Sepsis/Septic Shock RAPID unfolding clinical Reasoning Case Study (Jack Holmes, 72 years old)

Primary Concept Perfusion Interrelated Concepts (In order of emphasis)  Inflammation  Infection  Tissue Integrity  Clinical Judgment  Patient Education  Communication NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Safe and Effective Care Environment  Management of Care 17-23%  Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity  Basic Care and Comfort 6-12%  Pharmacological and Parenteral Therapies 12-18%  Reduction of Risk Potential 9-15%  Physiological Adaptation 11-17% Copyright © 2018 Keith Rischer, d/b/a KeithRN. All Rights reserved. Covered in Case Study History of Present 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. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?