Marie is a 27 year old female who is homeless
Marie is a 27 year old female who is homeless. She arrives at the emergency department with complaints pain in her left foot. After an assessment you discover that she has an open wound on the bottom of her left foot that is red, swollen, and draining green fluid.
Cellulitis is present up the leg to the knee. She states she has no chronic medical illnesses and doesn’t take any medication. She is alert and oriented to person, place and time. Her vitals are BP: 100/78 (her normal is 120/80), Heart Rate 100, Temperature 100.5, Pulse Ox 98%, respiratory rate is 22.
What condition are you suspecting?
Based on the symptoms presented—pain, redness, swelling, drainage of green fluid from the foot, and cellulitis extending up to the knee—Marie is likely suffering from a severe bacterial infection, possibly progressing to sepsis given the systemic symptoms (Salomão et al., 2019).
Does she have at least 2 criteria for Systemic Inflammatory Response Syndrome? If so, list
the criteria.
By the SIRS definition, Marie experiences the minimum grade of symptoms including a
temperature higher than the normal threshold and the heart rate that is greater than 90 bpm. For
instance, temperature is 100.5°F and the rate of the heart is 100 beats per minute. These
symptoms that point to her body fighting a major battle to recover from the infection and
possibly leading to septic shock (Otto, 2020).
What are your next steps?
Immediate actions should include (Otto, 2020):
• Continued monitoring of vital signs.
• Administering IV fluids and antibiotics.
• Preparing for possible escalation of care depending on the patient’s response.
What medication do you expect to be given, if any?
Antibiotics remain the basis for the treatment of bacteriological infections that help to
avoid further progress to sepsis. This would mean recommending suitable pain killers or
antipyretic drugs like aspirin for fever (Gyawali et al., 2019).
What labs do you expect the doctor to order?
The doctor is likely to order a complete blood count (CBC), blood cultures, lactate levels,
and other tests to assess the extent of the infection and organ function (Otto, 2020).
Is she improving?
Marie is not showing signs of improvement; her vital signs indicate worsening conditions
such as increased heart rate, respiratory rate, and fever. The chills and paleness could
suggest systemic infection progression (Salomão et al., 2019).
What do you expect the licensed practitioner to order?
The practitioner may order adjustments in antibiotic therapy based on culture results,
increased fluid administration, and potentially vasopressors if hypotension persists
(Gyawali et al., 2019).
If she was not improving, what would she be at risk for?
If Marie does not improve, she could be at risk for septic shock, organ failure, and
increased mortality (Gyawali et al., 2019).
What makes a person high risk for infection?
Factors include compromised immune system, chronic health conditions, wounds or injuries,
homelessness (exposure to unsanitary conditions), and lack of medical care (Otto, 2020).
Define sepsis.
Sepsis is an acute endogenous disease, caused by the body’s overall response to an infection
involving the development of damage to tissues, organs failure, and death (Gyawali et al., 2019).
In your own words, explain septic shock?
Septicemia (sepsis shock) is a severe state of an ill patient and blood pressure decrease occurs
secondary to septicemia by causing impaired metabolism in all body cells with septic
manifestations and multi-organ failure accompanied by extremely poor cardiovascular
metabolism and high mortality rate.
In your own words, explain the pathophysiology of Septic shock.
Septic shock results from the massive reaction of the immune system to an infection with
impaired normal organ and tissue function. The septic shock physiology involves different parts:
vessel dilatations, blood clot formations, and organ failures.
Give 2 examples of medications that can be used to treat Sepsis.
• Antibiotics: Essential for treating the underlying infection (Otto, 2020).
• Vasopressors: Used to stabilize blood pressure if fluid resuscitation is not sufficient
(Gyawali et al., 2019).
References
Gyawali, B., Ramakrishna, K., & Dhamoon, A. S. (2019). Sepsis: The evolution in definition,
pathophysiology, and management. SAGE open medicine, 7, 2050312119835043.
Otto, C. M. (2020). Sepsis. In The veterinary ICU book (pp. 695-709). CRC Press.
Salomão, R., Ferreira, B. L., Salomão, M. C., Santos, S. S., Azevedo, L. C. P., & Brunialti, M.
K. C. (2019). Sepsis: evolving concepts and challenges. Brazilian Journal of Medical and
Biological Research, 52, e8595.
Disseminated Intravascular Coagulation Case Study 2
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