Case Study of Elodie, a Patient with Acute Lymoblastic Leukaemia

According to the objective data of the patient she is reported to have a respiratory rate of 21 breath/min and heart rate of 103 beats /min, thus it is the primary area of concern because the elevated range depicts deteriorating condition. Thus, it can be said that due to a high toxin and increased heart rate, lungs receive less amount of blood and gaseous exchange mechanism become slow, which leads to increased respiratory rate.

Running head: CASE STUDY: SEPTIC SHOCK
CASE STUDY: SEPTIC SHOCK
Name of Student:
Name of University:
Author’s Note:

1CASE STUDY: SEPTIC SHOCK
The case study describes the deteriorating health condition of the patient name Elodie,
who was initially diagnosed with acute lymphoblastic leukaemia and have undergone
chemotherapy seven weeks ago. However, presently, she was feeling unwell and malaise and
admitted to the emergency department. On assessment, she has been suspected with sepsis in the
Hickman’s line. The two significant sign and symptoms that are associated with the clinical
deterioration are increased in respiratory rate and high heart rate. The normal heart rate of a
person is 72 beats per min, and the respiratory rate is 12-15 breaths/min (Mallick & Patro, 2016).
According to the objective data of the patient she is reported to have a respiratory rate of 21
breath/min and heart rate of 103 beats /min, thus it is the primary area of concern because the
elevated range depicts deteriorating condition. It is indicated in the study of Berlot and Passero
(2019) that tachycardia is the frequent occurrence of sepsis, due to the release of the
inflammatory substance like cytokine. Through the invasion of bacteria in sepsis, there is the
release of toxin, which consequently secretes cytokine in the body. Such a statement has a
harmful effect as it is known to dilate the blood vessel and leads to hypovolemia. It is reported in
the research of Kakihana et al. (2016) in the high level of sepsis, that prevails the condition of
hypovolemia, there is an increase in contraction of the ventricle and heart pumps harder which is
causes increase in heart rate, thus tachycardia. The finding is also supported by the Baygin and
Kararmar (2018) and states that tachycardia is the sign of sepsis which persists despite the
adequate repletion of fluid. The mechanism described is also related to high respiratory rate. It is
observed in the study of van Der Ster et al. (2018) that due to hypovolemia and increase heart
rate, the circulation of the blood in the body become slow. The reason can also be related by the
study of Carlson and Fitzsimmons (2019) that in sepsis the release of cytokine also causes the
formation of a blood clot, which also slows the pumping of the heart. Thus, it can be said that

2CASE STUDY: SEPTIC SHOCK
due to toxin and increased heart rate, lungs receive less amount of blood and gaseous exchange
mechanism become slow, which leads to increased respiratory rate. Therefore, the emergence of
two vital sign of increased heart rate and increased respiratory rate are indicative to a high level
of infection. Thus, it depicts the clinical deterioration of the health of the patient.
From the review of the case study, it can be said that the priority problem identified in
Eliode is the prevalence of hypoxemia which is referred to as a low level of oxygen in the blood.
According to the study of von Seth et al. (2017), it is inferred that patient who experiences septic
shock, the delivery of the oxygen is high. However, the oxygen extraction ratio in the body is
low. As the uptake of oxygen is depended on the supply of the oxygen over the wider range, in
the condition of sepsis, the bacterial invasion, slows the immune response due to which the
release of the inflammatory substance causes slow circulation of blood. It is seen in the case
study that the patient has SpO2 of 91%, which is low than the normal range and indicative of
decreased oxygenation. In the research of Goonasekera, Carcillo and Deep (2018), it is
highlighted that in sepsis, the heart is unable to pump sufficient blood and does not reach to the
lung for oxygenation. As a result of it, deoxygenated blood travels to the body and level of
oxygen in the blood become low. It is the severe consequence of sepsis patient as it can give rise
to various health issues like dizziness, coma or even death of the patient. Carhart-Harris et al.
(2015) have suggested in his research that decreased level of oxygen in the blood, can cause
insufficient transport of oxygen in the cell of the body. The function of the cells can be halted,
and normal metabolism of the body can lead to reverse reaction. In sepsis, there is an imbalance
between the supply and demand of oxygen, which thus leads to cellular dysfunction and failure
of the organ (Bjerkvig et al., 2016). In the oxidative stress condition, there is the production of
free oxygen radicals, which is regarded as the toxin of the body. It has the potential to impair the

3CASE STUDY: SEPTIC SHOCK
function of the heart, lungs and another vital organ. It was also is known to react with the cell
component like lipids, protein and nucleic acid. It is known to deteriorate the infection in the
patient and can have a lethal issue. Moreover, decreased oxygenation can lead to low blood
pressure, high body temperature and abnormal blood count. Such a sign is observed in the
patient, which suggest that the problem of hypoxemia is the clinical priority and needs
consideration.
In order to address the priority problem of the decreased oxygenation or hypoxemia, there
is the need to take appropriate intervention by the nurse. It is reported in the study of Cousins,
Wark and McDonald (2016) that due to decreased oxygenation in patient, there can be the
prevalence of various health issue like coma, dizziness, shortness of breath and increased
respiratory rate. Some of the obvious sign is observed in Elodie, thus requires nursing
intervention for the healthy outcome of the patient. The two nursing interventions to address the
priority problem are providing oxygen therapy to the patient and repositioning the patient by
raising the head of the bed.
In the first intervention of providing oxygen therapy to the patient is an important aspect
of increasing the level of oxygen in the blood. According to the study of Rheims et al. (2019), in
oxygen therapy, external oxygen is administered to the patient via the mask or intubation. It is a
proven effective treatment to balance the supply of oxygen in the body. It is seen in the case
study that, Elodie has SpO2 of 91%, which indicates that she needs supplemental oxygen to
increase the saturation level. Cousins, Wark and McDonald (2016) in his research has suggested
that nurse have to be mindful while giving oxygen therapy. They have to regularly check the
flow rate of oxygen and ensure the connectivity of the tube with the oxygen supply source. If
there is the use of a portable tank, the nurse must check its oxygen level to avoid any health

4CASE STUDY: SEPTIC SHOCK
hazard. In order to address the efficacy of the intervention, the nurse must regularly monitor the
oxygen saturation level and assess the signs for hypoxemia. If the saturation level lies in the
optimum range of 96-100%, reveals the effectiveness of the therapy.
In the second intervention of raising the head of the bed is also the most effective
intervention to increase oxygenation and normalize the respiratory rate. It is seen in the study of
Schultz et al. (2016) that by elevating the head of the bed is effective in promoting the breathing
and descent of the diaphragm, which is known to maximize inhalation. It is reported in the study
of Khandelwal et al. (2016) that such intervention helps in enhancing the airway patency in the
patient. These nursing interventions can benefit Elodie, and as she is reported high respiration
rate, will ease her breathing capacity. To evaluate the efficacy of this intervention, the nurse can
interrogate the patient about the health status and monitor the vital signs like blood pressure,
body temperature, heart rate and respiratory rate. When the breathing capacity in the patient
improves, the vital sign will consequently get normalize.
From the review of the case study, the psychosocial issue derived is related to the anxiety
and high level of stress in Elodie’s mother. She is worried about her daughter because of her
deteriorating health condition. According to the study of Rozental et al. (2016), psychosocial
issues have the potential to cause an adverse effect on the wellbeing of the patient and family.
Anxiety and stress are the two most prevalent psychosocial issues that are observed in the family
of the ill patient or in the patient itself. It is the responsibility of the nurse to address the
psychological issue and provide them with practical support and motivation by the mean of the
patient-centred approach (Caruso et al., 2017). The care they need is mental support that will
help in coping with the illness. It is indicated in the study of Craig, Betancourt and Muskat
(2015) that patient-centred approach is effective mean of care and support, which keeps the

5CASE STUDY: SEPTIC SHOCK
patient and their family in the centre of decision making. Elodie’s mother will be given adequate
support and education to develop coping strategies so that she can handle the situation. She will
be made to understand the importance of being resilient for the betterment of the Elodie. Further,
the nurse will communicate with her and try to acknowledge her concern. She will listen to the
concern of both the patient and her mother and give respect to their decision. Active listening
and communicating with respect, help to build a collaborative relationship with the nurse and
patient's family which also assist in dealing with the psychosocial issue (Wiener et al., 2015).
The nurse will discuss the care disposition for Eldioe and involve them in decision making. This
will help to build trust in the treatment process and thus assist in increasing their mental stability.
This will help them to get relief from anxiety and stress and promote health outcome of the
patient.
Elodie is at the risk of various health complication and seeing her mother anxious, and
stress can have a negative impact on her phycology. By the mean of patient-centred approach,
step is taken to address the psychosocial issue. The nurse will discuss the desire and choice of the
patient and her mother by respecting their right to express their health concern. Thus, it can be
said that being responsive and ensuring the value of the patient and her family will help to
improve their psychology and enhance mental stability.

6CASE STUDY: SEPTIC SHOCK
Reference
Baygin, O., & Kararmaz, A. (2018). Sepsis and Tachycardia: Etiologic Factors and Effects on
Prognosis. J Anaesth Ther 1: 103 Abstract RESEARCH ARTICLE Introduction, 1(1).
Berlot, G., & Passero, S. (2019). Immunoparalysis in Septic Shock Patients. In Sepsis.
IntechOpen.
Bjerkvig, C. K., Strandenes, G., Eliassen, H. S., Spinella, P. C., Fosse, T. K., Cap, A. P., &
Ward, K. R. (2016). “Blood failure” time to view blood as an organ: how oxygen debt
contributes to blood failure and its implications for remote damage control
resuscitation. Transfusion, 56, S182-S189.
Carhart-Harris, R. L., Murphy, K., Leech, R., Erritzoe, D., Wall, M. B., Ferguson, B., ... &
Tanner, M. (2015). The effects of acutely administered 3, 4-
methylenedioxymethamphetamine on spontaneous brain function in healthy volunteers
measured with arterial spin labeling and blood oxygen level–dependent resting state
functional connectivity. Biological psychiatry, 78(8), 554-562.
Carlson, B., & Fitzsimmons, L. (2019). Shock, sepsis, and multiple organ dysfunction syndrome.
Priorities in Critical Care Nursing-E-Book, 474.
Caruso, R., Nanni, M. G., Riba, M. B., Sabato, S., & Grassi, L. (2017). The burden of
psychosocial morbidity related to cancer: patient and family issues. International Review
of Psychiatry, 29(5), 389-402.

7CASE STUDY: SEPTIC SHOCK
Cousins, J. L., Wark, P. A., & McDonald, V. M. (2016). Acute oxygen therapy: a review of
prescribing and delivery practices. International journal of chronic obstructive
pulmonary disease, 11, 1067.
Craig, S. L., Betancourt, I., & Muskat, B. (2015). Thinking big, supporting families and enabling
coping: The value of social work in patient and family centered health care. Social work
in health care, 54(5), 422-443.
Goonasekera, C. D., Carcillo, J. A., & Deep, A. (2018). Oxygen delivery and oxygen
consumption in pediatric fluid refractory septic shock during the first 42 hours of therapy
and their relationship to 28-day outcome. Frontiers in pediatrics, 6, 314.
Kakihana, Y., Ito, T., Nakahara, M., Yamaguchi, K., & Yasuda, T. (2016). Sepsis-induced
myocardial dysfunction: pathophysiology and management. Journal of intensive
care, 4(1), 22.
Khandelwal, N., Khorsand, S., Mitchell, S. H., & Joffe, A. M. (2016). Head-elevated patient
positioning decreases complications of emergent tracheal intubation in the ward and
intensive care unit. Anesthesia & Analgesia, 122(4), 1101-1107.
Mallick, B., & Patro, A. K. (2016). Heart rate monitoring system using fingertip through arduino
and processing software. International Journal of Science, Engineering and Technology
Research (IJSETR), 5(1), 84-89.
Rheims, S., Alvarez, B. M., Alexandre, V., Curot, J., Maillard, L., Bartolomei, F., ... &
Tourniaire, D. (2019). Hypoxemia following generalized convulsive seizures: Risk
factors and effect of oxygen therapy. Neurology, 92(3), e183-e193.

8CASE STUDY: SEPTIC SHOCK
Rozental, A., Kottorp, A., Boettcher, J., Andersson, G., & Carlbring, P. (2016). Negative effects
of psychological treatments: An exploratory factor analysis of the negative effects
questionnaire for monitoring and reporting adverse and unwanted events. PloS
one, 11(6), e0157503.
Schultz, C. P., Rosca, J., Claussen, H., Joiner, C., Russell, S. A., & Tas, N. (2016). U.S. Patent
No. 9,375,142. Washington, DC: U.S. Patent and Trademark Office.
van Der Ster, B. J., Sperna Weiland, N. H., Westerhof, B. E., Stok, W. J., & Van Lieshout, J. J.
(2018). Modeling Arterial Pulse Pressure From Heart Rate During Sympathetic
Activation by Progressive Central Hypovolemia. Frontiers in physiology, 9, 353.
von Seth, M., Skorup, P., Hillered, L., Larsson, A., Sjölin, J., & Miklós, L. (2017). The role of
oxygen delivery and inflammatory response on plasma lactate and organ dysfunction in
experimental septic shock.
Wiener, L., Kazak, A. E., Noll, R. B., Patenaude, A. F., & Kupst, M. J. (2015). Interdisciplinary
collaboration in standards of psychosocial care. Pediatric blood & cancer, 62(Suppl 5),
S425.

9CASE STUDY: SEPTIC SHOCK
Annotated reference
Baygin, O., & Kararmaz, A. (2018). Sepsis and Tachycardia: Etiologic Factors and Effects on
Prognosis. J Anaesth Ther 1: 103 Abstract RESEARCH ARTICLE Introduction, 1(1).
Author has conducted prospective observational study and evaluated the association between
blood pressure, body temperature with sepsis and high heart rate.
Berlot, G., & Passero, S. (2019). Immunoparalysis in Septic Shock Patients. In Sepsis.
IntechOpen.
The study highlights the connection of immune response and septic shock focusing on
inflammatory phase.
Bjerkvig, C. K., Strandenes, G., Eliassen, H. S., Spinella, P. C., Fosse, T. K., Cap, A. P., &
Ward, K. R. (2016). “Blood failure” time to view blood as an organ: how oxygen debt
contributes to blood failure and its implications for remote damage control
resuscitation. Transfusion, 56, S182-S189.
The study has conducted literature review and depicts that sepsis can lead to oxygen debt and
eventually to Hemorrhagic shock.
Caruso, R., Nanni, M. G., Riba, M. B., Sabato, S., & Grassi, L. (2017). The burden of
psychosocial morbidity related to cancer: patient and family issues. International Review
of Psychiatry, 29(5), 389-402.
The author has conducted qualitative study and inferred that psychosocial issue is substantially
throughout the family member of patient and highlighted the method of assessment in the
patient.

10CASE STUDY: SEPTIC SHOCK
Cousins, J. L., Wark, P. A., & McDonald, V. M. (2016). Acute oxygen therapy: a review of
prescribing and delivery practices. International journal of chronic obstructive
pulmonary disease, 11, 1067.
The literature review indicates that oxygen therapy is the best intervention for the low oxygen in
the blood.
Goonasekera, C. D., Carcillo, J. A., & Deep, A. (2018). Oxygen delivery and oxygen
consumption in pediatric fluid refractory septic shock during the first 42 hours of therapy
and their relationship to 28-day outcome. Frontiers in pediatrics, 6, 314.
The research is experimental and concluded that septic shock could lead to less supply of
oxygen. It can cause death of the children and several health complication in adult.
Rheims, S., Alvarez, B. M., Alexandre, V., Curot, J., Maillard, L., Bartolomei, F., & Tourniaire,
D. (2019). Hypoxemia following generalized convulsive seizures: Risk factors and effect
of oxygen therapy. Neurology, 92(3), e183-e193.
Author has conducted descriptive studies, and analyses the factor for the occurrence of
hypoxemia.
von Seth, M., Skorup, P., Hillered, L., Larsson, A., Sjölin, J., & Miklós, L. (2017). The role of
oxygen delivery and inflammatory response on plasma lactate and organ dysfunction in
experimental septic shock
The study is based on retrospective cohort analysis where author found the effect of less oxygen
supply due to septic shock in the functioning of vital organ.