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61 yr old female admitted to the ER with septic shock d/t a

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by

Jessie Cutforth

on 11 June 2014

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Transcript of 61 yr old female admitted to the ER with septic shock d/t a

Priorities of Care
1. Manage sepsis
2. Diabetes education and management
3. Morbid obesity education and management
Morbid Obesity Management/Education
Exploring motivation for change
discussions of future complications/risks (circular questions)
Education on healthy eating habits
Encourage ROM exercise
Education teachings with family on how to support pt
Dietician referral
Physical therapist referral
Psychiatrist referral-CBT
Record measurements (BMI/waist circumference) to set specific weight loss goals
Evaluation of Interventions
Cons
:
Readiness for patient teaching
Social support networks enabling poor eating habits
Lack of motivation to change dietary intake/increase physical activity
Poor quality of life

Pros
:
Sepsis managed well
"Diet" managed type-2 diabetes
Dietary counseling positive resource
Dietary changes with CBT shown to be more effective
Determinants of Health
Social Support Networks:

Family members actively involved in care; however, Mrs. G's family enables her weight gain/poor diabetes management by bringing her unhealthy meals and snacks
Physical Environment:

Mrs. G is non-weight bearing and therefore is at high risk for pressure ulcers and makes her weight loss journey more difficult
Personal Health Practices & Coping Skills:
Mrs. G left her IUD insitu for 37 years, she has poor eating habits and is unmotivated to increase her physical activity
Education:
Mrs. G and her family require education on Mrs. G's health status, treatment, and maintenance of illnesses.


Referrals
Psych Referral
Cognitive Behavioural Therapy
Nutrition Counseling
Appointment with Diabetic Educator
Follow-up with gynecologist
Physical Therapist
Promote ROM activities
Family Mediator
Wound Care Specialist
Optometry Referral
Chronic Pain Management Referral
Home Care
Mrs. G
61 yr old female admitted to the ER with septic shock d/t a calcified IUD (insitu x37yrs). Mrs. G is morbidly obese with type 2 DM, hypotension, CRF, OA, RA, GERD, & gallstones. Non weight bearing and total lift for transfer. She has a foley catheter and will ring for the bedpan. Mrs. G has many wounds in her skin folds that require daily and scheduled dressing changes. She has one daughter and two grandchildren, that come in to visit her often, however, they usually bring in unhealthy foods for the pt. IV (NS) running at 100mL/hr.
Diabetes Management
Sepsis Management
Administer fluids
Administer antibiotics
General --> gram-negative
Administer antipyretics
Monitor intake and output
Insert foley catheter
Monitor HR
Increased cardiac output


Why Are These Our Main Priorities?
1. Sepsis - Mrs. G's admitting diagnosis needs to be managed in order to effectively treat comorbidities and other underlying health issues in her life.
2. Diabetes - Diabetes elongates Mrs. G's healing time, contributes to ESRD, and plays a role in her obesity.
3. Morbid Obesity - Mrs. G's weight affects all her comorbidities by increasing her body's work load, altering her self image and quality of life.
Systemic inflammatory response syndrome secondary to infection
Monitor A1C, FBG and RBG level
Assess current dietary intake
Create a mock meal plan that fits patient's preferences and realities
Referral to diabetic educator
Referral to Cognitive Behavioral Therapy in conjunction with dietitian
Plan a family meeting to provide education for patient support systems
Patient's Strengths

Resiliency
- she has made it this far with all of her health complications
Social Support (Family)
- she has a daughter that loves her very much and wants the best for her mum

Mrs. G is in the precontemplation/contemplation stages of change. She participates in all of her patient care and things like physio, however, she does not seem to understand how important the interventions are to her health

It is important for us as nurses to work with patients like this to bring forward all of their strengths, and help the patient to stop hiding behind their weaknesses


Mrs. G
Full transcript