Homeostasis and Pain Management in Patient with Multisystem Failure Western Governor’s University
Multisystem organ failure, also known as multiple organ dysfunction syndrome, is defined by The Principles of Internal Medicine as the “dysfunction of more than one organ, requiring intervention to maintain homeostasis” (Braunwald et al., 2001). To adequately assess multisystem organ failure in regards to Mrs. Baker, the emergency room nurse caring for Mrs. Baker must be concerned with maintaining homeostasis, assess her level of oxygenation and pain level as well. The emergency room nurse must first go back to nursing basics and remember her ABCs; airway, breathing and circulation. The airway must first be secured as the case study indicates that Mrs. Baker became unresponsive after having a difficult time breathing. The initial assessment shall include vital signs, oxygenation, level of consciousness, blood sugar, and pain. The taking of vital signs will provide an abundance of information with blood pressure, temperature, pulse and respirations being monitored frequently for changes as these are clues to what is happening in Mrs. Baker’s body. If the blood pressure were to decrease, this could indicate dehydration. If the temperature increases, this could be indicative of an infectious process. An increase in the pulse could indicate dehydration or blood loss and an increase in respirations could indicate stricture in the airway or not enough oxygen being circulated. Though vital signs must be taken often to give the provider direction in his or her assessment, they are not the only thing to be immediately assessed. To continue assessing homeostasis a pulse oximeter should be used to assess oxygenation as lower levels can cause difficulty breathing and lead to unresponsiveness similar to what Mrs. Baker is experiencing. Assessing skin color is also another way to evaluate oxygenation; a blood gas would also be helpful in determining adequate oxygenation. While all of these things are being assessed the patient should be simultaneously placed on the cardiac monitor for rhythm monitoring and an IV placed with blood drawn for lab work. To be included in the lab work would be a CBC to check for infection, a CMP to assess for electrolyte imbalances, a lactate level and blood cultures to check for sepsis and an ammonia level to check the liver because Mrs. Baker was described as confused before becoming unresponsive. Mrs. Baker’s blood sugar should be checked as she is diabetic and alterations in blood glucose can also be the cause of some of the symptoms described. An ECG should be obtained to acquire a definite heart rhythm as well as a head CT and chest x-ray to rule out stroke and respiratory diseases. Pain should be assessed, but as Mrs. Baker has become unresponsive it is no longer possible to ask a pain level using the 0-10 scale; pain assessment must now be done by another means. According to the American Journal of Critical Care (2004), “When patients cannot express themselves in any way, observable indicators, clustered into physiological and behavioral categories, become unique indices for the assessment of pain” (p 126-136). What this statement is saying is that the nurse must observe physiological and behavioral indicators to check for pain i.e. increases in blood pressure and/or heart rate, facial grimacing, or restless body movements.
The technological tools required to adequately assess Mrs. Baker include vital signs machines with intact blood pressure cuffs, pulse oximeters and thermometers. This machine is useful in gathering basic data about Mrs. Baker’s condition such as blood pressure, heart rate, oxygenation status and temperature. Continuous pulse oximetry with a pulse oximeter is necessary to monitor oxygenation status and is beneficial in determining the need for supplemental oxygen. Monitoring Mrs. Baker’s vitals provides insight into her condition and shows whether the interventions taken are...
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