case study help - page 4

I am currently working on the following case study and need a little guidance on which way to go with the info. Any ideas? I think the patient is possibly septic r/t her leg??? I am not sure... Read More

  1. by   Esme12
    Quote from laurensummers
    I wasnt trying to be rude..but this person is resistant to any FACTS im offering...I truely do not think this sitiation was caused by DM... look at the data..if the patient had poirly controlled DM they would be on SQ insulin..this pt is only on metformin...not saying the is no fluid deficit maybe mild but the The first part if stem clearly shows the pneumonia is the beginning of all the subsequent problems..really. .as they teach in school..the underlying problem must be fixed and treat symptoms I.e. insulin etc...
    I think your teachers would be proud of you for your grasp of physiology. Applied medicine isn't always clear and patients seldom meet the exacting criteria that is presented in the texts. The pneumonia, or the infected leg, clearly began a sequale of events of events and of course more information is needed to make a definitive diagnosis.

    I think we can agree this patient is sick and acidotic we just disagree on the definitive cause of the presenting labs.
    Shock is hypotension with end organ injury: it classified as being due to malfunction of 1) the Pump (cardiogenic), 2 ) the Tubing (distributive), or 3) the Fluid (hypovolemic).

    Hypotension and Shock are caused by a problem with Heart Rate, Stroke Volume or Peripheral Resistance.
    There are only three types of shock, problems with the heart, sometimes called cardiogenic shock, problems vascular system, known as distributive shock, and loss of circulating volume, known as hypovolemic shock.
    Although textbooks and examiners often emphasize the classification of shock, in the real world, it is often more effective to use the physiologic approach to shock:

    • Shock is due to inadequate blood pressure.
    • Low blood pressure is due to inadequate cardiac output or low peripheral resistance.
    • Low cardiac output is caused by a problem with heart rate or stroke volume.
    • Heart rate abnormalities: too fast (tachycardia), too slow (bradycardia).
    • Stroke Volume abnormalities: failure to receive, failure to eject, inadequate volume
    • Low peripheral vascular resistance is due to inappropriate vasodilatation.
    When you graduate you will find that the reality of caring for patients is convoluted and is seldom clearly defined........Be open to opinions even if they are in conflict with your own. You are intelligent and have a great grasp on physiology. I think you will make a great nurse.

    Great job! All the best.
    Last edit by Esme12 on Mar 22, '13
  2. by   nurseprnRN
    Part of your assignment is to present exactly these sorts of differential decisions-- you are not responsible for the medical diagnosis but it is perfectly appropriate to think if this, then that; if this, then that; if this, then that. This indicates that you are thinking ahead and alert for signs that could tell you more about the possibilities (getting more information is always a good idea while treating the immediate threat(s) to survival). Bless your faculty for teaching you so well.
  3. by   MendedHeart
    This is an excellent case study and discussion..did they ever find out what it was?