Group 2: Case study #5- Shock with multiple organ failure

Initial Nursing Assessments:

 In multiple organ dysfunction syndrome, clinical assessment tools include

APACHI (Acute Physiology and Chronic Health Evaluation), SAPS (Simplified
Acute Physiology Score); PIRO (Predisposing factors, the infection, the host
response and organ dysfunction) and SOFA score.

1. What do you believe may be going on patient Stewart?

 Patient Stewart has multiple organ dysfunction syndrome (MODS). It is altered
organ function in acutely ill patients that requires medical intervention to support
continued organ function.

2. What action should you take at this time for patient Stewart?
 First controlling the initiating event, second promoting adequate organ perfusion,
third, providing nutritional support and lastly, maximizing patient comfort.

3. Describe what is happening to patient Stewart?

 Patient Stewart has multiple episodes of emesis w/ vomits that was either bilious
or red brown and difficulty of breathing, diffuse myalgias, purplish as coloration
(purpuric rash). Patient also has tachypnea, hypoxemia and cyanosis. Dysfunction
left ventricle w/ regional wall motion abnormalities and right ventricle
dysfunction with underfilling.

4. What orders do you expect to receive from the provider?

 The provider is expected to order supplemental oxygen, and laboratory
examination/ test such as complete blood count, renal function test, liver function,
coagulation and measurement of electrolytes, glucose, lipase, lactic acid and
troponin.

5. Which order should you implement first? Why?

 The first order to implement is supplemental oxygen due to presenting symptoms
of difficulty of breathing this is to promote airway breathing. then next is to
gather our baseline which would be the vital signs of the patient as this would
guide us in navigating thru his progression.

6. what should be your immediate course of action?

 The first immediate action is to remove/ irradicate infection source if the initial
insolt is known. Prevention remains the top priority because of the lack of
physiologic reserve and the natural degenerative process especially immune
comprise.

7. What if anything, might you have done differently in this situation? Why?
 Continuing and transitional care to reinforce the importance of continuing mearcal
care and helps the patient and family identify and mobilize community resources.
The patient and family members should be given a brief health education in a way
that they could comprehend as this is to prevent further complications or episodes
of shock by identifying the factors implicated in the initial episode. The health
care team must address end of life decisions to ensure that supportive therapies or
congruent with the patients wishes.