Posted: September 12th, 2022

Admission Orders

Admission Orders

Admission Orders
Primary Diagnosis: Septic Shock

Status/Condition (Critical, Guarded, Stable, etc.): Critical

Code Status: R65. 21

Allergies: No known allergies

Admit to Unit: Yes.

Activity Level: Critical.

Diet: Proteins, calories, carbohydrates, glutamine, healthy fats, whole eggs, fatty fish, peanut butter, and tofu. The healthy foods are effective for the recovery of the patient and gaining sufficient energy for the body.

IV Fluids:
• Critical Drips:  30 mL/kg Crystalloid Fluid Bolus (0.9% NS or LR) for Hypotension or Lactate ≥4.

Respiratory: Oxygen oxygen 15 l O 2/min, pulmonary toilet needed, ventilator settings – semi-recumbent position with elevated head of 30 to 45 degrees

Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose and route): Lactate > 4.0 and/or Sepsis induced hypotension (SBP < 90 mmHg, MAP < 65 mmHg, or SBP decrease by 40 from previous “normal”
30 mL/kg Crystalloid Fluid Bolus (0.9% NS or LR) for hypotension or Lactate > 4.0 > 125 mL hr,
30 mL/kg Target Achieved within 6 hrs of Time Zero of Lactate > 4.0 and/or Sepsis induced hypotension

Nursing Orders (vital signs, skin care, toileting, ambulation, etc.): Broad Spectrum ATB AND Delivered within 3 hrs, need for toileting, and ambulation.

Follow-Up Lab Tests: Complete blood count and urine tests. The tests are vital to identify any co-occurring condition or determine the infection (Font et al., 2020).

• Diagnostic testing (CXR, US, 2D Echo, etc.): Blood cultures to check for infection. A healthcare worker will carry diverse tests since a sepsis shock cannot be diagnosed with one test. The tests are relevant to check for viral infections or organ damage (Font et al., 2020). The diagnostic test may involve an assessment of the presenting symptoms including lightheadedness, low blood pressure, rapid heart rate, cool and pale legs, and arms, and lethargy or confusion. High or low body temperature is also used to examine for septic shock (Font et al., 2020). A healthcare worker will use diverse tests to rule out other infections.

Consults: Resuscitate the patient from septic shock to correct hypoxia. Identify the source of infection and treat it using appropriate antibiotics. Provide oxygen therapy to the patient to avoid adverse outcomes (Pan et al., 2017). Provide intravenous fluid to the patient. Prescribe and administer medication to the patient to enhance blood flow. If the condition is worse or not improving, further tests are necessary while surgery may be an option. Working with a multidisciplinary team will provide quality care to the patient (Pan et al., 2017). Administer calcium-channel blockers or intravenous administration to treat new-onset AF. Recommend high protein and carbohydrate foods and drinks to the patient. It is vital to avoid prolonged starvation. Assessment of the patient is critical to avoid deleterious effects (Pan et al., 2017).

Patient Education and Health Promotion (address age-appropriate patient education. if applicable):
The patient education interventions will encourage a patient to avoid colds or flu, get a pneumococcal vaccine, clean wounds, and avoid smoking (Pepper et al., 2018). Emphasize the need for early diagnosis and treatment. The patient should adhere to the treatment to ensure full control of the condition. The patient should take antibiotics to avoid infections. Regular vaccinations against viral conditions such as colds or flu are necessary (Pepper et al., 2018). The patient should get a vaccine against Covid-19 to prevent adverse outcomes.
Discharge Planning and Required Follow-Up Care:
The patient should identify the source of the infection, take medication as prescribed, and avoid the sources of the infections. The patient should stay at home without involvement in risky activities such as driving (Riche et al., 2018). The patient should wash hands and maintain a high level of hygiene. The patient should eat healthily, exercise regularly, drink enough fluids, and get sufficient rest (Riche et al., 2018).

References
Font, M. D., Thyagarajan, B., & Khanna, A. K. (2020). Sepsis and Septic Shock–Basics of diagnosis, pathophysiology and clinical decision making. Medical Clinics, 104(4), 573-585.
Pan, B., Alam, H. B., Chong, W., Mobley, J., Liu, B., Deng, Q., … & Li, Y. (2017). CitH3: a reliable blood biomarker for diagnosis and treatment of endotoxic shock. Scientific Reports, 7(1), 1-8.
Pepper, D. J., Jaswal, D., Sun, J., Welsh, J., Natanson, C., & Eichacker, P. Q. (2018). Evidence Underpinning the Centers for Medicare & Medicaid Services’ Severe Sepsis and Septic Shock Management Bundle (SEP-1) A Systematic Review. Annals of internal medicine, 168(8), 558-568.
Riche, F., Chousterman, B. G., Valleur, P., Mebazaa, A., Launay, J. M., & Gayat, E. (2018). Protracted immune disorders at one year after ICU discharge in patients with septic shock. Critical Care, 22(1), 1-10.

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