallow – increases because there is a need for oxygen to the cells
o Has a build up of lactic acid since his lab came back as 5.9 mmol/L
o Heart rate increase at 136 bpm – due to lack of adequate blood supply
o WBC 21K – is elevated so indicates an infection
o Admitted with ALOC – due to lack of blood flow to the brain
o Extremities cool to the touch – beginning stages due to lack of adequate blood
flow
o Elevated glucose level of 298 – sign of hypermetabolic state
o Elevated BUN 1347 – indicates kidney failure
o Elevated bilirubin 4.8 – sign of hepatic dysfunction
4. Explain the significance of each of the patient’s lab results.
• ABG’s – show the patient is in Respiratory acidosis which means the lungs
cannot remove all the CO the body is producing.
• Serum lactate 5.9 mmol/L – is elevated since it is > 4 mmol/L indicating there is
lactic acid in the blood and will continue to increase with the progression of
sepsis due to hypoxemia.
• K 3.3 – is low and is significant to the patient’s low blood pressure. Can also cause
EKG changes such as prominent U waves, ST depression, and prolonged PR
interval.
• BUN/Cr 58/1.9 –normal range BUN 20 mg/dL. Normal range Cr 0.7 – 1.4 mg/dL.
Sepsis can increase these factors and these labs used to diagnose acute or chronic
