Case Study for (Septic Shock) Seminar
Hypotension, Lethargy, Nausea, and Abdominal Pain
Ms. D., a 54-year-old patient, is brought to the emergency department by her daughter because
of weakness and a decreasing level of consciousness. The patient responds to brief commands
to open her eyes and move her arms and legs, but she is unable to answer any of your
questions. The daughter tells you that when she stopped by her mother’s house today for a visit,
Ms. D. was complaining about abdominal and back pain. She also was a little bit nauseated and
vomited a small amount twice. Although usually she is very alert and oriented, today she
seemed lethargic and became increasingly sleepy. Because of her lethargy and nausea, she has
not had anything to eat or drink today.
Her past medical history includes hypertension, peripheral arterial disease, and diabetes
mellitus, type 2. The daughter brings in a list of her usual home medications, which include
enalapril (Vasotec) 40 mg daily, NPH insulin 42 units in the morning and 30 units in the evening,
lispro (Humalog) insulin sliding scale for elevated glucose levels, metformin (Glucophage) 500
mg twice daily, and atorvastatin (Lipitor) 10 mg daily.
You obtain the following initial vital signs:
Blood pressure 102/38
Pulse 102
Respirations 40
Temperature 102.4 degrees F orally
O2 saturation 76%
1. Based on your initial history and assessment, which of these physician orders will you
implement first?
a. Insert Foley catheter and send urine specimen for culture and sensitivity
b. Start oxygen and titrate to maintain oxygen saturation at 90% or greater
c. Place on the cardiac monitor
d. Check the blood glucose level
2. Which method of oxygen administration will be best to increase Ms. D.’s oxygen
saturation?
This study source was downloaded by 100000866399126 from CourseHero.com on 05-07-2023 15:37:32 GMT -05:00
https://www.coursehero.com/file/68896262/Case-Study-for-Septic-Shock-Seminar-Hypotension-Lethargy-Nausea-and-Abdominal-Paindoc/
, a. Nasal cannula
b. Non-rebreather mask
c. Venturi mask
d. Simple face mask
3. Available staffing in the ED includes you and an experienced nursing assistant. Which of
these collaborative interventions or nursing skills involved in caring for Ms. D. will be
best for you to delegate to the nursing assistant?
a. Obtain vital signs every 15 minutes
b. Place on cardiac monitor
c. Document head-to-toe assessment
d. Check orientation and alertness
e. Insert IV line
f. Monitor urine output hourly
4. The cardiac monitor shows atrial fibrillation, rate 90 -114. Routine treatment orders for
dysrhythmias are included in the Ed protocols. Which action will you prepare to take
next?
a. Continue to monitor cardiac rhythm
b. Administer lidocaine (Xylocaine) 1 mg/kg IV push
c. Prepare to cardiovert at 50 joules
d. Administer adenosine (Adenocard) 6 mg IV push
Arterial blood gases are drawn and the following results are obtained:
pH 7.23
Paco2 62 mm Hg
Pao2 50 mm hg
HCO3 22 mEq/L
O2 saturation 87%
5. Based on your analysis of these ABG’s, which collaborative intervention do you
anticipate?
a. Sodium bicarbonate (NaHCO3) bolus IV
This study source was downloaded by 100000866399126 from CourseHero.com on 05-07-2023 15:37:32 GMT -05:00
https://www.coursehero.com/file/68896262/Case-Study-for-Septic-Shock-Seminar-Hypotension-Lethargy-Nausea-and-Abdominal-Paindoc/
Hypotension, Lethargy, Nausea, and Abdominal Pain
Ms. D., a 54-year-old patient, is brought to the emergency department by her daughter because
of weakness and a decreasing level of consciousness. The patient responds to brief commands
to open her eyes and move her arms and legs, but she is unable to answer any of your
questions. The daughter tells you that when she stopped by her mother’s house today for a visit,
Ms. D. was complaining about abdominal and back pain. She also was a little bit nauseated and
vomited a small amount twice. Although usually she is very alert and oriented, today she
seemed lethargic and became increasingly sleepy. Because of her lethargy and nausea, she has
not had anything to eat or drink today.
Her past medical history includes hypertension, peripheral arterial disease, and diabetes
mellitus, type 2. The daughter brings in a list of her usual home medications, which include
enalapril (Vasotec) 40 mg daily, NPH insulin 42 units in the morning and 30 units in the evening,
lispro (Humalog) insulin sliding scale for elevated glucose levels, metformin (Glucophage) 500
mg twice daily, and atorvastatin (Lipitor) 10 mg daily.
You obtain the following initial vital signs:
Blood pressure 102/38
Pulse 102
Respirations 40
Temperature 102.4 degrees F orally
O2 saturation 76%
1. Based on your initial history and assessment, which of these physician orders will you
implement first?
a. Insert Foley catheter and send urine specimen for culture and sensitivity
b. Start oxygen and titrate to maintain oxygen saturation at 90% or greater
c. Place on the cardiac monitor
d. Check the blood glucose level
2. Which method of oxygen administration will be best to increase Ms. D.’s oxygen
saturation?
This study source was downloaded by 100000866399126 from CourseHero.com on 05-07-2023 15:37:32 GMT -05:00
https://www.coursehero.com/file/68896262/Case-Study-for-Septic-Shock-Seminar-Hypotension-Lethargy-Nausea-and-Abdominal-Paindoc/
, a. Nasal cannula
b. Non-rebreather mask
c. Venturi mask
d. Simple face mask
3. Available staffing in the ED includes you and an experienced nursing assistant. Which of
these collaborative interventions or nursing skills involved in caring for Ms. D. will be
best for you to delegate to the nursing assistant?
a. Obtain vital signs every 15 minutes
b. Place on cardiac monitor
c. Document head-to-toe assessment
d. Check orientation and alertness
e. Insert IV line
f. Monitor urine output hourly
4. The cardiac monitor shows atrial fibrillation, rate 90 -114. Routine treatment orders for
dysrhythmias are included in the Ed protocols. Which action will you prepare to take
next?
a. Continue to monitor cardiac rhythm
b. Administer lidocaine (Xylocaine) 1 mg/kg IV push
c. Prepare to cardiovert at 50 joules
d. Administer adenosine (Adenocard) 6 mg IV push
Arterial blood gases are drawn and the following results are obtained:
pH 7.23
Paco2 62 mm Hg
Pao2 50 mm hg
HCO3 22 mEq/L
O2 saturation 87%
5. Based on your analysis of these ABG’s, which collaborative intervention do you
anticipate?
a. Sodium bicarbonate (NaHCO3) bolus IV
This study source was downloaded by 100000866399126 from CourseHero.com on 05-07-2023 15:37:32 GMT -05:00
https://www.coursehero.com/file/68896262/Case-Study-for-Septic-Shock-Seminar-Hypotension-Lethargy-Nausea-and-Abdominal-Paindoc/
