Icu Case Presentation: Group 1B
Icu Case Presentation: Group 1B
PRESENTATION
GROUP 1B
Labaco, Nicanor
Navarro, Erby May
Kusain, Jaya Normina
Ranes, Jayne Kathleen
Labanero, Kristine Hope
Ongoing Diagnosis:
SEPTIC SHOCK SECONDARY
TO ASCENDING
CHOLANGITIS s/p ERCP
Endoscopic retrograde
cholangiopancreatography
Biographic
Data:
Name: ABCDEFU
Age: 58 years old
Gender: Female
Date of Birth: January 1, 1964
Address: Labangal, Gensan City
Religion: Roman Catholic
Nationality: Filipino
Informants: Patient and sister (good
reliability)
Chief Complain: Abdominal Pain
History of Present Illness:
• Hypertension • Annuled
• Asthma • Smoker
• Occasional alcohol beverage drinker
• Usual diet: prefers meat and fatty
food, soda
Assessment:
• CC: Abdominal pain (epigastric, RUQ areas)
• Accompanied by chills and fever
• Past medical history of cholecystectomy with biliary stent
insertion and replacement (2005 and 2007)
• Acute onset
• Hypertensive, smoker
• Overweight (BMI=29.4)
• At the ER: febrile and hypotensive
• Icteric sclerae and jaundiced
• Epigastric and RUQ tenderness
Assessment:
• CNS – Off midazolam; GCS 15
• CVS – off levophed (11/30); noted atrial fibrillation (11/30);
ECG (12/1): left atrial enlargement, leftward deviation
• Respiratory – weaning
• GI – NGT (supportan-1200kcal/day); jaundiced
• GU – Creatinine=16.83mg/dl GFR of 38.4 (CKD Stage 3)
• Hematology – anemia (Hb=9.5 “L”; Hct=28 “L”)
• Infectious – on ampicillin and ceftriaxone day 1
Septic Shock
Septic shock is a severe complication of sepsis that can include very
low blood pressure, an altered mental state, and organ dysfunction.
It has a hospital mortality rate of 30–50 percent, making it very
dangerous if not treated quickly.
Hair Evenness of growth Thickness or Not Applicable Not Applicable Normal Findings
No history of any over the scalp: Evenly thinness of
hair disease distributed hair: Thick ( Dillon Health Assessment, 2006).
hair
Texture & oiliness:
Silky and resilient hair
Presence of infections
or infestations: No
infection or infestation
Body Parts & Inspection Palpation Percussion Auscultation Interpretation
History
Head Size, shape and symmetry: Rounded, Not Applicable Not Applicable Not Applicable Normal Findings (Dillon, 2006).
smooth skull contour .
Absence of nodules and masses
Facial features: Symmetric/ slightly
asymmetric
Symmetry of facial movements:
Symmetric facial moveents
Ears Auricles (color, symmetry, and position): Not Applicable Not Applicable Not Applicable Impaired excretion of urinary
Grayish-bronze color (sallow); pigments (urochromes) as well as the
symmetrical; aligned with outer canthus presence of anemia due to lack of
of eye erythropoetin being produced
(Pietrangelo, 2019)..
Client’s response to normal voice tones:
normal voice tone audible
Eyes Sclera: Icteric Icteric sclera refers to the yellowing
Palpebral conjunctiva: Pink of the white area of your eye, which
- Patient has history of is a sign of jaundice. Jaundice can be
cholecystectomy. caused by a number of illnesses,
including disorders with the liver,
- Patient is anemic pancreas, or gallbladder (Griff, 2020).
(Hb=9.5; Hct=28)
Body Parts & Inspection Palpation Percussion Auscultation Interpretation
History
Mouth and Throat Outer and inner lips for Not Applicable Not Applicable Not Applicable Due to excessive
symmetry of contour, dryness, decrease
color and texture: hydration and impaired
Pallor, fissures and circulation(Dillon, 2006).
dryness
Condition of teeth: Teeth
is smooth, yellowish in
color
Position of tongue,
presence of lesion:
Central position; no
lesion
Neck No lesion, lumps noted Neck muscles for Not Applicable Not Applicable Normal Findings
abnormal swelling or (Dillon, 2006).
masses: Muscle equal
in size; head centered
Enlargement of lymph
nodes: Lymph node
not palpable
Breasts Breasts are No lump and masses Not Applicable Not Applicable Normally, Breasts are
asymmetrical. noted asymmetrical, and non-
No lesions noted tender.
(Dillon, 2006)
Body Parts & History Inspection Palpation Percussio Auscultatio Interpretation
n n
Thorax and Back (cardio-pulmo) Chest Clear breath Atrial fibrillation (AFib) is the
expansion are sounds. most common problem with
- Patient has history of asthma and smoking. symmetrical. your heartbeat's rate or rhythm.
Weaning noted The basic cause of AFib is
-noted atrial fibrillation (11/30); ECG (12/1): during disorganized signals that make
left atrial enlargement, leftward deviation expiration. your heart's two upper chambers
(the atria) squeeze very fast and
- Hematology – anemia (Hb=9.5; Hct=28) out of sync (Dillon, 2006).
• Respiratory – weaning
Abdomen Protuberant No masses Tympanitic Bowel Protuberant abdomen is a
palpated. sound sounds: 5 condition in which the
abdomen becomes unusually
- Patient has epigastric pain with a rate of Tenderness clicks per convex due to inadequate
6/10, and right upper quadrant tenderness. upon minute muscular tone or extra
palpation (normoactiv subcutaneous fat. In the case of
- Patient is an occasional alcohol beverage e). the patient, his diet consists
drinker. primarily of meat, fatty meals,
and soda, all of which are high
in fats and contribute to his
- Patient’s usual diet: prefers meat, fatty obesity (Driscoll, 2020).
foods, and soda.
Body Parts & Inspection Palpation Percussion Auscultation Interpretation
History
Genito-Urinary Urine color light Yellow Not able to assess Not Not Applicable It contains RBCs, WBCs and
– Transparency is turbid Applicable pus which indicates
Creatinine=16.83m
g/dl GFR of 38.4 malfunction of the kidneys to
(CKD Stage 3)
reabsorb and filters
(Bruners and Suddart, 2018).
Musculoskeletal/ Jaundiced in the Full and equal pulses. Hepatitis produces jaundice,
Extremities extremities. Good skin which is a yellowing of the
turgor. skin, nail beds, and whites of
Height: 152 cm the eyes, as well as light feces
and black urine. . The
Weight: 68 kg accumulation of a greenish–
yellow material (known as
BMI: 29.4 bilirubin) in the blood and
(overweight) tissues of the body causes
this (Dr. Mandal, 2019).
HEMATOLOGY:
Leukocytes 5.0-10.0 / mm3 21.70 “H” Result was above normal. This
shows that there is presence of
infection.
Erythrocytes 4.2-5.4 / mm3 3.24 “L” Result was below normal. This
indicates alteration in
erythropoietin production
secondary to renal malfunction.
Hemoglobin 11.0-15.0 / mm3 9.5 “L” Result was below normal. This
shows the decrease in the
oxygen carrying capacity of the
blood secondary low
hematocrit..
dysfunction.
Transparency Turbid It contains RBCs, WBCs
and pus which indicates
RBC 0-2/hpf
Bacteria Few
Ultrasound
Result
Findings:
Analysis:
Intrahepatic and/or extrahepatic duct dilatation (indicating
obstruction/stasis). Bile duct wall thickening or focal
outpouchings
Chest X-Ray
Result
Findings:
Decrease
cardiac output
Drug
Study
DRUG (Brand DOSAGE
MECHANISM OF
name and CLASSIFICA INDICATION (Recommended ADVERSE REACTION NURSING RESPONSIBILITIES
ACTION
Generic name) TION and Actual)
Brand Pharmaco
name: logical:
Versed The actions of Anterograde
Benzodiaz benzodiazepines amnesia
epines such as midazolam Recommended Euphoria Monitor and record
:
are mediated through Ataxia patient response to
Generic the inhibitory Falls and medication and
Intubated
name: neurotransmitter Confusion in the level of sedation.
Patients, 0.05–
gamma-aminobutyric 0.2 mg/kg/h by elderly Continuous
Midazolam Intravenous
Therapeu acid (GABA), which is continuous cardiorespiratory
tic: one of the major Indicated for promoting infusion Thrombophlebitis, monitoring.
inhibitory preoperative sedation, thrombosis, and Inspect insertion
Antianxiet neurotransmitters in anxiolysis, anesthesia IV Induction pain on injection site for redness,
y agents, induction, or amnesia. for General pain, swelling, and
the central nervous
Anesthesia other signs of
Anxiolytics system. Hypotension and extravasation during
, Benzodiazepines Adult: tachycardia can IV infusion.
Anticonvul increase the activity IV occur with rapid
sants of GABA, thereby Premedicated, intravenous Monitor for
producing a sedating 0.15–0.25 administration. A hypotension,
mg/kg over especially if the
effect, relaxing higher dose can
20–30 s, allow patient is
skeletal muscles, and result in premedicated with a
2 min for effect
inducing sleep, midazolam narcotic agonist
IV
anesthesia, and infusion syndrome analgesic.
amnesia. and respiratory
Benzodiazepines depression.
#1
DRUG (Brand DOSAGE
MECHANISM OF
name and CLASSIFICA INDICATION (Recommended ADVERSE REACTION NURSING RESPONSIBILITIES
ACTION
Generic name) TION and Actual)
Monitor vital signs
for entire recovery
period. In obese
• Residual hangover patient, half-life is
bind to the effect can happen prolonged during IV
benzodiazepine site CONTRAINDICATION: with nighttime infusion; therefore,
on GABA-A administration of duration of effects is
receptors, which Caution is necessary midazolam, which prolonged (i.e.,
for pregnant individuals, can impair the
potentiates the effects amnesia,
children, and individuals cognitive and
of GABA by with comorbid postoperative
increasing the psychomotor recovery).
psychiatric conditions.
frequency of chloride abilities, which can
Administration in elderly Actual:
channel opening. individuals and acutely result in falls in Observe for
These receptors have ill patients requires continuous elderly and impaired overdose symptoms
been identified in caution to prevent the infusion of coordination during include
different body tissues accumulation of active 0.1mg/kg/h driving. somnolence,
including the heart metabolites. Extra confusion, sedation,
precautions should be SIDE EFFECTS: diminished reflexes,
and skeletal muscle,
taken in critically ill coma, and
although mainly Nausea
individuals as dose untoward effects on
appear to be present accumulation can occur. Vomiting
in the central nervous vital signs.
Dizziness
system. Coughing Patient Education
Drowsiness
Do not drive or engage in
potentially hazardous
activities.
DRUG (Brand DOSAGE
MECHANISM OF
name and Generic CLASSIFICATI INDICATION (Recommended and ADVERSE REACTION NURSING RESPONSIBILITIES
ACTION
name) ON Actual)
Brand name: Pharmacol
ogical:
Monitor constantly
Levophed
Arrhythmias while patient is
Catechola Convulsions receiving
mine Chest pain
Indicated to restore BP in norepinephrine.
Norepinephrine
certain acute hypotensive Photophobia Take baseline BP
functions as a
states such as shock. Also Recommende Blurred vision and pulse before
Generic peripheral
as adjunct in treatment of d: Restlessness start of therapy,
name: vasoconstrictor
cardiac arrest. Anxiety then q2min from
Therapeuti by acting on
Adult: Tremors initiation of drug
alpha-
Norepinephri c: CONTRAINDICATION: IV Start with 8– Pallor until stabilization
adrenergic 12 mcg/min,
ne Plasma volume occurs at desired
receptors. It is Use as sole therapy in titrate to
Alpha and depletion level, then every 5
also an hypovolemic states, maintenance
Beta Edema min during drug
Adrenergic
inotropic except as temporary dose of 2–4 Hemorrhage administration.
stimulator of the mcg/min
Agonist emergency measure; Vomiting
heart and dilator
(Sympatho mesenteric or peripheral Observe carefully
of coronary vascular thrombosis; and record mental
mimetic) arteries as a profound hypoxia or Actual: SIDE EFFECTS: status (index of
result of it's hypercarbia; use during 4 mcg/min IV cerebral circulation),
activity at the infusion Headache
cyclopropane or halothane skin temperature of
beta-adrenergic anesthesia; pregnancy Vomiting extremities, and
receptors. (category D), lactation. Dizziness
color (especially of
Palpitation
earlobes, lips, nail
beds) in addition to
#2 vital signs.
DRUG (Brand DOSAGE
MECHANISM OF ADVERSE
name and CLASSIFICA INDICATION (Recommended NURSING RESPONSIBILITIES
ACTION REACTION
Generic name) TION and Actual)
Be alert to patient's
complaints of headache,
vomiting, palpitation,
arrhythmias, chest pain,
photophobia, and blurred
vision as possible symptoms
of overdosage. Reflex
bradycardia may occur as a
result of rise in BP.
#3
DRUG (Brand DOSAGE
MECHANISM OF
name and CLASSIFICA INDICATION (Recommended ADVERSE REACTION NURSING RESPONSIBILITIES
ACTION
Generic name) TION and Actual)
Lab tests: Baseline
C&S tests prior to
initiation of therapy.
Baseline and
periodic
assessments of
renal, hepatic, and
hematologic
functions,
particularly during
prolonged or high-
dose therapy.
#3 pain).
DRUG (Brand DOSAGE
MECHANISM OF
name and CLASSIFICA INDICATION (Recommended ADVERSE REACTION NURSING RESPONSIBILITIES
ACTION
Generic name) TION and Actual)
Monitor for
manifestations of
hypersensitivity.
Report their
appearance
promptly and
discontinue drug.
DRUG (Brand DOSAGE
MECHANISM OF ADVERSE
name and CLASSIFICA INDICATION (Recommended NURSING RESPONSIBILITIES
ACTION REACTION
Generic name) TION and Actual)
Check for fever if diarrhea
occurs: Report both promptly.
The incidence of antibiotic-
produced pseudomembranous
colitis is higher than with most
cephalosporins. Most
vulnerable patients: chronically
ill or debilitated older adult
patients undergoing abdominal
surgery.
Reference :
https://go.drugbank.com/drugs/DB00683
https://www.ncbi.nlm.nih.gov/books/NBK537321/
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/M067.html
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/N042.html
https://go.drugbank.com/drugs/DB00415
https://go.drugbank.com/drugs/DB01212
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/C050.html
https://www.rxlist.com/ceftriaxone-side-effects-drug-center.htm
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YOU!