Sepsis Shock Case Study part 2

History of Current Problem: Jack Holmes a 72-year-old Caucasian male brought to the ED by ambulance from a skilled nursing facility (SNF). According to report from the paramedic, when the SNF nursing staff attempted to wake him this morning, he would not respond, and his BP was 74/40 with a MAP of 51. He has a history of Parkinson’s disease, COPD, CHF, HTN, depression, and a stage IV decubitus ulcer on his coccyx that developed three months ago. He does not follow commands, is unresponsive to verbal stimuli, but responds to a sternal rub with grimacing and withdrawing from stimulus. Personal/Social History: He has lived in the skilled nursing facility the past three years and has been bed bound the past year due to his advanced Parkinson’s disease. He was a heavy smoker, 1 PPD for 40 years until he moved to the SNF. 1. What is the RELATIONSHIP between RELEVANT current problem data and the primary medical problem? RELEVANT Current Problem Data: Clinical Significance Low BP with MAP of 51 Hypoperfusion of the tissue which can hinder oxygenation Stage 4 Ulcer on his coccyx that developed 3 months ago Ulcer not healing due to inadequate tissue perfusion COPD, CHF, HTN, Parkinson’s disease and old age Unresponsiveness to verbal stimuli Altered immune response due to these comorbidities and lowered functioning immune system given the patient’s age. Altered LOC RELEVANT From Social History: Clinical Significance Skilled Nursing Facility Bed bound due to his parkinson’s Depression More exposure to pathogens or iatrogenic illness at the facility Poor skin integrity, atrophy of muscle, renal calculi, DVT, isolation Isolation, no interest or motivation in performing ADLs, unable to self advocate, withdrawing from peers