Nursing care of septic shock patient Tham Phannara Hospital Nakhon Si Thammarat Province: Two comparative case studies
Abstract
Sepsis is a life-threatening crisis caused by a severe and persistent inflammatory process in the body. It causes septic shock, leading to multiple organ dysfunction.
The purpose of this study was to comparative study; disease mechanism, pathophysiology, severity of disease and nursing care for patients with sepsis who are in shock. Nursing care of septic patients with shock who are screened at the outpatient department and admitted to the inpatient ward, Tham Phannara Hospital, Nakhon Si Thammarat Province.
The results of the study found that case study number 1, a Thai man aged 57 years, gave a history that 1 day before coming, he had a fever and pain, nausea, not vomiting, burning sensation when urinating. The patient went for treatment at the clinic and received antibiotics and medicine to treat nausea and vomiting and was sent home, but the symptoms did not subside. One hour before coming, he had a fever, pain, very tired, so relatives took him to Tham Phannara Hospital. The patient had symptoms of drowsiness and abnormal vital signs. The doctor admitted him for treatment in the inpatient ward. Diagnosis was pyelonephritis with sepsis. The patient had low blood pressure BP 60/40 mmHg. The doctor gave medication to increase blood pressure, gave intravenous fluids, retained Foley catheter. The patient was restless, urine came out in the stream, intubation was performed and the patient was referred to Maharaj Nakhon Si Thammarat Hospital. He was admitted to the male medical ward, the endotracheal tube was able to be removed after 1 day and he stayed for a total of 5 days. The doctor allowed him to go home.
Case study number 2, a Thai man aged 40 years, gave a history that 3 days before coming to the hospital he had fever, chills, pain in the left lower abdomen, normal urination. The patient went to buy medicine to take himself: Paracetamol, Brufen, Diclofenac, Ciprofloxacin, Buscopan, until 3 hours before coming to the hospital he had nausea and vomited 4 times, dizziness, no symptoms of diarrhea. After that, relatives took him to Tham Phannara Hospital. The patient had symptoms of drowsiness and slightly low blood pressure BP 89/60 mmHg. The doctor admitted him for treatment in the inpatient ward. Diagnosis was pyelonephritis with septic shock and gave Plasil 10 mg IV stat, antibiotic drugs, blood pressure–increasing drugs, intravenous fluids, retained Foley catheter. The patient had a pale face, cold sweat, numbness of the hands and feet, nausea, vomiting, low blood pressure 87/60 mmHg. The doctor increased the dose of blood pressure drugs, gave oxygen via cannula 3 LPM and referred him to Thung Song Hospital for continued treatment. He stayed at Thung Song Hospital for 7 days. The doctor allowed him to go home.
Nursing of septic patients with shock had symptoms and signs that could change over time and risk the patient’s life. Nurses had a duty to monitor, follow up, and evaluate results to cover all dimensions, using Gordon’s care model framework to assess the patient’s health condition including physical, mental, emotional, social and spiritual aspects according to nursing standards in order for the patient to be safe and have a good quality of life.
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