Problem
Patient I: M.J. is a 40-year-old female who had a mastectomy 3 days ago and has started on chemotherapy for stage 4 breast cancer. M.J. has a central line, a urinary catheter, and the surgical incision. She is alert and oriented. Her skin is flushed and hot to touch. Her vitals are: T 104, HR 110, RR 30, B/P 106/66. Hemodynamics are CO 5, CVP 3. EKG is sinus tachycardia per the monitor.
Patient II: N.H. is a 49-year-old male who was admitted 24 hours ago with chest pain. He has a history of hypertension. He is overweight and exercises little. He was diagnosed with a large Inferior STEMI. N.H. is lethargic and short of breath. His skin is cool and clammy. N.H. has crackles bilaterally in lungs. His vitals are: T 99.2, HR 110 and thready, RR 30, B/P 106/66. EKG shows sinus tachycardia with frequent PVCs. Hemodynamics are CO 3, CVP 6, preload is high.
Patient III: K.M. is a 25-year-old Korean American male who was not wearing his seatbelt when he was the driver involved in a motor vehicle collision. The windshield was broken and K.M. was found face down, conscious, and moaning, 15 feet from his car. In the ER, a chest tube was placed which drained 500 ml bright red blood immediately. He is on a morphine drip. Left lung without sounds, right lung diminished. His vitals are: T98.5, HR 108, RR 20, B/P 80/60. EKG shows sinus tachycardia. Hemodynamics show: CO 4, CVP 2, preload is decreased.
Patient IV: P.T. is a 76-year-old man who is 16 hours post-op from a left broken hip. He was alert and oriented with 3/10 pain in hip. His lungs are clear bilaterally. His second dose of Ancef began 5 minutes ago. He is now restless and short of breath. He is complaining of itching. His vital signs are T99, HR 130, RR 36, B/P 70/40. No hemodynamics given.
Looking at the above four patients,
1) What type of shock is each patient experiencing?
2) What are the manifestations for each shock that led you to that answer?
3) What are your top three nursing priorities with rationale for each patient?
4) What stage of shock is each patient exhibiting? Give rationale for your answer.