Early Goal-Directed Resuscitation

The early intravenous fluid administration for resuscitation of the critically ill hypovolemic patient is the corner stone of shock therapy (Kruemer & Ensor 2012). The Surviving Sepsis recommends early optimization in the first six hours, followed with fluid challenges in the case of persistent hypo

Resuscitation in the ED. Rapid Quantitative resuscitation is recommended in all patients with tissue hypoperfusion. According to the SSC guidelines, the goals of fluid resuscitation include a CVP of 8-12 mm Hg, a MAP > 65 mm Hg, urine

2.2 In the earlier stages individual’s may be able to express pain through verbal and non verbal communication, together the carer could recognise that they are in pain and a rough area of where this is coming from. This will enable carers to be able to provide medical intervention if needed I.e. Administering PRN paracetamol or seeking medical attention from a nurse/ doctor when required.

Sepsis is a severe complication of an inflammatory response due to various pathogens with the mortality rates ranging anywhere between twenty-five to thirty percent (Epstein, Dantes, Magill, & Fiore, 2016). Sepsis can be precipitated by various infections including some of the most common ones, like urinary tract infections, pneumonia, and cellulitis. An early sepsis recognition is crucial in improving patient outcomes and decreasing mortality rate. Thus, it is very important for a health care provider to start the necessary diagnostics and implementation of fluids, antibiotics, vasopressors and other necessary treatments based on the

Hadjiliadis, D. (2012, January 2). Septic Shock. New York Times. Retrieved November 23, 2013, from http://www.nytimes.com/health/guides/dise

Francis, M., Rich, T., Williamson, T., & Peterson, D. (2010). Effect of an emergency department

Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),

This scenario helped me understand the pathophysiologic process of pneumonia and decompensated shock and how they could possibly manifest in children. Since in our first simulation of the semester we learned different methods of assisting a patient in improving his/her breathing status I was better able to intervene and know what to do to improve our patient’s breathing status. However, I have never been exposed to a patient undergoing decompensated shock. Therefore, this time I was able to learn what to do in case a situation as such arises in the future on a real patient. Shock can be due to several reasons such as bleeding or severe dehydration. However, it was apparent in this case that the patient was not externally bleeding, but she was

1-Who is an attorney in advance directive? What should he do? What should be his relationship with the patient? P1.

Septic shock is a subset of severe sepsis and was defined as “sepsis-induced hypotension persisting despite adequate fluid resusci- tation” (see Fig. 12.1). While the quantity of fluid that qualifies as “adequate fluid resuscitation” is controversial, we believe septic shock is best defined as a “mean arterial pressure (MAP) less than 65 mmHg after a fluid challenge of 20 mL/Kg body weight (given 30–60 minutes) in patients with sepsis and in the absence of other causes for hypotension” (also see Chap. 14). According to the ACCP/SCCM defini- tions, three stages in the hierarchy of the host’s response to infection were recognized, namely, sepsis, severe sepsis and septic shock, with sepsis having the best prognosis and septic shock the worst. While the use of the SIRS criteria to define sepsis is some- what controversial [3–6], many consider sepsis to be best defined as the “systemic response to infection with the presence of some degree of organ dysfunction”

Sepsis is a phenomenon in which an infective agent results in a physiological response in excess of the pathogenic insult. Efforts to define and investigate sepsis have been somewhat fruitful in elucidating the nuances of this phenomenon. Yet, gaps exist in identifying and investigating sepsis. Recent efforts have streamlined the definition and identification criteria of sepsis and septic shock. The treatment of sepsis is based on the elements of identification, hemodynamic interventions (fluid and vasopressor resuscitation), and antimicrobial therapy/source control. A two-tiered approach employing the qSOFA (Quick Sepsis-Related Organ Failure Assessment) and SOFA (Sepsis-Related Organ Failure Assessment) tools now provide a succinct criteria for sepsis and septic shock. Various approaches may be taken to assess fluid responsiveness, provide fluid resuscitation, and determine the need for vasopressor support. Early, aggressive antimicrobial therapy is essential to the treatment of sepsis. Obtaining source control and considering early surgical

Intravenous (IV) fluids were bolusing; however, when blood pressure was only obtainable manually and revealed that her blood pressure was 74/34, the decision was made to send the patient to the intensive care unit (ICU). There, coagulation studies revealed an elevated PT, PTT, D-dimer, and a decreased fibrinogen count. She received a peripherally inserted central catheter (PICC), a transfusion of two units of packed red blood cells (PRBCs), as well as cryoprecipitate therapy during her treatment in the ICU.

Per office visit notes dated 8/7/2016, patient presents for a follow up for neck pain, left elbow pain and bilateral wrist pain. Current medications include Naprosyn EC 500 mg, Tramadol 50 mg, Lyrica 50 mg and Levora-28 0.15/0.03 mg. Patient was recommended retrial of Celexa for her depressed mood related to her chronic

The results showed that the use of SUP in patients with severe sepsis did not have a significantly decreased risk of GI bleeding or an increased risk of CDI. However, the use of SUP in critically ill patients had an increased risk of HAP. As a result, SUP might be unnecessary for patients with severe sepsis. Although there is extensive research concerning the effectiveness of pharmacologic agents of SUP, this study illustrates that prophylactic SUP may lead to adverse outcomes. Nurses can benefit from this practice because it can help prevent complications like HAP when treating patients with severe sepsis.

Understanding medications and relating them to a patient’s care is a legal requirement for the RN. Morphine an opioid analgesic is for moderate to severe pain which has respiratory suppression as the main side effect, naloxone and resuscitation equipment should be close by to reverse this effect. (Tiziani, 2013). Glyceryl trinitrate (GTN) used for chest pain, works by causing vasodilation to the blood vessels therefore increasing blood flow to the heart, the risk of repeated doses may lead to hypotension (Tiziani, 2013). Aspirin is used as an antiplatelet for Mr Jones and given for a suspected myocardial infarction (MI) due to plaque that may have broken away within a coronary artery and formed a blood clot that leads to a blockage (Tiziani,