Septic Shock: Deteriorating Patient Case Study

CASE STUDY 1-SHOCK: THE DETERIORATING PATIENT
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Introduction
Septic shock is a life-threatening medical condition that presents with persistent
hypotension following inflammatory responses to infections. It is very common among the
aging population. Disproportionately, it affects people with immunosuppression or cancer.
The paper will focus on case study 2 of Jedda Merinda, a 32-year-old male who was admitted
to the hematology and oncology unit following a recent diagnosis of Acute Myeloid
Leukemia. Jedda has a past medical history of depression, Acute Rheumatoid Fever, suicidal
attempt and hypercholesterolemia.
On assessment, it was discovered that Jedda was hypotensive (BP-92/65mmHg),
tachycardic (Pulse rate 118beats/minute), and a low urine output (less than 0.5mL/kg/hr). He
is tachypneic (28 breaths/min) evidenced by use of accessory muscles during breathing. The
essay will identify and discuss two signs/symptoms of clinical deterioration associated with
the presenting condition of the patient, develop a clinical plan of care with one priority of
clinical care. Eventually, the paper will identify and discuss three nursing interventions
directly addressing the identified clinical priority of patient care. Discussing this case study
would be help in exploration of the clinical priorities of patient care and appropriate nursing
interventions required.
Physiology and Pathophysiology of Septic Shock
Septic shock is a multi-organ disorder which is caused by chronic illnesses such as
hypotension, hypertension, cancers such as Acute Myeloid Leukemia, and
hypercholesterolemia. The illnesses suppress the immune system of the patient leading to its
reduced ability to fight invading pathogens and infection. Hypercholesterolemia is associated
with great risk of hypertension which is risk factor for the development of septic shock in a
patient. In connection with the case study, the patient has Acute Myeloid Leukemia and a
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past medical history of hypercholesterolemia which leads to immunosuppression hence
increasing the risk for the development of septic shock (Angus & Van der Poll, 2013).
Septic shock involves reduction in organ and tissue perfusion and acute multi-organ
failure. The organs involved include kidneys, heart, liver, lungs, and brain. An inflammatory
stimulus such as bacterial and viral toxins stimulate production and release of
proinflammatory mediators and cytokines which lead to neutrophil-endothelia adhesion of
cells hence activating the clotting mechanism and generating microthrombi (Daviaud et al.,
2015) Other mediators such as serotonin, lipoxygenase, leukotrienes, bradykinin, histamine,
and interleukin-2 are also fought back by the anti-inflammatory factors such as interleukin-4
and interleukin-10 leading to initiation of a negative feedback mechanism(Angus, & Van der
Poll, 2013).
The dilatation of arteries and arterioles decreases the arterial peripheral resistance
hence leading to decreased cardiac output. Later, this stage is followed by a decrease in
cardiac output, fall in blood pressure, and appearance of now the typical features of shock.
The vasoactive mediators are attributed to the flow of blood to bypass the vessels of capillary
exchange (Dellinger et al., 2013).
Poor blood flow in capillaries due to the shunting and obstruction of the capillaries by
microthrombi causes a decrease in oxygen delivery and impairment of waste products and
carbon (IV) oxide removal from the body. Reduced tissue perfusion causes dysfunction and
failure of body organs like lungs, heart, lungs, liver and brain. Signs of septic shock include
hypotension, tachycardia, confusion, fever, confusion and oliguria as presented in the case
study (De Backer, Orbegozo Cortes, Donadello, & Vincent, 2014).
According to the case study, the patient had been recently diagnosed with Acute
Myeloid Leukemia (AML) and he is on chemotherapy. Chemotherapy impacts on the body’s
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