NRNP 6566 Week 4 KC

• Question 1

A 47 year old male admitted with an infected elbow wound. On his second day in the hospital you find him in his

room confused and agitated.

Vital signs are as follows:

Temperature – 96.2 °F

Pulse -140 beats per minute

Respirations – 40 breaths per minute

Blood Pressure – 90/40 mmHg

Labs include a WBC count of 3,000

Pt weighs 185 pounds

Further assessment of him includes:

• Urine output of 100cc for the last 8 hours

• Pulse oximetry of 88% on room air

• Pallor

What is your working diagnosis?

Corre

ct

Answ

er:

There are 4 stages of sepsis.

Systemic Inflammatory

Response Syndrome

(SIRS)

Sepsis Severe Sepsis Septic Shock

Criteria – any 2 of the

following:

*Temperature over 100.9

or less than 96.8

*Heart rate over 90

*Respirations over 20 per

minute

*WBC over 12,000 or

less than 4,000

Meet SIRS criteria and

have a possible or

documented source of

infection

*positive cultures or

possible infection site

Sepsis criteria plus

evidence of organ system

dysfunction

*new need for invasive or

non-invasive respiratory

intervention

*BP less than 90 systolic,

MAP less than 65, or

Systolic BP 40 mmHg

less than previous

documented BP

*New altered mental

status

*Cr greater than 2 or

urine output less than

0.5cc/kg/hour for 2 hours

*Plateletssless than

100,000

*Lactate greater than 2

mm/L

Severe sepsis criteria plus

any one of the following:

*Tissue hypoperfusion

persists despite

crystalloid fluid

administered.

*need for vasopressors

documented by BP less

than 90 systolic, MAP

less than 65, or Systolic

BP 40 mmHg less than

previous documented BP

* Lactate greater than 4

mm/L