Download Nursing 203 Theory Case Studies

BMT and Septic Shock
Joe is a 16-yr. old boy transferred to the PICU @ 1000 from the Oncology Unit. Joe is
10 days status post BMT for ALL. On rounds this morning Joe was found to have a BP
of 80/60, pulse of 120, and a Capillary Refill Time (CRT) of >5 seconds. His extremities
were cool and mottled, and he was very anxious.
He received several fluid boluses on the Oncology Unit with no improvement of
perfusion, and he was transferred to the PICU with a diagnosis of Septic Shock. His
parents who are also very anxious accompany Joe to the PICU.

What is the pathophysiology of Septic Shock, and why is it common with patients
post BMT?

Would you classify this as a mild, moderate or severe episode?

What are the Nursing priorities for this patient at this time?

What other diagnostic tests would expect this patient to receive at this time?
At 1500, Joe is receiving humidified O2 @ 10 LPM . He received another 3 rounds of
fluid boluses upon admission, and was started on a Dopamine Drip. Since admission he
has received 2 Units of PRBC & 1 Unit of Platelets for a HCT of 22 and a platelet Count
of 40,000. His INR is 2, his D-Dimer is 3mcg/ml, and his ANC is 700/mm3. Joe’s BP is
92/60, HR is 100 with a CRT of < 4 seconds.

Is Joe’s condition improving or deteriorating, and what evidence informs your
impression?

What other signs/ symptoms would you look for to tell you that Joe’s condition is
improving or deteriorating?
The physician’s orders for Joe include:
(Joe’s weight is 45kg)
 IV fluids D5.25NS with 20 mEq of K per liter @ 55cc/hr (maintenance =
1500 cc + 20cc per kg for every kg over 20kg)
 Titrate O2 to keep O2 Saturation above 90
 Dopamine (concentration = rate of 1cc/hr =1mcg/kg/min) TRA
20mcg/kg/min or 20cc/hr
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at [email protected]

Do these orders make sense for this patient’s condition?

Assuming the information in parenthesis is the correct dose per kg for this
patient, are the ordered doses correct?

What other medications might be ordered for this patient to treat his Septic
Shock?

What are the educational needs for Joe and his family during his stay in the
PICU?

Would the care and treatment have been different if Joe had been:
o 6 years old instead of 16? If so, how?
o
26 years old instead of 16? If so, how?
o
76 years old instead of 16? If so, how?
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at [email protected]