Case Study, Chapter 14, Shock and Multiple Organ Dysfunction Syndrome
1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home
to the intensive care unit with septic shock secondary to urosepsis. The patient 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 patient has a
history of urinary and bowel incontinence. The patient 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 SaO2 greater than 90%. The patient responded
to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient 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 patient 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 patient’s blood pressure
during the usage of the vasopressor therapy. (Learning Objectives 6 and 7)
a. What predisposed the patient to develop septic shock?
What most likely caused the patient to become septic is the urinary catheter along with
poor nursing care.
b. What potential findings would suggest that the patient’s septic shock is worsening
from the point of admission?
Worsening hypotension, diaphoresis, increased WOB, decreased pulses, signs of
decreased CO, decreased LOC, decreased SaO2, increased lactate level.
c. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS).
Explain how the nurse should administer the medication. What nursing
implications are related to the usage of a vasoactive medication?
Norepeniphrine should be given, according to the order, 2mcg/min and titrated up to keep
the systolic >100mmhg. Nursing implications:
Monitor constantly while patient is receiving norepinephrine. Take baseline BP and pulse
before start of therapy, then q2min from initiation of drug until stabilization occurs at
desired level, then every 5 min during drug administration. I/O should be taken to assess
for perfusion. Monitor LOC.
d. Explain why the effectiveness of a vasoactive medication decreases as the septic
shock worsens. What treatment should the nurse anticipate to be obtained to help
the patient?
As sepsis worsens, more endotoxins are being circulated throughout the blood stream
causing damage to the arterial bed. Also, being a geriatric patient will make the patient’s
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1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home
to the intensive care unit with septic shock secondary to urosepsis. The patient 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 patient has a
history of urinary and bowel incontinence. The patient 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 SaO2 greater than 90%. The patient responded
to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient 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 patient 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 patient’s blood pressure
during the usage of the vasopressor therapy. (Learning Objectives 6 and 7)
a. What predisposed the patient to develop septic shock?
What most likely caused the patient to become septic is the urinary catheter along with
poor nursing care.
b. What potential findings would suggest that the patient’s septic shock is worsening
from the point of admission?
Worsening hypotension, diaphoresis, increased WOB, decreased pulses, signs of
decreased CO, decreased LOC, decreased SaO2, increased lactate level.
c. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS).
Explain how the nurse should administer the medication. What nursing
implications are related to the usage of a vasoactive medication?
Norepeniphrine should be given, according to the order, 2mcg/min and titrated up to keep
the systolic >100mmhg. Nursing implications:
Monitor constantly while patient is receiving norepinephrine. Take baseline BP and pulse
before start of therapy, then q2min from initiation of drug until stabilization occurs at
desired level, then every 5 min during drug administration. I/O should be taken to assess
for perfusion. Monitor LOC.
d. Explain why the effectiveness of a vasoactive medication decreases as the septic
shock worsens. What treatment should the nurse anticipate to be obtained to help
the patient?
As sepsis worsens, more endotoxins are being circulated throughout the blood stream
causing damage to the arterial bed. Also, being a geriatric patient will make the patient’s
This study source was downloaded by 100000858936669 from CourseHero.com on 02-02-2023 05:41:01 GMT -06:00
https://www.coursehero.com/file/33910701/Case-Study-Septic-and-Hypovolemic-Shock-29696doc/
