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Septic Shock - Coggle Diagram
Septic Shock
23 y/o female
- Hispanic family based
- Spanish speaking only family
- Nuclear family based
- in home health care provider
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Assessment:
- C/C decreased temperature and HA x 1 day
- Initial --
- GCS 15
- no respiratory distress
- Temperature 32.3 degrees C
- BP 101/70
- HR 88 NSR
- Foley cath present- yellow & clear urine, w/ no odor
- lung sounds clear
- Repeat -- after 3 L NS bolus
- GCS 15
- no respiratory distress
- Temperature 34.6
- BP 112/64
- HR 86 NSR
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Medications:
- essential medications to treat septicemia
- aids in shock treatment
Broad spectrum antibiotic that was ordered by MD due to suspicion of infection based complications. MD ordered a broad base antibiotic as the initial tx until blood cultures return. The antibiotic ill then be modified depending on the culture results.
NS bolus:
- 1000 mL (repeat based on BP per MD order)
MD ordered to rehydrate the pt. Pt was given larger boluses in order to increase lowered BP. 3 boluses given via pressure bag in order to increase pt's BP, which remained low and had little to no effect.
MD ordered in order to tx pt's complaint of HA upon arrival. NSAID analgesic that inhibits the inflammatory response and reduces inflammation and relieves pain.
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The formation of stable and loving relationships and how successful are the relationships. (Van Nieuwenhove, L., & De Wever, B. 2023)
Even though the pt is older, due to the TBI and current cognitive state, her mental state is that of a younger child. The need for further establishment of her existing relationships within her home/family circle is important since she is reliant upon others for her total care needs. This concept also applies to the pt since beyond her family relationships, she is building new relationships with her care team. These relationships are significant since again she is reliant on them for basic essentials of living surrounding the care they provide her.
Ancillary evaluations:
- Laboratory blood work
- Laboratory urinalysis
- blood cultures
- tracheal aspiration culture
CBC:
Frequent basic blood assessment that obtain diagnostic information regarding body systems and functions. (Fischbach, F. & Fischbach, M. 2018)
- WBC -- 13.6 (elevated)
- RBC -- 5.29 (elevated)
- HGB --15.2
- HCT -- 44.2%
- RDW -- 16.9% (elevated)
- PLT -- 217
UA:
Urine assessed for presence of pathogens causing infection. (Fischbach, F. & Fischbach, M. 2018)
- There were trace amounts of bacteria. UA did not indicate excessive amounts of bacteria causing infection. MD stated source of infection was elsewhere.
Blood cultures:
Blood exam to assess for the presence of pathogens causing infection. (Fischbach, F. & Fischbach, M. 2018)
- Cultures take time in order to grow specific bacteria. Results were still pending.
Tracheal aspiration culture:
Sputum obtained when suspecting respiratory tract infections. (Fischbach, F. & Fischbach, M. 2018)
- RT was unable to obtain culture sample from the pt. No mucus was present in the tracheal tube even after instilling NS to moisten.
Implementation Plan:
Goal:
Pt will maintain a BP above 110 systolic during and after fluid resuscitation STAT until transfer to higher level of care.
Objective:
Pt will receive a rapid infusion, via pressure bag, of LR fluids to maintain BP during septic workup in the ED.
Intervention:
Ensuring adequate fluid administration with monitoring of vital signs and lung sounds for any significant complications until transfer to higher level of care.
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