Shock and Multiple Organ Dysfunction Syndrome

1. Complete the following case study by developing a care plan:
2. Please complete the entire care plan. Please use textbook to fill in information not given in case study.

Case Study Shock and Multiple Organ Dysfunction Syndrome
1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with an SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy.
2. Additional patient information:
IVF: Normal saline at 100cc/hr, NPO, lives in house alone, smokes 1 pack of cigarettes daily, full code. Additional meds: Benicar 40mg daily, Vancomycin 1gm every 12 hours IV.

 

 

 

 

Sample Solution

laterally to give the wellbores extended contact with the formation. The advantage of horizontal wells is the long and constant exposure to source rocks. For example, a vertical well piercing a 30m-thick layer would only have 30m of exposure to the oil and gas interval, whereas a horizontal well would have several hundreds of exposures.

Figure. The cartoon shows the difference between conventional (right) and unconventional (left) drilling methods. The branches extended on the horizontal well are the representatives of hydraulic fracturing.

https://www.croftsystems.net/oil-gas-blog/conventional-vs.-unconventional

Hydraulic fracturing, commonly known as fracking, further extends the drainage pattern around horizontal wellbores by creating fracture patterns that facilitate flow. Fracking injects a high-pressure ‘fracking fluid’ (primarily water, sand and chemicals) into a wellbore to create cracks in the rock formations which release the oil and gas inside. (https://ec.europa.eu/jrc/en/publication/eur-scientific-and-technical-research-reports/overview-hydraulic-fracturing-and-other-formation-stimulation-technologies-shale-gas-0) This method is now widely used world-wild, ensuring the US and Canada to have constant gas supply for 100 years and has presented an opportunity to generate electricity at half the CO2 emissions of coal. (https://www.bbc.co.uk/news/uk-14432401)

Steam-assisted gravity drainage (SAGD) is another method used to open up large deposits below the surface and produce heavy crude oil and bitumen. It is an advanced form of steam stimulation in which a pair of horizontal wells are drilled into the oil reservoir, one a few meters above the other. High-pressure steam is continuously injected into the upper wellbore to heat the oil and reduce its viscosity, causing the he

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