Transition - Exam 3 Sepsis

Question 1

Case study S&S

Answer 1

74 year old

generalized weakness and fatigue for 2 days

Hx: DM2, CAB, CABG, HTN, CHF

Meds: ASA, metformin, Lasix, lisinopril, metoprolol

VS
T: 101
HR: 60
RR: 24
BP: 90/40
MAP: 57
O2: 95%

Question 2

What can keep a patient from becoming Tachycardic?

Answer 2

Pacer is set low

meds like metoprolol

their bodies may not be able to raise the heart to compensate for the necessary increased cardiac output

So easy to miss

be aware that if a patient is febrile and hypotensive, they should be tachycardic

Question 3

Calculate cardiac output

Answer 3

heart rate x stroke volume

Question 4

Case study patient assessment

Answer 4

fatigue

regular rate and rhythm

diminished in bilateral bases

abd: tender to light palpation, dysuria, decreased appetit, nausea, no vomiting

Question 5

What can cause fatigue in an older person

Answer 5

malnutrition

depression

medication

blood glucose

cancer

lack of sleep

there are a thousand things that could cause it

therefore, it is important to ask more questions about fatigue (do you have the energy to do ADL’s, etc.)

Question 6

Orders that can be delegated and what are priorities

Answer 6

Delegated tasks:
glucose
pulse ox
cardiac monitor
get UA for culture
IVx2
nasal swab

Priorities:
cultures
blood work (CBC, CMP, lactic)
Cardiac monitor
Pulse ox
bolus going (2L LR)sugar
sugar
acetaminophen, or Toradol if NPO

why wait until ready for CT: make sure their stable, get the renal panel back

Question 7

What med shouldn’t be given with contrast die

Answer 7

Metformin

Black box warning, lactic acidosis

Question 8

What type of shock is septic

Answer 8

distributive

other types:
anaphylactic
neurogenic
cardiogenic

Question 9

what other kind of shock can this person have

Answer 9

hypovolemic

(especially if has 3+ pitting edema - third spacing the fluid, so she has fluid, but she doesn’t have fluid)

Question 10

What can give the patient while giving fluid to ensure that the fluid is going to the right place and not leak out into the third space

Answer 10

albumin

Question 11

Lactic acid

Answer 11

over 8 is very significant

lactic acid is a significant indicator of mortality

Normal is: ?????????

Question 12

What are red flag assessments for this patient

Answer 12

WBC is 18k (infx)
Lactic acid 4.4
Anion gap 20 (acidosis)
Hgb 16 (dehyd)
Hct 48 (dehyd)
Neutrophils 12 (infx)
Nitrites urine (?????)
gravity 1.10 (dehyd)
urine glucose 500
bacteria 3+ urine
epithelial cells 3.8

Question 13

What is one of the first things you ask when responding to an emergency or rapid response

Answer 13

Code status