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Management of Mr. Ahmed’s Clinical Deterioration, Student’s name: Deema…
Management of Mr. Ahmed’s Clinical Deterioration
Respiratory Failure
Lab results
Respiratory Acidosis (pH: 7.28, PaCO_2: 50 mmHg), Hypoxemia (PaO_2: 55 mmHg).
Nursing diagnoses
Impaired Gas Exchange related to alveolar-capillary membrane changes (Pneumonia).
Assessment findings
RR: 32/min, SpO_2: 84% (despite 6L O_2), severe dyspnea, use of accessory muscles.
Interventions:
High-Fowler’s position, escalate oxygen therapy (consider CPAP/BIPAP), frequent lung auscultation.
Rationale
To maximize lung expansion and maintain arterial oxygenation to prevent cellular hypoxia
Acute Kidney Injury
Nursing diagnosis
Risk for Electrolyte Imbalance (Hyperkalemia) and Fluid Volume Excess..
Intervention
Strict I/O monitoring, administer Insulin + Dextrose (to shift K^+ into cells), monitor ECG for peaked T-waves.
Lab results
Creatinine: 2.8 mg/dL, BUN: 45 mg/dL, Potassium (K^+): 5.8 mmol/L.
Rationale
To prevent life-threatening cardiac arrhythmias caused by high potassium and manage waste buildup.
Assessment findings
Urine output < 20 mL/hr (Oliguria), history of CKD Stage 3.
Shock
Nursing diagnosis
Ineffective Peripheral Tissue Perfusion related to systemic infection and vasodilation.
Intervention
Administer IV Fluids (bolus), initiate Norepinephrine as ordered, monitor MAP (Mean Arterial Pressure).
Lab results
Elevated Lactate (4.5 mmol/L), WBC: 18,000/mm³.
Assessment findings
BP: 86/52 mmHg, HR: 128 bpm, cool/clammy skin, delayed capillary refill, confusion/lethargy.
Rational
To restore circulating blood volume and maintain vital organ perfusion (especially the brain and heart).
History impact:
Pre-existing conditions (Type 2 DM, Hypertension, and CKD Stage 3) acted as 'Predisposing Factors' that impaired Mr. Ahmed’s immune response to pneumonia. This underlying frailty accelerated the progression from localized infection to Systemic Inflammatory Response (Sepsis), rapidly precipitating Acute Kidney Injury (AKI) and Septic Shock."
Student’s name:
Deema Thammer 444202495
Yara Alkhulaifi 444202477
Reyof Alomosh 444202512