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Branching_Exercise_Cardiac_Case 2

branching task study

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28 views5 pages

Branching_Exercise_Cardiac_Case 2

branching task study

Uploaded by

japheekim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Branching Exercise: Cardiac Case 2

Student’s name

Institution

Course

Professor’s name

Date
2

Branching Exercise: Cardiac Case 2


Admission Orders Template

Primary Diagnosis: Septic Shock secondary to Urinary Tract Infection (UTI)

Status/Condition: Critical

Code Status: Do Not Resuscitate (DNR), Full treatment at this time

Allergies: None known

Admit to Unit: Intensive Care Unit (ICU)

Activity Level: Bedrest with the head of the bed elevated to 30 degrees

Diet: NPO (Nothing by mouth) initially. Advance to clear liquids as tolerated based on
clinical status.

IV Fluids

 Start with Normal Saline (NS) bolus 30 mL/kg (approximately 2L) over the first 3
hours.
 After bolus, initiate maintenance fluids with Lactated Ringer’s at 100 mL/hour.
Adjust based on hemodynamic response and urine output.

Critical Drips

 Norepinephrine infusion: Initial dose should be 5 mcg/min and increase dose to


achieve target mean arterial pressure of greater than or equal to 65 mmHg.

Respiratory

 Oxygen via nasal cannula at 2 L/min. Titrate to maintain SpO2 ≥ 94%.


 If respiratory distress remains unchecked, proceed to Non Invasive Ventilation (NIV)
or invades to endotracheal intubation.

Medications
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 Antibiotics

o Broad-spectrum coverage: Piperacillin-tazobactam 3.375 g IV q6h


o Add Vancomycin 15 mg/kg IV q12h (based on renal function, monitor levels)
o Adjust antibiotics based on culture results.

 Insulin

o Regular insulin infusion to target glucose ≥ 140 and ≤ 180 mg/dL. Monitor
blood glucose q1h.

 Pain Management

o Acetaminophen 650 mg PO/PR q6h PRN mild pain.


o Morphine 2 mg IV q4h PRN moderate to severe pain.

 Antipyretic

o Acetaminophen as above for fever > 101°F.

 DVT Prophylaxis

o Enoxaparin 40 mg SC daily (if no contraindications).

Nursing Orders

 Obtain a baseline set of vitals followed by continuous monitoring with checks every
15 minutes until they become stable, then one hour apart.
 Strict intake and output monitoring. Notify provider if urine output < 0.5 mL/kg/hr.
 Daily weights.
 Skincare: Turn patient every 2 hours to prevent pressure ulcers.
 Blood glucose monitoring hourly until stable, then every 4-6 hours.
 Maintain urinary catheters for strict output monitoring.

Follow-Up Lab Tests

 Blood cultures x2 (from two different sites) before starting antibiotics.


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 Repeat lactate level q6h until normalized.


 CBC with differential q12h.
 BMP q6h to monitor renal function and electrolytes.
 ABG (arterial blood gas) if respiratory status worsens.

Diagnostic Testing

 Perform another chest X-ray after 24 hours to check for worsening pulmonary
symptoms.
 Echocardiogram, to look for septic cardiomyopathy, if the patient remains
hemodynamically unstable.

Consults

 Infectious Disease: This is for antibiotic prescription and management of the septic
patient.
 Nephrology: For possible Acute kidney injury and need for dialysis.
 Nutrition: For Total Parenteral Nutrition (TPN) recommendations if prolonged NPO.

Patient Education and Health Promotion

 Teach patient/family about septic shock and its outcome with necessary management.
 Emphasize periodic checking of the blood sugar level because of diabetes.
 Elaborate on an advanced care plan with the patient and family where appropriate.
Importance of monitoring glucose levels due to diabetes.
 Discuss advanced care planning with family and patient when clinically appropriate.

Discharge Planning and Required Follow-Up Care

 Once the patient is stable, switch antibiotics to intravenous-based according to the


culture result.
 Discuss and coordinate an outpatient follow up to follow up with primary care and
endocrinology preferably in a week after discharge.
 Inform patient about early signs of infection and its implications of contacting a
doctor.
 Closely discuss the problem of falls with an assessment of home safety.
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References

Dawn Carpenter, D. N. P. (2020). Sepsis. Clinical Journal of Oncology Nursing, 24(1), 99-
102. DOI: 10.1188/20.CJON.99-102

Dellinger, R. P., Rhodes, A., Evans, L., Alhazzani, W., Beale, R., Jaeschke, R., ... & Levy,
M. M. (2023). Surviving sepsis campaign. Critical care medicine, 51(4), 431-444. DOI:
10.1097/CCM.0000000000005804
Newman, E. A., Olsen, J. M., Bogle, B. D., Kranig, R., & Schiller, L. F. (2024). Improving
Diabetes Management Screening Adherence in a Free Clinic. The Journal for Nurse
Practitioners, 20(4), 104961. https://doi.org/10.1016/j.nurpra.2024.104961

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