Pre-Scenario: Sepsis
Jannette is a 33-year-old female who presented to the ED accompanied by her significant other with complaints of generalized malaise and night sweats. Jannette states that over the last week she has been feeling overly fatigued and developed a coarse, congested cough that she states she got from her daughter. At the time of initial assessment Jannette’s vital signs are the following: 94, 127/67, 17, 38.2, 91% on RA, 4/10 pain (headache) Jannette is started on Avelox for a suspected pneumonia confirmed by x-ray in the emergency department.
Today is Jannette’s third day on your unit. She complains today of a tight sore chest that is worsened by coughing. She states she has not been able to stop coughing as of yesterday afternoon but has not been expectorating anything. A repeat chest x-ray, echocardiogram and blood cultures were completed. The results are pending. Today her vital signs are the following: 116, 93/49, 22, 38.4, and 90% on 2L.
PMH
DMI
Hepatitis C
Cesarean sections x2
Incision and drain (MRSA +)
Polypharmacy abuse (last use 6 years ago – prior to daughter’s birth)
Initial examination:
Alert and orient x4; withdrawn and sluggish
Fatigued-dizzy upon standing
Skin- flushed (face)
Rigors (tremors)
HR 116
Murmur present
LLE- edema (+2)
Scattered rhonchi
Non-productive cough
Inflammation and wound to left great and second toe (appear to originate at puncture site between toes)
- What can you do to engage yourself with this patient’s experience and show that he/she maters to you as a person. Utilize Swanson’s caring frame work to guide your practice.
- What are your top three discharge planning concerns? How will you seek addressing them?