Question

please use complete sentences . no bulletpoint answer

Patient 1: 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 2: 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. He is lethargic and short of breath. His skin is cool and clammy. He 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 3: 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 4: 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,

• What type of shock is each patient experiencing?
• What are the manifestations for each shock that led you to that answer?
• What are your top three nursing priorities with rationale for each patient?
• What stage of shock is each patient exhibiting? Give rationale for your answer.

Answer 1

Patient 1 experience with septic shock..bacterial infection cause this condition..patient is with an indwelling catheter and drainage tube it made fungal infection..so patient experience high temperature,low blood pressure, increased venous capacitance and decrease venous return to the heart and decreased stroke volume and ejection fraction it made tachycardia. patient having low cardiac output and low CVP...
nursing priority for this patient
- controlling infection by providing antibiotics
-correcting hypoperfusion by crystalloids
-Administer vasoactive medication to correct the hemodynamic changes
Patient 2 experience with cardiogenic shock...patient administered with the complaint of chest pain and having a history of hypertension, obese and with low activity. patient having symptoms of shortness of breath, cool and clammy skin...vitals showing high heart rate and low blood pressure...there is frequent PVCs, low cardiac output and CVP is high.
Nursing priority
- Manage patient chest pain with pain medication.
-monitor hemodynamic to increase CO
-correct patient shortness of breath and low blood pressure
-correct hemodynamic by continuous monitoring
Patient is in stage 1 condition fluid loss up to 500ml
Patient
- Manage patient chest pain with pain medication
- Monitor hemodynamics to increase CO.
-correct patient shortness of breath and low blood pressure
patient in compensatory stage with low cardiac output and increased venous return and arterial blood pressure...
Patient 3 Experience hypovolemic shock with the symptoms profuse bleeding from a chest, diminished lung sound, less respiratory rate and blood pressure..Hemodynamic result shows less cardiac output and high CVP and sinus tachtcardia..
nursing priority
- administer oxygen to support tissue perfusion
- stop bleeding to prevent fluid loss by surgery
-correct hemodynamic by continuous monitoring
patient is in high stage 1 condition to fluid loss up to 500 ml
Patient 4 experience anaphylactic shock, because the patient experience more pain and restlessness and itching and shortness of breath and complaint of itching..his blood pressure is less and his heart rate is high and respirations high... The patient is on Ancef induced side effect an allergic reaction.
nursing priority
-stop the medication immediately
- administer antihistamines and epinephrine as a slow dose
-administer oxygen and monitor the vitals continuously