Septic Shock Case Study – NUR331 Complex Care Task 1B

Introduction

Septic shock is a life-threatening medical emergency that requires immediate intervention to prevent organ failure and death. It results from uncontrolled infection, leading to widespread inflammation, severe hypotension, and impaired tissue perfusion (Singer et al., 2016).

In this case study, Mr. John Douglas, a 70-year-old factory worker, presents to the emergency department with a 4-day history of nausea, vomiting, and abdominal pain. His vital signs indicate septic shock (T 39°C, HR 120, BP 90/60, RR 24, O2 Sats 92%). This case study will apply evidence-based principles of care assessment, prioritization, and discharge planning within the social justice framework, ensuring equitable and responsive care.

Systematic Assessment (600 words)

A structured systems approach is used to assess the severity of Mr. Douglas’s septic shock and guide nursing interventions.

1. Central Nervous System (CNS) Assessment

• GCS 15 (alert, oriented, no neurological deficits).
• Monitor for early signs of sepsis-related encephalopathy (confusion, agitation).

2. Cardiovascular System (CVS) Assessment

• HR 120 (tachycardia due to compensatory response).
• BP 90/60 (hypotension indicating septic shock).
• Capillary refill > 3 sec, indicating poor perfusion.
• Nursing action: Immediate fluid resuscitation (30mL/kg crystalloid bolus).

3. Respiratory System (RESP) Assessment

• RR 24 (increased due to metabolic acidosis).
• O2 Sats 92% (suggests respiratory compromise).
• Monitor for respiratory failure and need for oxygen therapy.

4. Abdominal (ABDO) & Renal System Assessment

• Generalized abdominal pain, distension (suspected peritoneal infection).
• No bowel movements for 4 days → risk of septic ileus.
• Monitor urine output (<0.5mL/kg/hr = acute kidney injury).
• Nursing action: Insert urinary catheter to monitor output and renal function.

5. Other Important Considerations

• Sepsis Workup: Blood cultures, lactate levels (>4 mmol/L indicates tissue hypoxia).
• Early Empirical Antibiotics: Administer broad-spectrum antibiotics within 1 hour.

Priorities of Treatment (1000 words)

Priority 1: Fluid Resuscitation & Hemodynamic Support

• Goal: Restore circulating volume & prevent organ failure.
• Immediate actions:
  ✅ Administer IV fluids (30mL/kg crystalloid bolus).
  ✅ Monitor BP response & urine output.
  ✅ Escalate to vasopressors (norepinephrine) if fluids are inadequate (Perner et al., 2016).

Priority 2: Infection Control & Antibiotic Therapy

• Goal: Eradicate infection source & prevent worsening sepsis.
• Immediate actions:
  ✅ Obtain blood cultures before antibiotic administration.
  ✅ Administer empirical broad-spectrum IV antibiotics within 1 hour (Evans et al., 2021).
  ✅ Monitor for signs of antibiotic resistance.

Priority 3: Respiratory & Oxygenation Support

• Goal: Prevent respiratory failure & maintain oxygenation.
• Immediate actions:
  ✅ Apply supplemental oxygen (target SpO2 > 94%).
  ✅ Monitor ABGs for metabolic acidosis.
  ✅ Escalate to high-flow oxygen or ventilation if needed.

Priority 4: Renal & Metabolic Monitoring

• Goal: Prevent acute kidney injury due to hypoperfusion.
• Immediate actions:
  ✅ Monitor urine output hourly (<0.5mL/kg/hr suggests AKI).
  ✅ Check lactate levels (>4 mmol/L suggests hypoperfusion).
  ✅ Consider dialysis if renal function deteriorates.

Discharge Planning (200 words)

• Social Justice Framework: Ensure equitable access to post-discharge care for vulnerable patients like Mr. Douglas, a low-literacy factory worker.
• Education on Infection Control: Reinforce the importance of early symptom recognition & follow-up care.
• Home Support: Given his low health literacy, assign a community nurse for post-discharge monitoring.
• Alcohol Cessation Support: Since he drinks 6 beers daily, refer to alcohol dependency programs to prevent further immunosuppression.

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