A 70-year-old female patient presents in the nursing home, and she has been unwell for the last 24 hours. The patients present with pyrex, tachycardia with borderline hypotension. The presenting vitals are Heart rate 110, blood pressure 100/70, respiration 16, temperature 38.8, AVPU= Voice, SpO2 97%.
The differential considerations when the patients present in the nursing home with the above signs include; causes of tachycardia and hypotension. Tachycardia can be associated with many causes that increase the heartbeat. Anything that interrupts the electrical impulse of the heart can be associated with increased pulse and thus tachycardia. For this presenting sign, it is advisable to consider atrial fibrillation. Atrial fibrillation is initiated by chaotic electrical impulses of the atria. Another consideration for this patient according to the presenting symptoms is the pyrexia. When looking at pyrexia from all dimensions, various agents and conditions may elevate the body temperature above the borderline. Some of the common agents include viruses, bacterial infections, extreme heat, and tumors. The conditions associated with elevation of temperature above the borderline include inflammatory diseases such as rheumatoid arthritis. Endocarditis is an infection of the heart muscles that is a key cause of the fever. When one has a persistent endocarditis, the body may respond to increased body temperature to mitigate the bacterial manifestation. For this case, therefore, the inflammatory diseases are also considered according to the presenting symptoms. Concern the third sign which is borderline hypotension; it is a critical consideration in this case study (Kortgen, et al., 2009).
When considering the borderline hypotension, it is a low blood pressure that is low in one individual, but it might be normal to another individual. The borderline hypotension will require a continued monitoring, but following the history of the patient, it is an essential tool for ruling out the presence of this condition. Considering this presenting symptom, the common causes of hypotension are any reduction of the blood volume, dehydration, and medications. Another cause of hypotension is the inflammation of some vital organs in the body. Since the heart functions to pump the blood throughout the body, any weakening of the heart muscles may cause a low blood pressure. The purpose of considering this condition into details is to locate the principal cause of the overall signs and symptoms. Pericarditis is a condition that falls under this consideration since it is a condition associated with low blood pressure due to inflammation of the pericardium muscles. Any infection that may cause an inflammation of the pericardium, it has a direct effect on the function of the heart muscles. Inflammation of the pericardium leads to accumulation of fluid in the pericardial cavity thus restricting the action of the heart to pump blood (Kortgen, et al., 2009).
The third differential consideration regarding this case study is sepsis or SIRS (systemic inflammatory response syndrome). This condition has to present symptoms that combine the above signs that the patient presented in the nursing home. From a clinical investigation of this condition in relation to the presenting signs and symptoms, sepsis is a complex condition that occurs when the immune system responses to the prevailing infections and injuries to the various organs and tissues. In the clinical setup, the common presenting signs for sepsis are elevated breathing rate, heartbeat, confusion, and fever. With the presence of bacteria in the circulation system, the body is triggered to react to these invading agents. The massive response of the immune system then manifests with similar signs and symptoms especially fever, increased heart rate, breathing, and low blood pressure (Kortgen, et al., 2009).
Patient History Review
According to the case study above, the patient has been unwell for the last twenty-four hours which is equivalent to a one-day-old symptomatic infection. Following this history of illness, there are key considerations to make that follow the guidelines for disease manifestation. In most infections whether bacterial, viral or bacterial infection, it takes a specific duration for disease manifestation. Concerning the bacterial infection, depending on the bacterial load, it is easy to make an estimate of when the disease might have invaded the body. Otherwise, some body factors may limit the use of this assumption since the capacity of the immune system varies from person to person. Concerning the presentation of symptoms within the last 24 hours, this might be an acute infection. Another consideration following this history is that some infectious agents may take a long manifestation period than expected. Some infections are accompanied with latent stages of infections especially for the viruses. This makes it harder to estimate when the infection took place as well its manifestation stage.
Assessment and Findings
On the assessment, the patient is asked to prepare for both physical and objective assessment. Firstly, is to ensure the safety of the patients before beginning the assessment. Patient security is comprised of different aspects such as data security, privacy, and confidentiality as well as not exposing the patient to harmful agents or even infectious agents during the assessment.
The purpose of patient assessment is to support the subjective findings with objective findings. In this case study, the subjective findings of presented by the patient were increased temperature, heartbeat, reduced blood pressure, and increased fever. The patient has no medical history of illness presenting with such symptoms. The patient didn't point out any life history incidence that might have exposed her to any bacterial or viral infection or any other infectious agent. Additionally, regarding the subjective findings for this patient, she didn't complain of any systematic dysfunction of body parts. Again there are no incidences of current medication that the patient is taking making it a newly manifesting infection. According to the findings of the subjective assessment, the illness appears to have newly manifested itself and therefore not an underlying condition. From the subjective findings, the diagnosis can't be made at this stage until further investigations are carried out under objective assessment. Following the above subjective findings, the assessment plan for this patient will go to the next assessment phase which is an objective assessment (Nhs.uk, 2017).
Concerning the objective assessment, it an assessment step that incorporates a physical examination of the patient, evaluation of vital signs, and laboratory examination of the patients to aid in the diagnosis. To begin with, a physical examination of the patient guided by the presenting signs and symptoms in the subjective findings starts with a head to toe examination. For the physical examination, the essential parts of the body that are examinable include the eyes, skin, and extremities (Nhs.uk, 2017). From the physical examination in relation to the chief complaints, the patient is examined for any observable inflammation that can be visualized with naked eyes or felt through a palpable touch. Concerning the suggestion that the patient is suffering from sepsis, a physical examination will check the skin and detect any inflamed glands. For glandular examination, the patient will be examined on her lymph nodes starting with the most common which are tonsils, and other systematic lymph in the various body parts that can be seen or felt through a touch. The essence of examining any inflammation of the lymph nodes is because these organs are highly affected when the body is attacked by any infectious agent may it be a virus, bacteria or even fungal agents (Nhs.uk, 2017).
The physical examination to assess any inflammation will also examine both the left the right upper hypochondriac region. In the right hypochondriac region, we have the liver as the major organ which can be felt by tender touch. While examining the region, the patient is also asked for any gritty pain that might be caused by the examination which can indicate any disorder. Other organs that might be inflamed following a sepsis incidence are the kidneys that are also found on the left and the right hypochondriac region (Nhs.uk, 2017). After doing a thorough examination of any inflammation of the visible organs and glands, another key examination goes to the skin. For the skin, it is a body organ that can indicate any objective finding related to a particular illness. Concerning the physical skin examination, the first key objective is to check for any breakage of the skin barrier such as a wound. Wounds are key routes for bacterial, viral, and fungal infections to the body. Since the skin acts as the barrier to protect the named agents, when any infectious agent bypasses this barrier, an infection takes place. Additionally, the skin will serve as an essential tool to prove the presence of hypotension. During hypotension, some of the extremities are poorly supplied with blood, and this condition can be visualized on the skin. During the physical examination on the skin, due to hypotension, the skin appears clammy, cold and pale (Nhs.uk, 2017).
Another set of objective assessment for this particular patient included testing the body temperature, blood pressure, respiration rate, and oxygen saturation rate. These are the key objective findings that will support the subjective findings.
Concerning the body temperature, the patient presented with fever to the nursing home. The fever having manifested for about the past twenty-four hours, it is a reliable indicative subjective finding that the patient was experiencing increased systematic core temperatures. Following the assessment, the patient presented with a core body temperature of 38.8. From the reference chart, the normal body temperature ranges between 36.5 to 37.5 degrees Celsius. Concerning the body temperature ranges for adults, the range is wider and accommodates figures from 33.2 to 38.2 degrees Celsius. To describe a fever, if the temperature falls above 38.2 degrees Celsius, it is referred to as a temporary rise in body temperature whereby it indicates something out of the normal physiological activities is taking place. In most cases, the fever is referred to as anything beyond 38 degrees Celsius. The patient having an average body temperature of 38.8 degrees Celsius indicates a serious infection that has caused the body to respond in this manner (Hopkinsmedicine.org, 2017).
According to the American Heart Association, low blood pressure is an abnormal condition that happens when the pressure caused by the flowing blood against the wall decreases below the borderline pressure. Through the many studies, the borderline blood pressure for one person differs from another, and therefore this objective finding relies on the given range. Any the cases of low blood pressure, the blood supply to the tissues and the vital organs decreases. With a significant decrease in pressure, for instance, 20 mm Hg, this change can cause an effect on some organs or tissues (Homeopathic Treatment & Homeopathy Medicines for all Diseases, 2017).
Concerning the patient assessment for blood pressure, a healthy individual will fall between ranges of 120 mmHg for the systolic and 80 mmHg for the diastolic results. In this study case, the patient had a reading systolic of 100 mmHg and a diastolic reading of 70 mmHg. From the subjective findings of these results, the patient was at her borderline hypotension. Although there are various causes of low blood pressure, some if the known causes have an underlying condition that is associated with the pathological changes (Hopkinsmedicine.org, 2017). In this case, the underlying patient cause of hypotension is not yet identified, but suggestively the patient is suffering from sepsis. Sepsis is a cause of low blood pressure when the infection affects the heart. Any infection that causes a negative impact to the heart tissues has a direct effect on its operation and therefore affecting the blood pressure (Homeopathic Treatment & Homeopathy Medicines for all Diseases, 2017).
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