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Medical-Surgical Nursing

Chapter 23

Medical-Surgical NursingChapter 23

Chapter 23

Unfolding Case Study

1.
a
Rationale: IV resuscitation is an immediate need to increase tissue perfusion and reverse hypovolemia. Administration of vasopressors constrict the blood vessels and increase tissue perfusion. Obtaining a CXR is an early diagnostic test that can help diagnose a pulmonary infection consistent with sepsis. The hemodynamic measurements are obtained as clinically indicated. IV crystalloids are recommended to administer because they contain nonproteins, minerals, salts, and sugars, and are responsible for maintenance of adequate F&E balance. They are also usually the first choice for IV solution recommended.
2.
a, c, e
Rationale: Anuria, or absence of urine output, is an indication of organ failure in septic shock. MODS result when two or more organs are dysfunctional as the result of having progressive sepsis. An elevated lactic acid of > 4mm/L is indicative of septic shock. With the value rising, the lactic acid continues to demonstrate the progression of septic shock and MODS. Metabolic acidosis is a physiologic disturbance defined by a pH less than 7.35 and a low HCO3 level. Metabolic acidosis can develop if sepsis progresses and there are too many acids in the blood, which decreases the bicarbonate. Respiratory acidosis can be reversed early in the sepsis progression.
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