Skip to Main Content

Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mheducation.com) for more information.

LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Recognize the signs and symptoms of sepsis and septic shock.

  • State patient variables used to diagnose sepsis and septic shock.

  • Identify the initial treatment goals for patients after the diagnosis of sepsis.

  • Formulate a comprehensive treatment plan for the initial management of patients with sepsis.

  • Recommend appropriate supportive care therapies for patients with sepsis.

PATIENT PRESENTATION

Chief Complaint

The patient presents from her nursing home with altered mental status and lethargy that has progressively worsened over the past 24 hours.

HPI

Ruth Carter is an 80-year-old woman who resides in a nursing home with a past medical history that includes hypertension, advanced dementia, chronic kidney disease, depression, and GERD. She was discharged last week from another hospital after being treated for 5 days for a urinary tract infection. She did well through the first 2 days after discharge but has become increasingly lethargic and drowsy in the past 24 hours. She is barely responsive at the time of assessment. She has had no reports of fever, nausea, vomiting, or pain.

PMH

HTN

Advanced dementia

CKD, stage II

Depression

GERD

PSH

Noncontributory

FH

No HTN, DM, CAD, cancer, or vascular disease

SH

Lives in a nursing home due to dementia

No tobacco, alcohol, or illicit drug use

Medications

Clonidine 0.2 mg/24 H transdermal patch every week

Acetaminophen 500 mg PO Q 6 H as needed for pain/fever

Lorazepam 0.5 mg PO Q HS

Hydralazine 50 mg PO TID

Omeprazole 20 mg PO QAM

Rivastigmine 4.6 mg/24 H transdermal patch Q HS

Levofloxacin 500 mg PO Q 24 H for 3 days (received 5 days of inpatient therapy; completed total course 2 days ago)

Allergies

NKDA

Review of Systems

Unable to obtain due to patient’s mental status

Physical Exam

Gen

Unresponsive, thin appearing woman in acute distress

Vital Signs

BP 86/42 mm Hg, P 118–142 bpm, RR 14–35 breaths/min, T 35.6°C; SpO2: 94% on 8L NC, Ht 5′3″, Wt 50.8 kg

Skin

Skin is warm, dry and ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.