A 79-year-old male patient with a past medical history of controlled hypertension, hyperlipidemia, previous heavy alcohol use, and mild cognitive impairment presented to the emergency department with an acute onset of 10/10 abdominal pain in the past 24 hours. His vital signs stable (VSS) in the emergency department were as follows:
Blood pressure (B/P) 75/50 mm Hg
Heart Rate (HR) 130
Respiratory Rate (RR) 22
Temperature 38.3 Celsius
Upon a physical exam, the patient was found to have the following:
Drowsiness and confusion
Fingers and toes were cold with cyanosis
Abdomen was distended and tense
Patient was given one liter of crystalloid and sent to have a CT of the abdomen and pelvis. The CT revealed extraluminal gas and suspected extraluminal fecal matter consistent with a perforated sigmoid colon. Patient was started on broad spectrum antibiotics and taken for emergent laparotomy. During the procedure, gross fecal peritonitis from the perforated sigmoid colon was confirmed. The patient underwent a resection of the sigmoid colon with closure of the rectal stump and creation of an end colostomy (Hartmann’s procedure). The procedure was completed with an extensive peritoneal toilet and washout. During surgery, the patient received a total of four liters of crystalloid and required blood pressure support with norepinephrine.
On arrival to the ICU, the patient was intubated and sedated from surgery. The patient currently has no infusions running except Lactated Ringer (LR) @ 500 ml/hr. It is noted on arrival the patient’s B/P is 88/52, HR 125, central venous pressure (CVP) of 6 mm HG, and temperature is 35.6 C. The arterial blood gases test (ABT) reveals the following results: pH 7.31, PaCO2 39, HCO3 17, PaO2 85 mm Hg. The results of the labs revealed: WBC 24 with 8% bands, Potassium 4, Sodium 130, Creatine 1.8, Lactate 5, Blood glucose 175, AST 100, ALT 73, Platelets 150, Hgb 7.3, HCT 38%. Blood cultures were performed and are pending.
As the AGACNP on call for the ICU team, you are notified that a new patient arrived at the ICU and are asked to come and evaluate.
Note: Case study was modified from a previous case study in the New England Journal of Medicine.
Assignment Guidelines
Prepare a written analysis of the case study that answers the following questions:
What is sepsis? What are the diagnostic criteria for sepsis? What is the incidence of sepsis in hospitalized patients? What is the mortality rate of patients with sepsis?
How would you screen a patient for sepsis?
What are the differential diagnoses for this patient?
What information in the case study supports a diagnosis of sepsis?
Is there any additional testing you would consider ordering?
Is there any additional information you need to obtain in order to care for this patient?
What type of pharmacologic interventions (antibiotics, pressors, fluids, etc.) would you anticipate using in this patient. Please include dosages and monitoring parameters.
What are the potential short-term and long-term effects of sepsis?
Support your explanation with at least three credible references (not older than three years) cited in APA 7th edition format:
No more than one reference from websites (Appropriate websites are only those that end in .org, .gov, or .edu.)
At least one research article
At least one professional nursing journal article