Mr. McCannon, a 82-year old male, presents to the Emergency Department (ED) with urinary hesitancy and burning and a fever at home of 101.8?F. His caregiver states “he just doesn’t seem like himself”.What initial nursing assessments need to be performed for Mr. McCannon?Upon further assessment, Mr. McCannon is weak, his skin is warm and dry, and his face is flushed. He is oriented to person and place, but states the year is 1947. His vital signs were:BP 98/63 mmHgHR 94 bpm and regularRR 29 bpmSpO2 92% on Room AirTemp 38.9?CHt 170.4 cmWt 61 kgWhat diagnostic tests should be ordered for Mr. McCannon?What nursing actions would you take at this time for Mr. McCannon Why?The ED provider orders the following:Bloodwork – CBC, BMP, ABG, Lactic Acid, Blood Cultures x 2Urine Tests – Urinalysis, Urine CultureDiagnostics – CXR (chest x-ray), KUB (x-ray of kidneys, ureters, and bladder)Nasal Cannula to keep SpO2> 92%Meds – 1L Normal Saline bolus IV x 1, now. 1,500 mg Vancomycin IVPB x 1 dose, nowWhich order should you implement first? Why?Which order should you implement first? Why?All blood and urine tests are completed and you initiate the fluid bolus for Mr. McCannon You are still waiting for the Vancomycin to arrive from the pharmacy. You notice he is more drowsy. He is now only oriented to self and feels warmer. You take another set of vital signs to find the following:BP 85/49 mmHg MAP 62 mmHgHR 107 bpm Temp 39.3?CRR 35 bpm SpO2 87% on Room AirMr. McCannon lab results have also resulted, the following abnormal values were reported:WBC 22,000 / mcL Lactic Acid 3.6 mmol/LpH 7.22 pCO2 30 mmHgHCO3 16 mEq/L pO2 64 mmHgUrine Cloudy with sedimentWhat action(s) should you take at this time? Why?What orders do you anticipate for Mr. McCannon? (procedures, meds, transfer, etc?)Mr. McCannon responds well to the first liter of fluids, and antibiotics are initiated within an hour of arrival. The ED physicians place an arterial line and central line to initiate vasopressors. They order a Norepinephrine infusion to be titrated to keep MAP > 65 mmHg. The Critical Care team asks you to prepare the patient for transfer to the ICU.Art. Line BP 82/48 mmHg MAP 58 mmHgHR 122 bpm CVP 4 mmHgRR 32 bpm SVR 640 dynes/sec/m-5SpO2 90% on Room AirWhat, physiologically, is going on with Mr. McCannon?What explanation or education topics would you want to provide to the patient and his caregiver before discharge?
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