Case Study, Chapter 14, Shock and Multiple Organ Dysfunction Syndrome

1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. 

1. What predisposed the patient to develop septic shock?
2. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?
3. 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?
4. 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?
5. Explain the importance for nutritional support for this patient and which type of nutritional support should be provided?

2. Carlos Adams was involved in a motor vehicle accident and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.

The following orders are written for the patient:

Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line

Obtain complete blood count, serum electrolytes

Oxygen at 2 L/min via nasal cannula

Type and cross for 4 units of blood

Flat plate of the abdomen STAT

(Learning Objectives 1, 4, and5)

1. Describe the pathophysiologic sequence of events seen with hypovolemic shock.
2. What are the major goals of medical management in this patient?
3. What is the rationale for placing two large-bore IVs?
4. What are advantages of using 0.9% NS in this patient?
5. What is the rationale for placing the patient in a modified Trendelenburg position?

ORGINAL only! Must follow instructions and answer all questions! DO NOT TRY TO FAKE IT! 

WEB For DATA

 https://www.healthypeople.gov/2020/topics-objectives

1. Discuss aspects of a health concern not being addressed despite the efforts of services and partnerships involved and describe the ultimate outcome(s) or goal(s) from Healthy People 2020 relating to that specific health concern.

Answering the following questions may assist in data interpretation:

• What similarities are apparent between the data that were gathered and the data that were generated?
• What differences are apparent between the data that were gathered and the data that were generated?
• What are the weakness and strengths of this community?
• In what areas is improvement needed in this community?

Respond to your colleagues, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

At least 2 references in each peer responses!

In 2009, Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Reinvestment and Recovery Act, so healthcare facilities will adopt and incorporate meaningful use of health information technology (IT). At first only a small number of hospitals had any kind of electronic health records (EHR), but RAND Corporation studies showed success, which motivated other companies to follow (Reider, 2018). However, RAND studies were not accurate predictors of widespread success due to unintended consequences, safety, and efficiency concerns (Reider, 2018).

Hackers come from all across the globe. In fact, the Pentagon is a very common target for hackers because it is the Defense Department. Not long ago 30,000 plus Pentagon employees’ personal information was exposed due to contractor breach (Martindale, 2018).   Naturally Pentagon officials downplayed the event, and it makes one wonder how much national security information was exposed to foreign powers due to data leaks (Martindale, 2018). 

Hospitals are also common targets due to multitudes of clients containing personal information that can be sold on the Dark Web to hackers around the world, and antiquated software making them vulnerable (Garrity, 2019).  In fact, where I work, Winter Haven Hospital is still using Windows 7 as an operating system, which is not even supported by Microsoft anymore.

With these issues in mind, imagine the potential if hackers had to access prescriber accounts, and prescriptions, especially narcotics. I do not think many hackers have thought of this, because they are more apt to steal from bank accounts and credit cards. Considering the opioid epidemic and the street value of narcotics, it surprises me this sort of hacking is not more commonplace. This indicates to me that most hackers are not sophisticated and lack creativity.  However, be assured they are out there, only not as common; the sophisticated hacker is more attracted to infrastructure manipulation instead due to varients of Stuxnet malware.  Stuxnet would be too difficult to discuss here, but it illustrates how powerful computer hacking can be when it can take down electrical grids.  Computer technology, indeed, released a Pandora’s box.   

This paper will have an 8-page narrative (8 pages maximum – 5 point deduction for over page limit) plus a title page, abstract page, and reference list. 

You must use a minimum of four original research articles for your paper.

The purpose is to write a review of the literature on to answer your PICOT question using original research evidence. Discuss how this health problem is applicable in both the United States and a non-USA country, and appraise four original research studies on this topic.

This is a scholarly paper, written as if it was a “Review of the Literature” article published in a nursing journal. Select articles published within the past five years (2014 to present).
Do not use a non-peer review journal. Do not use a literature review article or systematic review article or clinical protocols as one of your articles. At least TWO of the four original research report articles MUST BE authored by nurses and published in a peer-reviewed nursing journal.  At least ONE of the two nursing research studies must address nursing practice in a non-USA country.

• Page 1: Title page Create a title for your paper. Refer to your APA Manual.
• Page 2: Abstract The abstract should open with a sentence that will serve as an introduction to and purpose of the paper. Then describe what is in each part of the paper. An abstract is usually a brief outline of the contents of the paper that typically does not exceed 250 words. At the end of the abstract place the phrase Key Words, and denote 3-4 keywords that would describe your paper (as for publication and indexing in CINAHL or PubMed).
• Pages 3-11: Narrative
  
  • Heading: Significance and Background: Start the paper with a short paragraph that introduces the health problem in your PICOT question. (Approximately ½-page).
  • Heading: Purpose: Clearly define the global health problem, and discuss why it is important for nursing (why you are discussing this topic).  Discuss what is known about this problem in the United States and in a non-USA country.  For example, if the focus is adult hypertension, discuss guidelines for defining hypertension in the US and in a non-USA country.  (Approximately 1 page).
  • Heading: Methods: Discuss the methods used to select the following research studies.
    Next use the subheading:
    • Sub-headings: Study #1: Nursing research Study in the USA (Approximately 1½ pages)
    • Sub-headings: Study #2: Nursing Research Study Non-USA (Approximately 1½ pages)
    • Sub-headings: Study #3: Nursing Research Study USA or Non-USA (Approximately 1½ pages)
    • Sub-headings: Study #4: Nursing Research Study USA or Non-USA (Approximately 1½ pages)
  • Heading: Conclusion.  Summarize the key points from your discussion. How would you translate (use) the new evidence found from your appraisals to change practice or answer your PICOT question? (Approximately 1 page).
• Page 12+: Reference page: Refer to your APA Manual.

This review is a scholarly paper in APA format and with at least three APA references (two articles and textbook), cited both in the text and the reference page.

No plagiarism please.  

Will need minimum of 300 words, APA Style, double spaced, times new roman, font 12, and Include: (3 references within years 2015-2018) with intext citations. 

Topic 1: Access to Primary Care for All?

To what extent is primary care accessible to all populations in this country?

Answer the following in your discussion:

 Use the below headings while answering the questions.   

• What are the main barriers to accessing primary care?
• What is being done to solve this problem?
• What else can be done?
• How are NPs making a difference?
• What does the literature say about the NPs ability to provide primary care?
• What does the literature report as comparisons between primary care provided by an NP versus a physician?