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Edwina Brown D.O.B. 14.01.1978 URN 67232 Weight 73kg No known allergies Edwina has been admitted to the intensive care unit you are working on. At the start of the shift you receive the ISOBAR handover below. ISOBAR handover Details Identity Edwina Brown D.O.B. 14.01.1978 URN 67232 Situation Edwina was admitted overnight to the intensive care unit. She was being treated 12 hrs ago for severe anaphylactic shock. Initially she was treated in the Emergency Department, where she suffered a cardiac arrest, but was successfully resuscitated. Her anaphylactic shock was treated initially with adrenaline, intravenous fluid and corticosteroids. Her oxygen saturations are low despite having high flow oxygen Her blood pressure initially improved, the urticaric rash has resolved and the acute respiratory wheeze resolved. However over the past three hours, Edwina’s blood pressure has fallen again. Her urine output has fallen. Her lactate level has risen to 4.5mmol/l She has been administered 1 litre of Normal Saline intravenously over 1 hour. There are NO signs of ongoing anaphylaxis Observations A – patent – but at risk due to GCS B – RR26bpm, SaO2 86% on 15l/min Oyxgen C – HR112bpm, BP 80/65mmHg, Hourly urine output 25 mls. D – GCS = 8 (E1, V3, M4) – BSL E – Temp 36.5.0 deg C Arterial Blood gas: pH: 7.25 pO2: 75mmHg pCO2: 45mmHg Bicarb : 18mmHg Base excess: -4 Background Edwina is a student physiotherapist in her final year of university. She lives with her parents. She is known to be allergic to bees and usually carries two epipens. Agreed plan Current treatment: On highflown oxygen – 15l/min oxygen via non-rebreather mask 1 litre normal saline administered IV over past hour Indwelling urinary catheter in situ Attached to cardiac monitor Read back / questions None PRIMARY SURVEY AND PROVISIONAL DIAGNOSIS Edwina has been diagnosed with multi-organ dysfunction syndrome (MODS). Pathophysiology (min 250 words) Explain in your own words what multiorgan dysfunction syndrome (MODS) is and how a nurse might recognise it in their patient. Discuss why this condition can be difficult to manage. How common is the condition? Has the condition become more common following the outbreak of COVID 19? If so, why might this be? Edwina cannot sustain oxygenating her organs unassisted. What measures can be take to address this? Pharmacodynamics (min 250 words) Edwina is hypotensive and is not responding to a fluid challenge. The doctor orders a nor-adrenaline infusion How is the dose calculated and how what would the correct dose be for Edwina. What are the potential advertse effects for this drug? What is the current evidence for the use of this drug? Are there alternatives? Pharmacokinetics (min 250 words) With reference to the vasopressor you have discussed in the previous section – discuss the following: The drug has been ordered through the intravenous route. Discuss the considerations that should be taken into account when administering this drug. Are there any patients this drug should be used with caution – if so discuss the rationale for caution. What other drugs could be used that have a similar effect? What does current evidence recommend regarding the choice of vasopressor for treatment of neurogenic shock? Ethico-legal aspects of nursing (min 250 words) With reference to Edwina’s case discuss the how the nurse is accountable for Edwina’s well being and the consequences of below standard care. You should refer to the Registered Nurse standards for practice. You may choose to discuss issues such as maintaining capability for practice, providing safe, appropriate and responsive nursing care. What would constitute negligence from a legal perspective should Edwina suffer harm?
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