Septic Shock Case Study
Septic Shock case study
Introduction This paper is talking about the patient who has septic shock then use the holistic nursing care to him. Holistic care is defined, as total patient care that include the physical, psychological, economic, and family needs of the person; Holistic nursing is using a knowledge, theories, and proficiency interaction with people in their care (Lucia, 2013) The definition of the septic shock is systemic inflammatory response syndrome, caused by any type of bacteria, fungi and viruses. The bacteria or fungi release toxins, which can block oxygen and nutrients from organs to make tissue damage, and cause low blood pressure and organ dysfunction. This may cause a may result in death due to drop in BP. Septic …show more content…
shock also is the most common cause of death (National Institute of General Medical Sciences, 2012).
Prevalence of septic shock In the United States, Disease Control and Prevention has assessed that septic shock is the tenth leading cause of death (Hoyert 2001). The numbers of persons are attracted with the deaths related to septic shock higher public awareness than other disease such as breast cancer and prostate cancer (Moss 2005)
According to Ricardo Fernandez in 2012, the mortality rate in 624 patients with septic shock admitted to the ICU 66.2%. The mortality rate of septic shock is decreasing in the United States, but patients with septic shock still have a high risk of death than other disease patients who are non-septic (Ricardo, 2012).
.
Pathophysiology of septic shock According Paul M.
Maggio & Carla Carvalho in 2013, bacterial toxin caused 70% of septic shock cases. In the first stage, arterioles and arteries will dilate, decreasing the resistance of peripheral arterial; then the cardiac output wills increases. That is base on the warm shock. And than, cardiac output will decrease, blood pressure will falls and typical sign and symptom of shock appear. Septic shock can cause low blood pressure, which would cause a poor capillary flow, then decrease in the amount of blood and oxygen to reach the other organs, and thus the result that decreased perfusion causes dysfunction and failure of one organs or more. If a patient with septic shock does not treat as soon as possible and appropriately, such as medications, antibiotics, blood pressure, and respiratory support with ventilator or oxygen, the patients will be death (Paul & Carla, …show more content…
2013).
Patient background
Patient Tim, a 45-year-old man, who had diagnosed as peritonitis secondary to acute appendicitis, was admitted to the intensive care unit (ICU) one day ago by accident and emergency department due to acute pain. He had complained of dull lower abdominal pain for 2 days before admission. His blood pressure was dropped to 94/54 mmHg, pulse was raised to 124/min, respiration rate were elevated to 25/min, and temperature was raised to 38.3C upon arrival to accident and emergency department. He then developed unconsciousness after half and hour admitted to ICU and diagnosed to have septic shock by the case doctor. On day two, Tim’s most updated vital signs were blood pressure 90/48 mmHg, pulse 130/min, respiration rate 30/min, oxygen saturation 93%, and temperature 39C, K+5.3 mEq/L, Creatinine 118 umol/L, HCO3 20, and Peaked T wave noted on ECG. Moreover, refer to appendix A for Tim’s latest blood tests result
Assessment: Gordon’s function health patterns
Health Perception and Management:
Tim had well past medical history, and no known drug or food allergy. According to his wife, he is no use of cigarettes, drug and alcohol. He has dull lower abdominal pain for 2 days before admits to hospital. Then his pain became not tolerated, so is colleague then rushed him into the hospital.
Nutritional metabolic:
Tim haven not drink and eat anymore after he went into the hospital and coma stage. We use the intravenous fluid support his body needs. His skin and oral mucous is dry but intact. Because he was in coma stage so we cannot assess his weight and height.
Elimination:
Before he admitted into the hospital, he had complained of constipation for 2 days, and he had not any stool in these one and half days in ICU ward. He was oliguria. His urine output only was about 15-20 ml per hour and the color was dark yellowish. We cannot to know his elimination pattern because he was unconscious.
Activity exercise:
According to his wife, he has not any regular exercise in the leisure time. After he admitted to the ICU ward, he only lies on the bed, but we will help him to turn to the different side every two hours to prevent pressure sore.
Sleep rest:
According to his wife, generally he
Cognitive-perceptual:
We done the Glasgow coma scale for him, his score was 5, which showed that he was unconsciousness and may had some kind of neurological damage.
Self-perception/self-concept:
Tim was unconscious. His self-perception pattern was not able to assess.
Role relationship:
According to his wife. He lived with his wife and two teenage sons. They had the good relationship. And then he had very few closed friends.
Sexuality reproductive:
Their sexual relationship as satisfied and they used contraceptive pill for birth control.
Coping-stress tolerance:
His coping stress tolerance was not able to assess because he was unconscious.
Value-Belief pattern: His value belief pattern was not able to assess because he was in coma.
Focus assessment
Elimination: monitor intake and urine output every one to two hours. He had intravenous fluid infused 125 ml sodium chloride per hour that was used to support his body needs. And then the urine output was about 15 to 20 ml per hour and he had not any stool after admitted to ICU. Monitor the electrocardiogram tracings every hour, because hypokalemia is the most common reflection of cardiac. The result of the ECG, peaked T wave noted on ECG.
Skin assessment was done. His skin was dry and intact, no pressure sore and the wound were found. Oral mucous was also assessed, no dryness was found. After palpation was found that Tim’s peripheral pulses have signs of decrease of blood flow and inadequate tissue perfusion such as delayed capillary refill, clammy skin, rapid pulses.
Furthermore, routine blood test for whole blood count, renal function, electrolyte, and arterial blood gas was also done to Tim, K+5.3 mEq/L, Creatinine 118 umol/L, HCO3 20. Other refers to appendix A for detail results.
Possible nursing diagnoses
1. Rick of complications of hypovolemia related to peritonitis secondary of septic shock.
2. Rick of complication of hyperkalemia related to reduce renal perfusion secondary to septic shock.
Diagnoses Priority Rick of complications of hypovolemia related to peritonitis secondary of septic shock is the first priority of all the diagnoses because shock of hypovolemia results from decreased circulating volume of blood and water.
The circulating volume if loss more than 30%, which will decrease the cardiac output and vital organs supply. Thus, the cells will be oxygen insufficient, the patient will develop metabolic acidosis. Acidosis in normal tissue metabolism will lead to cellular destruction and, and then finally will be death. (Lawrence & Sharon, 2006) The second diagnosis based on prioritization is rick of complication of hyperkalemia related to reduce renal perfusion secondary to septic shock, because hyperkalemia is a potentially life- threatening problem caused by failure kidney to excrete potassium, and impair the acid-base and fluid balance, and affect the depolarization of skeletal muscle and heart (Joyce & James,
2006)
Name: Tim Sex/Age: 45-year-old man Date of Assessment: October 5th, 2013
Medical Diagnosis: Septic shock
Diagnostic Statement: Rick of complications of hyperkalemia related to reduce renal perfusion secondary to septic shock
Data
Diagnosis
Goal and Expected Outcomes
Interventions
Rationales
Evaluation
Assessment
Subjective Data:
Not available
Objective data:
Laboratory and diagnostic tests show the following abnormal results.
• K+5.3 mEq/L (normal 3.5 to 5 mEq/L)
• Creatinine 118 umol/L (normal 62-115 umol/L)
• Urine output 15-20ml per hour which less than 0.5ml/kg/hour
• Peaked T wave noted on ECG
Problem: Rick for complications of hyperkalemia
Etiology:
Renal
Reduce renal perfusion secondary to septic shock
Goal:
To manage and minimize episode of hyperkalemia by using laboratory result.
Expected Outcomes:
1. Maintain normal ECG
2. Maintain serum potassium level within normal range
3. Maintain urea and creatinine level within the normal range
4. Maintain urine output within the normal range
1. Monitor for signs and symptoms of hyperkalemia.
Weakness to flaccid paralysis
Muscle irritability
Parenthesis
Nausea abdominal cramping or diarrhea
Oliguria
2. Monitor Electrocardiogram (ECG): tall, tented T waves, ST segment depression, prolonged PR interval (>0.2 seconds), first-degree heart block, bardycardia, broadening of the QRS complex, eventual ventricular fibrillation, and cardiac standstill.
3. Monitor vital sign every four hours.
4. Monitor intake and output.
5. Restrict food with high potassium, fluids and IV solutions with potassium
6. Provide range-of-motion (ROM) exercise to extremities.
7. Administer medications to reduce serum potassium levels such as IV calcium, Sodium bicarbonate, glucose, insulin, and cation-exchange resins (e.g. Kayexalate, hemodialysis) as prescribed.
1. Hyperkalemia can result from the kidney’s decreased ability to excrete potassium or from excessive potassium intake. Acidosis increases the release of potassium from cells. and reduce the action of GI smooth muscle. (Carpenito, 2013).
2. Fluctuations in potassium will affect neuromuscular transmission and cardiac monitoring may show early changes as premature ventricular beats. (Carpenito, 2013).
3. For baseline records. (NANDA, 2012).
4. To detedt complications due to renal insufficiency (Carpenito, 2013).
5. To reduce the potassium level (Carpenito, 2013).
6. ROM improves muscle tone and reduces cramps cause by hyperkalemia (Carpenito, 2013).
7. To block effects on the heart muscle and force excretion of potassium (Carpenito, 2013).
.
To evaluate expected outcome 1:
1. Monitor Tim ‘s ECG, within 8 hours, his T waves return to normally baseline.
To evaluated expected outcome 2:
1. Testing every one to two hours of serum potassium level until returned to normal.
To evaluated expected outcome 3:
1. Monitor urea and creatinine level.
To evaluated expected outcome 4:
1. Monitor the urine output hourly in the bedside bag.
Name: Tim Sex/Age: 45-year-old man Date of Assessment: October 5th, 2013
Medical Diagnosis: septic shock
Diagnostic Statement: Rick of complications of hypovolemia related to peritonitis secondary of septic shock
Data
Diagnosis
Goal and Expected Outcomes
Interventions
Rationales
Evaluation
Assessment
Subjective Data
Subjective data:
Not available
Objective data:
1. Dry mucous membranes
2. Cold clammy skin
3. Blood pressure 90/48
4. Tachycardia 130 beats per min
5. Oliguria: urine output 15-20ml per hour
Problem: Rick for complications of hypovolemia
Etiology:
Related to peritonistis secondary of septic shock
Goal:
To manage and minimize hypovolemic episodes and prevent for complications of hypovolemia.
Expected Outcomes:
1. Show no signs and symptoms of dehydration such as dry oral mucous.
2. Urine output back to normal range: 0.5ml/kg/hr
3. Blood pressure back to normal range: systolic 100-120 mmHg and diastolic 60-90 mmHg
4. Pulse back to normal range: 60-100 beats/min
8. Monitor intake and output including parenteral and oral, urine and drainage.
9. Monitor vital sign especially blood pressure and pulse.
10. If not contraindicated, place the client in supine position.
11. Insert an IV line and use a large-bore catheter if blood or large volume fluid replacement is administered.
12. Collaborate with physician or advanced practice nurse to replace fluid losses at a rate sufficient to maintain urine output more than 0.5mL/hg/hour (e.g. saline or Ringer’s lactate).
13. Administer oxygen as ordered.
8. Early detection of fluid deficit allows early interventions to prevent complication of hypovolemia (Carpenito, 2013).
9. To obtain baseline records and detect early signs of change in condition (NANDA, 2012).
10. Placing the patient in supine position during shock can increase venous return and cardiac output
11. To maintain adequate electrolyte and IV line is necessary for fluid infusion and IV medication such as vasopressin (Carpenito, 2013).
12. To promote optimal renal tissue perfusion (Carpenito, 2013).
13. Oxygen therapy can increase oxygen circulation level which is necessary for hypoxemia (Carpenito, 2013)
To evaluated expected outcome 1:
1. Skin assessment, oral mucous assessment, and blood test for whole blood count and electrolytes.
To evaluated expected outcome 2:
1. Monitor fluid intake and urine output.
To evaluated expected outcome 3:
1. Monitor blood pressure every hour.
To evaluated expected outcome 4:
1. Monitor pulse every hour.
Barrier and limitation One of the barriers is lack of experienced nurse work in the intensive care unit. Inexperienced nurses do not have enough knowledge in taking care of the patients in ICU, which require special care. Also the communication among medical staffs and between the nurses and the family are not enough. Therefore, misunderstanding will happen when taking care of the patient. One of the limitations is the shortage of nurses. The workloads are too high and thus nurses are always too busy and do not have time to communicate with the family. The facilitator in nowadays is that the nursing program is based on university degree and therefore they are more professional and have more knowledge as compare with the old systems where nurses were trained in the hospital and did not have a bachelor degree. To improve the current barriers and limitations, hospital should hire more nurses to reduce the workload. Consequently, the nurses will be able to have better communication with the colleagues and family. With better communication, patient will receive better care.
Conclusion
Tim was diagnosed with septic shock and transferred to the ICU one day ago. Abdominal assessment, blood test, and ECG were performed to him. Gordon function pattern was also done. After the assessment,
Introduction This paper is talking about the patient who has septic shock then use the holistic nursing care to him. Holistic care is defined, as total patient care that include the physical, psychological, economic, and family needs of the person; Holistic nursing is using a knowledge, theories, and proficiency interaction with people in their care (Lucia, 2013) The definition of the septic shock is systemic inflammatory response syndrome, caused by any type of bacteria, fungi and viruses. The bacteria or fungi release toxins, which can block oxygen and nutrients from organs to make tissue damage, and cause low blood pressure and organ dysfunction. This may cause a may result in death due to drop in BP. Septic …show more content…
shock also is the most common cause of death (National Institute of General Medical Sciences, 2012).
Prevalence of septic shock In the United States, Disease Control and Prevention has assessed that septic shock is the tenth leading cause of death (Hoyert 2001). The numbers of persons are attracted with the deaths related to septic shock higher public awareness than other disease such as breast cancer and prostate cancer (Moss 2005)
According to Ricardo Fernandez in 2012, the mortality rate in 624 patients with septic shock admitted to the ICU 66.2%. The mortality rate of septic shock is decreasing in the United States, but patients with septic shock still have a high risk of death than other disease patients who are non-septic (Ricardo, 2012).
.
Pathophysiology of septic shock According Paul M.
Maggio & Carla Carvalho in 2013, bacterial toxin caused 70% of septic shock cases. In the first stage, arterioles and arteries will dilate, decreasing the resistance of peripheral arterial; then the cardiac output wills increases. That is base on the warm shock. And than, cardiac output will decrease, blood pressure will falls and typical sign and symptom of shock appear. Septic shock can cause low blood pressure, which would cause a poor capillary flow, then decrease in the amount of blood and oxygen to reach the other organs, and thus the result that decreased perfusion causes dysfunction and failure of one organs or more. If a patient with septic shock does not treat as soon as possible and appropriately, such as medications, antibiotics, blood pressure, and respiratory support with ventilator or oxygen, the patients will be death (Paul & Carla, …show more content…
2013).
Patient background
Patient Tim, a 45-year-old man, who had diagnosed as peritonitis secondary to acute appendicitis, was admitted to the intensive care unit (ICU) one day ago by accident and emergency department due to acute pain. He had complained of dull lower abdominal pain for 2 days before admission. His blood pressure was dropped to 94/54 mmHg, pulse was raised to 124/min, respiration rate were elevated to 25/min, and temperature was raised to 38.3C upon arrival to accident and emergency department. He then developed unconsciousness after half and hour admitted to ICU and diagnosed to have septic shock by the case doctor. On day two, Tim’s most updated vital signs were blood pressure 90/48 mmHg, pulse 130/min, respiration rate 30/min, oxygen saturation 93%, and temperature 39C, K+5.3 mEq/L, Creatinine 118 umol/L, HCO3 20, and Peaked T wave noted on ECG. Moreover, refer to appendix A for Tim’s latest blood tests result
Assessment: Gordon’s function health patterns
Health Perception and Management:
Tim had well past medical history, and no known drug or food allergy. According to his wife, he is no use of cigarettes, drug and alcohol. He has dull lower abdominal pain for 2 days before admits to hospital. Then his pain became not tolerated, so is colleague then rushed him into the hospital.
Nutritional metabolic:
Tim haven not drink and eat anymore after he went into the hospital and coma stage. We use the intravenous fluid support his body needs. His skin and oral mucous is dry but intact. Because he was in coma stage so we cannot assess his weight and height.
Elimination:
Before he admitted into the hospital, he had complained of constipation for 2 days, and he had not any stool in these one and half days in ICU ward. He was oliguria. His urine output only was about 15-20 ml per hour and the color was dark yellowish. We cannot to know his elimination pattern because he was unconscious.
Activity exercise:
According to his wife, he has not any regular exercise in the leisure time. After he admitted to the ICU ward, he only lies on the bed, but we will help him to turn to the different side every two hours to prevent pressure sore.
Sleep rest:
According to his wife, generally he
Cognitive-perceptual:
We done the Glasgow coma scale for him, his score was 5, which showed that he was unconsciousness and may had some kind of neurological damage.
Self-perception/self-concept:
Tim was unconscious. His self-perception pattern was not able to assess.
Role relationship:
According to his wife. He lived with his wife and two teenage sons. They had the good relationship. And then he had very few closed friends.
Sexuality reproductive:
Their sexual relationship as satisfied and they used contraceptive pill for birth control.
Coping-stress tolerance:
His coping stress tolerance was not able to assess because he was unconscious.
Value-Belief pattern: His value belief pattern was not able to assess because he was in coma.
Focus assessment
Elimination: monitor intake and urine output every one to two hours. He had intravenous fluid infused 125 ml sodium chloride per hour that was used to support his body needs. And then the urine output was about 15 to 20 ml per hour and he had not any stool after admitted to ICU. Monitor the electrocardiogram tracings every hour, because hypokalemia is the most common reflection of cardiac. The result of the ECG, peaked T wave noted on ECG.
Skin assessment was done. His skin was dry and intact, no pressure sore and the wound were found. Oral mucous was also assessed, no dryness was found. After palpation was found that Tim’s peripheral pulses have signs of decrease of blood flow and inadequate tissue perfusion such as delayed capillary refill, clammy skin, rapid pulses.
Furthermore, routine blood test for whole blood count, renal function, electrolyte, and arterial blood gas was also done to Tim, K+5.3 mEq/L, Creatinine 118 umol/L, HCO3 20. Other refers to appendix A for detail results.
Possible nursing diagnoses
1. Rick of complications of hypovolemia related to peritonitis secondary of septic shock.
2. Rick of complication of hyperkalemia related to reduce renal perfusion secondary to septic shock.
Diagnoses Priority Rick of complications of hypovolemia related to peritonitis secondary of septic shock is the first priority of all the diagnoses because shock of hypovolemia results from decreased circulating volume of blood and water.
The circulating volume if loss more than 30%, which will decrease the cardiac output and vital organs supply. Thus, the cells will be oxygen insufficient, the patient will develop metabolic acidosis. Acidosis in normal tissue metabolism will lead to cellular destruction and, and then finally will be death. (Lawrence & Sharon, 2006) The second diagnosis based on prioritization is rick of complication of hyperkalemia related to reduce renal perfusion secondary to septic shock, because hyperkalemia is a potentially life- threatening problem caused by failure kidney to excrete potassium, and impair the acid-base and fluid balance, and affect the depolarization of skeletal muscle and heart (Joyce & James,
2006)
Name: Tim Sex/Age: 45-year-old man Date of Assessment: October 5th, 2013
Medical Diagnosis: Septic shock
Diagnostic Statement: Rick of complications of hyperkalemia related to reduce renal perfusion secondary to septic shock
Data
Diagnosis
Goal and Expected Outcomes
Interventions
Rationales
Evaluation
Assessment
Subjective Data:
Not available
Objective data:
Laboratory and diagnostic tests show the following abnormal results.
• K+5.3 mEq/L (normal 3.5 to 5 mEq/L)
• Creatinine 118 umol/L (normal 62-115 umol/L)
• Urine output 15-20ml per hour which less than 0.5ml/kg/hour
• Peaked T wave noted on ECG
Problem: Rick for complications of hyperkalemia
Etiology:
Renal
Reduce renal perfusion secondary to septic shock
Goal:
To manage and minimize episode of hyperkalemia by using laboratory result.
Expected Outcomes:
1. Maintain normal ECG
2. Maintain serum potassium level within normal range
3. Maintain urea and creatinine level within the normal range
4. Maintain urine output within the normal range
1. Monitor for signs and symptoms of hyperkalemia.
Weakness to flaccid paralysis
Muscle irritability
Parenthesis
Nausea abdominal cramping or diarrhea
Oliguria
2. Monitor Electrocardiogram (ECG): tall, tented T waves, ST segment depression, prolonged PR interval (>0.2 seconds), first-degree heart block, bardycardia, broadening of the QRS complex, eventual ventricular fibrillation, and cardiac standstill.
3. Monitor vital sign every four hours.
4. Monitor intake and output.
5. Restrict food with high potassium, fluids and IV solutions with potassium
6. Provide range-of-motion (ROM) exercise to extremities.
7. Administer medications to reduce serum potassium levels such as IV calcium, Sodium bicarbonate, glucose, insulin, and cation-exchange resins (e.g. Kayexalate, hemodialysis) as prescribed.
1. Hyperkalemia can result from the kidney’s decreased ability to excrete potassium or from excessive potassium intake. Acidosis increases the release of potassium from cells. and reduce the action of GI smooth muscle. (Carpenito, 2013).
2. Fluctuations in potassium will affect neuromuscular transmission and cardiac monitoring may show early changes as premature ventricular beats. (Carpenito, 2013).
3. For baseline records. (NANDA, 2012).
4. To detedt complications due to renal insufficiency (Carpenito, 2013).
5. To reduce the potassium level (Carpenito, 2013).
6. ROM improves muscle tone and reduces cramps cause by hyperkalemia (Carpenito, 2013).
7. To block effects on the heart muscle and force excretion of potassium (Carpenito, 2013).
.
To evaluate expected outcome 1:
1. Monitor Tim ‘s ECG, within 8 hours, his T waves return to normally baseline.
To evaluated expected outcome 2:
1. Testing every one to two hours of serum potassium level until returned to normal.
To evaluated expected outcome 3:
1. Monitor urea and creatinine level.
To evaluated expected outcome 4:
1. Monitor the urine output hourly in the bedside bag.
Name: Tim Sex/Age: 45-year-old man Date of Assessment: October 5th, 2013
Medical Diagnosis: septic shock
Diagnostic Statement: Rick of complications of hypovolemia related to peritonitis secondary of septic shock
Data
Diagnosis
Goal and Expected Outcomes
Interventions
Rationales
Evaluation
Assessment
Subjective Data
Subjective data:
Not available
Objective data:
1. Dry mucous membranes
2. Cold clammy skin
3. Blood pressure 90/48
4. Tachycardia 130 beats per min
5. Oliguria: urine output 15-20ml per hour
Problem: Rick for complications of hypovolemia
Etiology:
Related to peritonistis secondary of septic shock
Goal:
To manage and minimize hypovolemic episodes and prevent for complications of hypovolemia.
Expected Outcomes:
1. Show no signs and symptoms of dehydration such as dry oral mucous.
2. Urine output back to normal range: 0.5ml/kg/hr
3. Blood pressure back to normal range: systolic 100-120 mmHg and diastolic 60-90 mmHg
4. Pulse back to normal range: 60-100 beats/min
8. Monitor intake and output including parenteral and oral, urine and drainage.
9. Monitor vital sign especially blood pressure and pulse.
10. If not contraindicated, place the client in supine position.
11. Insert an IV line and use a large-bore catheter if blood or large volume fluid replacement is administered.
12. Collaborate with physician or advanced practice nurse to replace fluid losses at a rate sufficient to maintain urine output more than 0.5mL/hg/hour (e.g. saline or Ringer’s lactate).
13. Administer oxygen as ordered.
8. Early detection of fluid deficit allows early interventions to prevent complication of hypovolemia (Carpenito, 2013).
9. To obtain baseline records and detect early signs of change in condition (NANDA, 2012).
10. Placing the patient in supine position during shock can increase venous return and cardiac output
11. To maintain adequate electrolyte and IV line is necessary for fluid infusion and IV medication such as vasopressin (Carpenito, 2013).
12. To promote optimal renal tissue perfusion (Carpenito, 2013).
13. Oxygen therapy can increase oxygen circulation level which is necessary for hypoxemia (Carpenito, 2013)
To evaluated expected outcome 1:
1. Skin assessment, oral mucous assessment, and blood test for whole blood count and electrolytes.
To evaluated expected outcome 2:
1. Monitor fluid intake and urine output.
To evaluated expected outcome 3:
1. Monitor blood pressure every hour.
To evaluated expected outcome 4:
1. Monitor pulse every hour.
Barrier and limitation One of the barriers is lack of experienced nurse work in the intensive care unit. Inexperienced nurses do not have enough knowledge in taking care of the patients in ICU, which require special care. Also the communication among medical staffs and between the nurses and the family are not enough. Therefore, misunderstanding will happen when taking care of the patient. One of the limitations is the shortage of nurses. The workloads are too high and thus nurses are always too busy and do not have time to communicate with the family. The facilitator in nowadays is that the nursing program is based on university degree and therefore they are more professional and have more knowledge as compare with the old systems where nurses were trained in the hospital and did not have a bachelor degree. To improve the current barriers and limitations, hospital should hire more nurses to reduce the workload. Consequently, the nurses will be able to have better communication with the colleagues and family. With better communication, patient will receive better care.
Conclusion
Tim was diagnosed with septic shock and transferred to the ICU one day ago. Abdominal assessment, blood test, and ECG were performed to him. Gordon function pattern was also done. After the assessment,