TABIJE, ARVIE JAYSELLE P.

NCENH06

1.
A. What predisposed the patient to develop septic shock?
The circumstance indicated that when the patient is in the nursing home, one of the most
common causes of infection / microorganisms is the foley catheter in place. It has sediments
once removed, and the appearance was cloudy and greenish yellow in colour, which may
indicate urinary tract infection. It may be the involvement of that contraption that predisposed
the patient to urosepsis, which then led to septic shock.

B. What potential findings would suggest that the patient’s septic shock is worsening
from the point of admission?

The scientific data that provides the worsening of septic shock in clients includes the
following: tachypnea caused by elevated respiratory rate, low blood pressure called
hypotension, low o2 saturation, cloudy greenish urine, yellow infection, hyperglycemia.

C. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain

how the nurse should administer the medication. What nursing implications are related
to the usage of a vasoactive medication?

The healthcare professional can offer norepinephrine at the subcutaneoous or

intramuscular injection site as the first line treatment for septic shock, antibiotcs may also be
given.
Nursing considerations are:
*obtain history, including drug and known allergies,
*monitor vita signs
*observe cyanosis which may indicate ineffective tissue perfusion.
*it should not be given with normal saline solution.
*discard solution after 24hrs
*instruct patient to report symtoms like dizziness, nausea, addominal and chest pain.

D. Explain why the effectiveness of a vasoactive medication decreases as the septic

shock worsens. What treatment should the nurse anticipate to be obtained to help the
patient?
As the septic shock worsens, the efficiency of a vasoactive drug decreases due to how
the drugs are given to restore the perfusion force to a certain stage at which blood flow is
corrected to its outcome, and also to change the cellular metabolism used to clevate cardiac
output and administration of 02

E. Explain the importance for nutritional support for this patient and which type of
nutritional support should be provided?

To promote the delivery of nutrients to the systemic tissue, nutritional support can be
provided. To help increase the amount of oxygen-carryng cells in the body, foods high in iron
may be provided. It was also possible to order low-calori and low-carbohydrate. Nutritional
support will be provided primarily in the form of tpn and careful balance of essential nutrients,
electrolytes and fluids by hand in hand.

2.
a. Describe the pathophysiologic sequence of events seen with hypovolemic
shock.

hypovolemic shock:- hypovolemia is a condition in which the fluid content of our body
decrease it can be due to vomiting bleeding diarrhoea but when it comes to shock that is a life
threatening condition in which our body will have less fluid content to meet the enough
demand of organs for oxygen nutrients and removing the waste that may even cause death
in some cases due to ischemic changes in vital organs of our body

pathophysiology:-
1. due to etiological factors fluid level will decrease in our body
2. That will lead to death of mitochondria due to lack of oxygen
3. If mitochondria is dead then there won't be synthesis of ATP
4. Body will try to compensate this by the production of lactic acid and NDA
5. Hemodynamically our heart will try to pump as blood as it can to meet the
demand that leads to increase in heart rate and decrease in BP
6. If fluid restoration is not done timly this hypovolemia will convert in a shock that may lead
to into shock condition and the sympathetic system will get activated
7. This will lead to compromise in the blood supply of peripheral organs and it will lead to
ischemic changes in those areas.

b. What are the major goals of medical management in this patient?

Medical care's primary goal is to recover the amount lost due to haemorrhage.

c. What is the rationale for placing two large-bore IVs?

Large bore cannula can offer an excess amount of fluid to the patient as required, while
if we put a small bore cannula, it will give drop-by-drop fluid that does not meet the patient's
needs, and it will experience ischemic changes.
d. What are advantages of using 0.9% NS in this patient?

e. What is the rationale for placing the patient in a modified Trendelenburg position?
Modified trendlenberg position means only raised legs, leading to an improvement in the
cardiac output of the patient and bp