Page 443 - Critical Care Nursing Demystified

428 CRITICAL CARE NURSING DeMYSTIFIED

Dull sounds percussed at the bases
On 100% nonrebreather
GU: Urine output via indwelling catheter foul-smelling, with shreds of white
milky sediment
Output = 15 mL in the past 4 hours after ECU irrigated Foley
GI: Diminished bowel sounds throughout 4 quads

Stomach flat but soft protuberance
Spleen, liver unable to palpate; no tenderness in areas

QUESTIONS
1. From the above symptoms, describe what terminology related to sepsis this
patient might be experiencing.
2. What do her ABGs indicate? What would cause you concern about them?

3. What assessment data confirms the probable location of Ms. Cranton’s sepsis?
4. The resident asks you to confi rm calculation of the patient’s absolute neutro-
phil count (ANC). What value will you show her?
5. Prioritize collaborative care that the nurse would anticipate.
It is decided to insert a pulmonary artery catheter to monitor fl uid status.
6. What values in the PAP, PAOP, CO, and SVR would the nurse predict? Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Despite aggressive therapy, Patricia spirals downward and the family decides
Patricia has had enough. They know that she has expressed if she gets gravely
sick she does not want to “go through anything more.” She has left a living that
includes mechanical ventilation and life support but not after a week. The medical

and nursing staff, pastoral care, and the ethics committee confirm this decision.
Patricia is started on a morphine drip, is extubated, and passes on a week after
admission.