A 48-year-old female was admitted to a medical-surgical unit last night following a scheduled right,

Question: A 48-year-old female was admitted to a medical-surgical unit last night following a scheduled right, large toe amputation. Her medical history includes diabetes mellitus type I with multiple complications including peripheral neuropathy, retinopathy, gangrenous toes, and chronic kidney disease for which she manages continuous ambulatory peritoneal dialysisA 48-year-old female was admitted to a medical-surgical unit last night following a scheduled right, large toe amputation. Her medical history includes diabetes mellitus type I with multiple complications including peripheral neuropathy, retinopathy, gangrenous toes, and chronic kidney disease for which she manages continuous ambulatory peritoneal dialysis (CAPD). A nurse from the dialysis center arrives at 0615 to assist the client in a dialysate exchange. During the nurse’s pre-procedure assessment, the client states, “I don’t feel good this morning. I am really tired and have pain in my belly. I probably just need to get this exchange done.” The nurse completes the assessment and assists the client to begin draining the effluent which is cloudy and smells foul. The nurse collects a sample of the effluent and reviews the client’s EHR prior to calling the primary health care provider.
Peritoneal and blood cultures are sent to the lab and focused assessments are completed.
The following assessment data is obtained.
Anxious and restless in bed
Oriented to person and place
Shallow depth of respirations
Auscultated lung fields clear throughout
2 radial pulses, 1 pedal pulses
Capillary refill >3 seconds
Skin cool and pale
Diminished bowel sounds
Client denies chest pain, heartburn, and nausea
Time
1600
1700
1745
2120
2230
0200
0615
0730
Unit
Pre-op
Surgery
Post-op
MS
Vital signs
Temperature
98.9° F (37.2° C)
99.5° F (37.5° C)
100.9° F (38.3° C)
101.6° F (38.7° C)
102.3° F (39.1° C)
102.5° F (39.2° C)
Heart rate
89 beats/min
95 beats/min
88 beats/min
108 beats/min
116 beats/min
120 beats/min
Cardiac rhythm
NSR
NSR
NSR
ST
ST
ST
Blood pressure
145/67 mm Hg
126/60 mm Hg
120/60 mm Hg
108/57 mm Hg
95/51 mm Hg
90/48 mm Hg
Respiratory rate
18 breaths/min
18 breaths/min
22 breaths/min
24 breaths/min
28 breaths/min
28 breaths/min
O2 saturation
95%
94%
98%
92%
90%
91%
O2 device
None
None
2L NC
2L NC
4L NC
50% VM
Pain
Denies
Denies
Abdomen 4/10
Abdomen 4/10
Abdomen 6/10
Abdomen 6/10
Capillary blood glucose
148 mg/dL (8.2 mmol/L)
136 mg/dL (7.6 mmol/L)
186 mg/dL (10.33 mmol/L)
205 mg/dL (11.39 mmol/L)
260 mg/dL (14.4 mmol/L)
Labs
RBC
4.8 × 1012/L
4.9 × 1012/L
4.8 × 1012/L
WBC
11,000/mm3 (11 109/L)
11,800/mm3 (11.8 × 109/L)
13,000/mm3 (13 × 109/L)
Platelet
110,000/mm3 (110 × 109/L)
100,000/ mm3 (100 × 109/L)
90,000/ mm3 (90 × 109/L)
BUN
72 mg/dL (25.71 mmol/L
79 mg/dL (28.21 mmol/L
Creatinine
4.8 × 1012/L
5.6 × 1012/L
APTT
33 sec
55 sec
INR
1.3
1.7
Lactate
3.5 mmol/L (31.53 mg/dL)
Arterial blood gas
pH
7.32
PaO2
65 mm Hg
PaCO2
55 mm Hg
HCO3−
20 mEq/L
Cultures
Peritoneal
Pending
Blood
Pending
4. What is the most likely explanation for this client’s condition?
5. What interventions are most appropriate at this time?
The client is transferred to the critical care unit. Intravenous resuscitation, mechanical ventilator support, antibiotics, and an insulin sliding scale are all implemented. The client is also medicated for pain, anxiety, and elevated temperature.
Time
2230
0200
0615
0730
0900
1000
Unit
MS
ICU
Vital signs
Temperature
100.9° F (38.3° C)
101.6° F (38.7° C)
102.3° F (39.1° C)
102.5° F (39.2° C)
101.3° F (38.5° C)
100.7° F (38.2° C)
Heart rate
88 beats/min
108 beats/min
116 beats/min
120 beats/min
110 beats/min
103 beats/min
Cardiac rhythm
NSR
ST
ST
ST
ST
ST
Blood pressure
120/60 mm Hg
108/57 mm Hg
95/51 mm Hg
90/48 mm Hg
92/50 mm Hg
88/46 mm Hg
MAP
64 mm Hg
60
CVP
4 mm Hg
6 mm Hg
Respiratory rate
22 breaths/min
24 breaths/min
28 breaths/min
28 breaths/min
16
16
O2 saturation
98%
92%
90%
91%
99%
99%
O2 device
2L NC
2L NC
4L NC
50% VM
Ventilator 100% O2
Ventilator 60% O2
Pain
Abdomen 4/10
Abdomen 4/10
Abdomen 6/10
Abdomen 6/10
0/10
0/10
Capillary blood glucose
136 mg/dL (7.6 mmol/L)
186 mg/dL (10.33 mmol/L)
205 mg/dL (11.39 mmol/L)
260 mg/dL (14.4 mmol/L)
210 mg/dL (11.7 mmol/L)
220 mg/dL (12.2 mmol/L)
Labs
RBC
4.9 × 1012/L
4.8 × 1012/L
WBC
11,800/mm3 (11.8 × 109/L)
13,000/mm3 (13 × 109/L)
Platelet
100,000/ mm3 (100 × 109/L)
90,000/mm3 (90 × 109/L)
BUN
79 mg/dL (28.21 mmol/L
Creatinine
5.6 × 1012/L
APTT
55 sec
INR
1.7
Lactate
3.5 mmol/L (31.53 mg/dL)
Arterial blood gas
pH
7.37
7.41
PaO2
65 mm Hg
86 mm Hg
PaCO2
42 mm Hg
44 mm Hg
HCO3−
20 mEq/L
16 mEq/L
Cultures
Peritoneal
Pending
Blood
Pending
6. Were the interventions effective? What signs indicate the client’s status is improving, declining, or unchanged?
7. What other interventions may be more effective?
Show transcribed image text4. The patient is most likely experiencing the MODS (Multiple organ Damage Syndrome) following septic Shock. The criteria for MODS are : 1. Presence of sepsis 2. 2 or more organ system damage Here, presence of Sepsis can be determined by following ob…View the full answerTranscribed image text: WBC wwwwww Platelet BUN Creatinine APTT INR 11,000/mm³ (11 x 10%/L) 110,000/mm³ (11 0 x 10%/L) 72 mg/dL (25.71 mmol/L 5.2 mg/dL 33 sec 1.3 11,800/mm³ (11. x 10%/L) 8 x 100,000/ mm³ (100 x 10⁹/L)