Part II It has now been 24
Part II It has now been 24 hours since Sam has been intubated and in the ICU. His parents are at his bedside. Both Sam and his parents are practicing Buddhists. Sam has a living will that states he does not want to be on the ventilator longer than 4 days without improvement. Sam’s parents have asked to have the sedation discontinued because of their religious beliefs. Assessment: Vital Signs: B/P 80/40, HR 120, T 102, RR 20, Pulse Ox 88% Ventilator: Vent: Assist Control (AC), TV 550, FiO2 90%, RR 20, PEEP 15 ABG: pH 7.30, PaCO2 46, Bicarb 24, PaO2 60 PaO2/FiO2 ratio: 68 Neuro: Patient is sedated Resp: Lungs with rhonchi bilaterally in all lobes Cardiac: CO 3.5, CVP 3, SVR 800 dynes/sec/cm-5 GI: Bowel sounds absent, NG tube to low continuous suction GU: Foley in place with Urine output <20 ml/hr Lab Values: Lactic Acid 40 mg/dL, Potassium 5 meq/L, Sodium 140 meq/L, Platelets 50,000, Creatinine 4 mg/dL, WBC 20,000 mm3 Doctor's Orders: Begin Dobutamine at 3 mcg/kg/min (IV bag is supplied with 500 mg Dobutamine mixed in 250ml D5W) Begin Levophed at 1.5mcg/kg/min (IV bag is supplied with 1000 mg Levophed in 500 ml D5W) Sam is now in septic shock. What manifestations do you see that would indicate septic shock (be specific to Sam)? Calculate the Mean Arterial Pressure (MAP). Should you be concerned about the MAP? Calculate the ml/hr drip rate for the Dobutamine drip. What are two adverse reactions you need to monitor for Dobutamine? What are the two effects of Dobutamine that will help Sam? Calculate the ml/hr drip rate for the Levophed drip. What two adverse reactions do you need to monitor for Levophed? What are the two effects of Levophed that will help Sam? What are your top three priorities, with rationale, at this time? (These must be discussed in detail to get the full points.) Discuss one ethical dilemma you identify in relation to Sam's parents' request. Use either beneficence or non-maleficence to justify our answer.
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