Case Study - Caring for Clients in Shock

John Phillips, an 82-year-old male client weighing 70 kg, was admitted to a medical-surgical unit from a nursing home with recent mental status changes. He is confused to place and time and restless. He reports seeing puppies and children playing, and he knows they are not there. He has a Foley catheter in place from the nursing home because he is incontinent of urine, and there is cloudy foul-smelling dark amber urine with sediments of 100 mL present for the past 8 hours according to the nursing home report. He has crackles and rhonchi in the right lower lobe of his lung and coughs up yellow sputum. Vital signs: T, 95° F; BP, 88/60 mm Hg; HR, 130beats/minute; RR, 32 breaths/minute; pulse oximeter, 88% on room air. The client denies any pain or discomfort. The physician ordered blood cultures × 2 separate sites, a sputum culture and a urine culture, which were obtained and sent to the lab. Oxygen was ordered 2 L per nasal cannula; titrate to keep SaO2 90% or above. The nurse provided the oxygen, and the SaO2 is 90%. The physician wants to be called once the labs are obtained and results of the CBC and renal profile are back. The ordered labs are on the chart and as follows: CBC: WBC, 15,000 mcL; RBC, 4.1 million; Hgb, 15 g/100 mL; Hct, 37%; Plt, 150,000.

Renal profile: BUN, 40 mg/dL; serum creatinine, 1.8 mg/dL; Na+, 135 mEq/L; Cl, 95 mEq/L; K+, 4 mEq/L

The LPN/LVN needs to determine the necessary nursing management for the client, update the RN, and talk with the physician for further orders.

a. What is possibly causing the underlying shock symptoms, and why is the client afebrile?

b. What nursing management is needed for Mr. Phillips?