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Pancreatitis/Septic Shock Case Study

Pancreatitis/Septic Shock Case Study
The following case study is a short answer assignment. Consider the weight of marks as a guide to the detail required for each answer. Please copy the assignment questions and include your answer under each question. APA format. references for each question must be included with your work as well as a reference page at the end of your case study.

Total reference- 6
mandatory reference
Urden, L. D., Stacy, K. M., & Lough, M. E. (2018). Critical care nursing, diagnosis and management (8th ed.). St. Louis, Mo: Elsevier/Mosby. you can use 2017 edition as well.

Case Study Phase 1

Mr. Jones, a 57 year old male, arrived in the Emergency Department at 2030 hours and is complaining of acute abdominal pain. The pain has been present for approximately 2 days but has increased in severity over the last 8 hours. The pain is localized to the upper-left abdominal quadrant with some radiation to the back. Mr. Jones vomited four times in the last 8 hours with no relief from pain. Mr. Jones has a history of hypertension and heavy alcohol use. He is accompanied by his wife and children; two daughters and one son, all in their mid to late twenties.

Vital Signs: BP 131/77, HR 75 bpm, respirations 22 breaths/minute, temperature 38.1° Celsius.

At 0200 hours
Mr. Jones becomes anxious, unsettled and indicates that the pain in his abdomen has increased. Mr. Jones then proceeds to vomit 125 mL of brown liquid emesis.

Vital Signs:
BP 105/61, HR 95 bpm, respirations 28 breaths/minute, temperature 38.6 Celsius

Mr. Jones is admitted to the Critical Care Unit post diagnostic tests. Diagnosis is pancreatitis.


Questions
1. Discuss nursing priorities of the patient related to the clinical manifestations of pancreatitis. (4 marks)
2. What blood work and diagnostic tests would you expect to be ordered for Mr. Jones and why? (4 marks)



Case Study Phase 2
0400 hours
Mr. Jones is conscious but confused at times. Vital signs on the last assessment indicate a change in condition.

Vital Signs: BP 88/56, HR 120, respirations 30/minute, O2 sat 93% on 6 litres via nasal prongs, temperature 39.9° Celsius.
The most responsible physician (MRP) is notified and has not yet returned the call.

0500 hours
Just prior to the MRP’s arrival Mr. Jones becomes difficult to rouse.
Vital Signs: BP 78/52, HR 125 bpm, respirations 32 breaths/minute, O2 sat 89% via facemask,
temperature 36.9° Celsius, WBC is 32.

Mr. Jones receives a normal saline fluid bolus of 500 mL with little effect. He is started on vasopressors to maintain a BP systolic of 90 or a mean arterial pressure of 70. ABGS are drawn -- pH 7.48, PCO2 40 mm Hg, P02 84 mm Hg HC03- 30mmol/L and he is subsequently intubated and ventilated.


3. Interpret the arterial blood gases. (total 2 marks)
4. Explore the medical management for a patient diagnosed with septic shock? (4 marks)


Case Study Phase 3

The physician orders intra-abdominal pressure (IAP) monitoring for Mr. Jones. His IAP readings are 22 and 28 mm Hg on two separate measurements.


5. Intra-abdominal pressure monitoring three part question (total 5 marks)
a. Why might this patient require IAP monitoring? (one mark)
b. Explain how the gastrointestinal system might be impacted by increased intra-abdominal hypertension (IAH) and/or abdominal compartment syndrome (ACS). (2 marks)
c. Explain how the cardiac system might be impacted by increased intra-abdominal hypertension (IAH) and/or abdominal compartment syndrome (ACS). (2 marks)


6. Mr. Jones’s cardiac monitor alarms and the following cardiac rhythm is noted. Interpret the following cardiac rhythm and describe appropriate nursing priorities. (You may wish to refer to your Cardiac book. Urden, L. D., Stacy, K. M., & Lough, M. E. (2018). Critical care nursing, diagnosis and management (8th ed.). St. Louis, Mo: Elsevier/Mosby.
(1 mark for naming the rhythm, 2 marks for nursing priorities--total 3 marks.)



7.
Mr. Jones’s 12 Lead EKG shows the following (see below). Interpret this 12 Lead ECG using the 8 step systematic approach for ECG interpretation (from learning in the Cardiac Course text book Urden , stacy). Please include rhythm, axis, voltage, transition, BBB, hypertrophy, MI location and stage of MI.) (8 marks)



8.
Mr. Jones is remains hemodynamically unstable and his creatinine continues to rise. A decision is made to start continuous renal replacement therapy (CRRT). Discuss the nursing considerations for Mr. Jones. (5 marks)

9.
Mr. Jones condition is very poor and has a poor prognosis. Discuss key inter-professional priorities related to end-of-life care for Mr. Jones and his family. (You may wish to refer to the End-of-Life section in your Critical Care text book urden stacey.)
(5 marks)

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