Case Study: The Deteriorating Patient

Case Study: The Deteriorating Patient
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Introduction
Sepsis and septic shock result is multi-organ failure is a leading cause
of mortality in intensive care units. Therefore, timely detection and initiation
of treatment is essential to prevent patient deterioration and death (Berg &
Gerlach, 2018, 1). The case study approach is used in this paper to explore the
vital signs, nursing interventions and psychological problems related to septic
shock as evidenced by paediatric deteriorating patients. The focus is to
investigate the effectiveness of evidence-based care in managing deteriorating
patients. The timely recognition of critically ill patients is an important
component of the rapid response systems (RRS), and is essential in reducing
the length of stay in the intensive care unit (ICU) length of hospital stay, and
mortality (Douw et al., 2015, 1).
The phenomenon in this study is psychological problems related
to septic shock as evidenced by deteriorating patients. The study presents case
study of Elodie Greer, a 14 year old girls with a previous diagnosis of Acute
Lymphoblastic Leukaemia (ALL). She underwent chemotherapy and a
subsequent allogenic stem cell transplant 7 weeks ago. Elodie has been
responding well to the treatments until three days ago when she started feeling
generally unwell and malaise. He is admitted with suspected sepsis resulting
from an infected Hickman’s line. The vital signs include temperature of 38.4,
elevated heart rate at 103 beats/min, blood pressure of 102/67mmHg,
increased rrespiratory rate of 21 breaths/minute, SpO2 of 91%, mouth dryness
and feeling thirsty, lack of appetite and feeling tired, low platelets count of
101 and increased white cell count of 12.5. She also feels lethargic and
diaphoretic. The case study approach is applied in this research to address
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issues such as increased temperature, elevated heart rate, and altered gas
exchange using evidence-based research. The focus is to address the risk of
secondary complications and improve patient outcomes.
Recognition of vital signs is critical in the effective realization of RRS.
Vital signs refer to observations that deviate from the normal values. Some of
the vital signs that are often considered include blood pressure, consciousness,
heart rate, respiratory rate and oxygen saturation (Douw et al., 2015, 1). Septic
shock is demonstrated by several signs which include body temperature above
38°C or below 36°C, health rate that is more than 90 beats/minute, respiratory
rate above 20 breaths/minute, partial carbon dioxide pressure (PaCO2 ) below
mmHg, while blood cell count above 12,000/mL or below 4,000/mL or over
10% immature neutrophils (Berg & Gerlach, 2018, 4).
In the case of Elodie, one sign of clinical deterioration is increased
respiratory rate, demonstrated by elevated breathing rate (21 breaths/minute).
Respiratory rate is an essential vital sign in a variety of clinical settings.
Changes is respiratory rate is a key indicator of deterioration (Elliott, 2016, 1).
Increased respiratory rate is one indicator of septic shock and may result from
respiratory alkalosis, abnormal blood gases in the arteries and respiratory
muscle fatigue (Hotchkiss et al., 2016, 11).
The second vital signs in Elodie’ case is elevated temperature of
38.4°C. Hyperthermia, demonstrated by temperature of above 38°C, and
hypothermia, which refers to temperature below 36°C, are vital signs of sepsis
and septic shock. Hyperthermia may result to damage of tissues and organs
and consequently lead to poor prognosis. The high temperature may be an
indicator of an infection and deterioration of the patient. Consequently,
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controlling fever may harm a patient with septic shock, as it results in
elevation of neutrophils and white blood cells (Gao et al. 2017, 1). The
insights of Gao et al. (2017, 1) explain the increased white blood cells in the
case of Elodie.
Alteration of respiratory function is a priority problem associated with
the patient’s clinical presentation of sepsis. The respiratory failure among
patients with Sepsis results from damage of the alveolar capillary membranes,
which is often induced by inflammatory mediator. The outcome is lung injury
mediated by cytokine, which results in noncardiogenic pulmonary oedema
which may cause decreased compliance of the lungs, and impaired oxygen
uptake and carbon dioxide elimination. The decreased compliance of the lungs
results in activation of juxtacapillary receptors; hence increased ventilation
and the risk of tachypnoea (Hotchkiss et al., 2016, 11).
The alteration of respiratory function is a critical priority in the
management of Elodie, in this case study. The reason why it is a priority is
that acute respiratory compromise is the deterioration of the respiratory
function that may result in rapid progression of respiratory failure or death.
Therefore is essential to identify at-risk patients and monitor patients who
have already developed respiratory compromise to ensure timely interventions
and prevent further deterioration (Morris et al., 2017, 497). Ptints who are
admitted wuth respiratory complications have higher deathrates as compared
to patents admitted for any other medical condition. The mortality rate of in-
hospital respiratory complications is 40%, which is multiple times higher than
that of patients admitted with illnesses such as cancer, congestive heart
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