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. (Learning Objectives 6 and 7)

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?

 

Create a 6-8 slide presentation (with detailed speaker’s notes) on how you would select, foster collaboration among, and educate a team dedicated to solving a diversity issue.

Introduction

Assessments 1 and 2 are scenario-based, so you must complete them in the order in which they are presented.

Finding, organizing, and motivating teams is a key leadership skill as is the ability to communicate and present information.

Overview

In this assessment, you will continue your work on the project by creating a 5–7 slide PowerPoint presentation for the diversity project kickoff meeting.

Preparation

• View the PowerPoint Presentation Instructions for guidelines and hints for an effective presentation.
• Download the PowerPoint Template found in the resources and use it to complete this assessment.

The following resources are required to complete the assessment.

• PowerPoint Template [PPTX]. Use this template to complete your presentation for this week’s assessment.

Scenario

Imagine that Lynette follows up with you in an e-mail shortly after reading your views on leadership and collaboration:

Hi,
Thanks for sending me your thoughts last week on the diversity issue at the clinic. Your next step is to select a team of professionals who can help you in this project and prepare an introduction of the project for a first meeting with them.
I want you to prepare a presentation to serve as a brief, but substantive introduction for the first meeting with a group of 4–5 members who will participate on the committee tasked with addressing the diversity issue. Once I review more information about the proposed team I can help you with the recruitment. The presentation should be 5–7 minutes and use 6–8 slides with detailed speaker’s notes so I can understand your approach. Not a lot of time or space, so keep things pretty high level. Do the following:
Briefly outline the project goals and highlight 2–3 of the initial priorities to be addressed by the group. Also, explain why they are important.
Explain the composition of the team and why you chose them. Note that you will not know the exact individuals yet, but assume we will recruit the people with the desired qualities and characteristics that you outline in the presentation. Consider the following:Include a group of professionals you believe can help define the problem and ultimately make recommendations on how to address it.
Make sure each member is either trained in, sensitive to, or has experience with the concept of workplace diversity.
Give some thought to having some members from outside the organization.
Provide member profiles: their diversity, qualifications, experience, internal versus external, and so forth.
Explain your role and describe how the committee will work together and achieve effective interprofessional collaboration.Describe how the group will communicate. How and when they will meet.
Describe how ideas will be shared and decisions made.
Describe roles, group function, and structure.
Describe the basic characteristics of a diverse workplace.
Provide a convincing argument regarding the benefits of a diverse workforce using support from current research.Thanks,
Lynette

Instructions

Create a 6–8 slide presentation in response to the content defined in the above scenario and submit it in the courseroom.

Presentation Guidelines

• Length: 5–7 PowerPoint slides (not including title slide) that would accompany an approximately 5-minute oral presentation.
• Notes: Prepare detailed speaker’s notes describing items on each slide so that the viewer can accurately interpret the deeper meanings and intentions that would have been conveyed orally. Support your claims, arguments, and conclusions with credible evidence from 2–3 current, scholarly or professional sources.
• Visuals: Create visuals that are easily read and interpreted. Use colors, fonts, and formatting and other design principles that make the information clear and generally add to the aesthetic of the presentation.

 Instructions:

 Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (7th ed.)

·      Minimum of two (2) references, not older than 2015.

Nursing Research:

QD1.  

Discuss the topic you are planning to use for the clinical practice experience. Create a PICOT research question that will guide the practice experience.

*See the attachment for a PICOT selection guidelines

 QD2. Discuss the purpose of the literature review and which topics are you going to search for your topic? Discuss also what are the challenges that nurses are facing today when they have to do a literature review?

Pathophysiology:

 QD1. Fifty-four–year-old Fred is complaining of a headache that started about 2 weeks ago. For the past 2 days, the headache has increased in severity, and he is photophobic and has uncial rigidity and projectile vomiting. CT scan results show an arteriovenous malformation in the basal artery and a small hemorrhagic bleed in the middle meningeal artery

1.How is the concept “disorders of brain function” related to Fred’s presenting symptoms?

2.What aspects of cerebral circulation would come into play in Fred’s case?

 

QD2. A 32-year-old mother is driving her 10-year-old daughter home from the store when their van is stuck by a drunk driver, causing their vehicle to careen over a bridge into the water below. The daughter’s arm is caught underneath a crumpled seat. Acting quickly, the mother is able to move the entire 400-lb seat to free her daughter’s arm and take her to safety. They are taken to a local emergency room and treated for minor injuries.

1. When the mother arrives to the ER, she is perplexed at how she was able to move the seat. She tells you she can barely lift 50 lb at home. She asks you how it was possible for her to move such a tremendous amount. How would you respond?
2. The woman asks you how to further explain to her “how all levels of the brain work together to perform such a complex movement”?

  

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

Review this week’s interactive media pieces and select one to focus on for this Discussion.

Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

Note:

1 page

APA format

3 references not more than 5 years