Case study: A 62-year-old female (Jessica Simpson) with a history of type 2 diabetes mellitus and hypertension was admitted to a trauma center following a Motor vehicle accident. Examination revealed blunt thoracic and abdominal trauma and a fractured right femur. The patient was dyspneic, tachycardic, hypotensive, and her skin was pale and cool. A right-sided hemothorax was managed by chest tube insertion. Imaging studies, along with exploratory surgery, revealed extensive trauma and bleeding within the abdominal cavity. Surgical management of the abdominal hemorrhage and the fractured femur resulted in significant improvement in vital signs, and the patient was moved to the ICU.
Four days later, JessicaRespiratory rate was 28 bpm, Systolic blood pressure 90 mm Hg and an altered GCS 12/15. Sepsis was immediately suspected, broad-spectrum IV antibiotic therapy was initiated, and blood cultures were obtained. During the following 24-48 hours, the patient experienced a decrease in urine output and an increase the serum creatinine and blood urea nitrogenin her Full blood count. Deteriorating blood gases necessitated intubation and mechanical ventilation. The patient was determined to be septic leading towards septic shock.
Clinical findings: Vital Signs on Fourth Day
Temperature: 40.1, Bp 90/40, RR 28,HR 136, patient became confused and showed signs of abdominal distension and rebound tenderness.
1. Define Sepsis and septic shock, discuss each criteria using the new 2016 guidelines.
2. Discuss the following terms qSOFA, (quick SOFA)and SOFA: Sequential [Sepsis-related] Organ Failure Assessment.
3. Identify the causative organisms commonly associated with sepsis?What could be the leading organism for Jessica, were it is situated in her body and why?
4. Examine and evaluate the following six topics in relation to the evidenced-based care requirements for a patient with septic shock (Journal Articles and recent texts only). Briefly discuss in your answer
• Antibiotics Therapy - Discuss IV antibiotics commonly used in Septic Patients with Gram Positive infections. Why are they used and how are they administered?
• IV Fluids - Including Rationale for Colloids/Crystalloids
• Blood Glucose control - Why we need strict BGL's
• Hemodynamic Monitoring - Central Venous pressure, what is it, how does it work, what does it measure?
• Ventilation management - How does Invasive Ventilation benefit septic patients, what is its purpose?
• Stress Ulcer Prophylaxis - Why do patients get stress ulcers and what does the literature say regarding new treatment and protocols?
5. Multi Organ Dysfunction Syndrome (MODS) is commonly associated with sepsis. Briefly explain the changes to the following systems when a patient is in MODS.
• Endocrine - Blood Glucose disorders
• Respiratory - ARDS
• Gastrointestinal - Paralytic ileus
• Renal - Acute Renal Failure (AKI)
• Cardiovascular - Hemodynamic instability
• Hematologic - DIC
6. Explain Vasopressors (Noradrenaline and Dobutamine) in relation to Jessica. Briefly explain what these drugs do, how they are administered and why Jessica has been prescribed them.
7. Complete the attached reflection? This is a part of your marking rubric, completion of the task will be included in the final mark.
What is Plagiarism?
Plagiarism means presenting the work or property of another person, as one's own without appropriate acknowledgement or referencing. It includes:
Copying of sentences, paragraphs or creative products (in whole or in part) which are the work of other persons without due acknowledgment.
Creative products include webpages, books, articles, theses, unpublished works, working papers, seminar and conferencepapers, internal reports, lecture notes or recordings, computer files, images or video.
Too closely paraphrasing sentences, paragraphs or themes without due acknowledgmentUsing another person's work/s (including words, music, creative or visual artifacts, computer source code, designs, problem solutions or ideas).
Submitting one's own previously assessed or published work for assessment or publicationelsewhere, without appropriate acknowledgement (self-plagiarism).
Plagiarism is a form of fraud and intellectual theft, and is a serious breach of academic integrity. Any forms of plagiarism in this case study may lead to failure of the unit.