Admission Order Set for Septic Shock

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For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

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To prepare:
Review the interactive media piece/branching exercise provided in the Learning Resources.
Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.
You will be asked to develop a set of admission orders based on the patient in the branching exercise.
The Assignment
Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.
Be sure to address each aspect of the order template
Write the orders as you would in the patient’s chart
Make sure the order is complete and applicable to the patient
Any rationale you feel the need to supply should be done at the end of the order set – not included with the order
Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.
A minimum of three current, evidenced based references are required.

Case study
About Your Patient in the Branching Exercise:
Your patient is an 84 y/o female who presents with c/o increased confusion and lethargy
• She lives alone and is fully functional
• Son reports that she has been increasingly confused and sleeping a lot at home.
• Son denies fever
• Patient c/o “Pain all over” and responds with repeated questions with, “I think I’m sick.”
• Vital Signs: 105/64, HR 115, RR 24, Temp 96, SP02 92% on room air
• Weight 165lbs, Height 5’4″
• The patient is alert and oriented to person but thinks its “1990”
• PMH: HTN, Recurrent UTI, Type II DM, HLD, CAD,
• Allergies: No known allergies
• Medications
o Metoprolol 50mg po daily
o Lasartan20mg po daily
o Atorvastatin 20mg po daily
o Lantus 20 units qhs
o Metformin 500mg po bid
o ASA 81mg po daily
o Calcium Citrate 1.2g daily

Diagnosis Septic Shock UTI
Patient presents with the above
through diagnostic efforts she meets criteria for:
Septic shock orders with antibiotics for UTI Sepsis
Serum Lactate 4.5

A patient must have two or more of the following:
Temp >36.0 > 38
Heart rate above 90 bpm
Respiratory rate above 22-24 or Paco2 WBC 12000
or Bandemia > 10 %

First decision point
ordered
12 lead EKG
CBC to assess WBC potential or anemia
BMP electrolyte disturbance or potential for DKA
UA – urine analysis for infections
Chest X ray
Significant result for diagnosis for Septic shock for UTI
BMP results show:
glucose 1766
BUN 55 mg
Creatine 2

UA results:
Yellow Dark Cloudy urine
Sp gravity 1.042
protein (-)
Glucose (+)
Hematuria (+)

Diagnosis for admission orders UTI Septic Shock
results of follow up blood pressure 82/42
Serum Lactate 4.5

Patient is rapidly becoming severe septic
https://www.ihaconnect.org/Documents/SepsisPDF

I have included the order set, the diagnosis, I just need you to put it on the form and I can adjust the orders later, in APA with resources of course

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