MEDICAL MANAGEMENT

IDEAL MEDICAL MANAGEMENT FOR SEPTIC SHOCK

 Septic AKI patients tend to have lower urinary outputs, receive more fluid therapy and/or diuretics and are more likely to develop fluid retention.
 Administration of intravenous antibiotics to fight infection, vasopressor medications, corticosteroids.
 Obtain blood cultures before administering antibiotics
 Administer broad-spectrum antibiotics
 Administer 30 mL/kg of crystalloid solution for hypotension or for lactate levels of 4 mmol/L or higher (The following should be completed within 6 hours:
 Administer vasopressors for hypotension that does not respond to initial fluid resuscitation to maintain a mean arterial pressure (MAP) of 65 mm Hg or higher).
 Fluid replacement therapy. The therapy is done to correct the tissue hypoperfusion, so aggressive fluid resuscitation must be implemented.
 Pharmacologic therapy. Drotrecogin alfa is used to act as antithrombotic, anti-inflammatory, and profibrinolytic agent.
 Nutritional therapy. Aggressive nutritional supplementation is critical in the management of septic shock because malnutrition further impairs the patient’s
resistance to infection
IDEAL MEDICAL MANAGEMENT FOR diabetes mellitus
 Administer insulin for blood sugar stability
 Administer medications such as Metformin (Sulfonylureas. Meglitinides, Thiazolidinedione, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, Insulin.)

IDEAL MEDICAL MANAGEMENT FOR acute kidney injury

 Pharmacologic therapy. Cation-exchange resins or Kayexalate can reduce elevated potassium levels; IV dextrose 50%, insulin, and calcium replacement may be
administered to shif potassium back into cells; diuretic agents are ofen administered to control fluid volume.
 Nutritional therapy. Replacement of dietary proteins is individualized to provide the maximum benefit and minimize uremic symptoms; likewise, caloric
requirements are met with high-carbohydrate meals, because carbohydrates have a protein-sparing effect; foods and fluids containing potassium or phosphorus
are restricted; and afer diuretic phase, the patient is placed on a high-protein, high-calorie diet.
ACTUAL MANAGEMENT

 Monitor Vital Signs

 Monitor blood glucose
 Repositioned Pt every 2 hrs
 Diet: Sof (OF)
 IVF: PRLC @20 gtts/min,D53 NaCl @ 530 gtts/min, MgSo4 with gram +100 cc PNSS, PNSS 1L @30 gtts/min
 Labs: blood chemistry result, urinalysis report, microscopic examination
 I and O every shif
 Medications:
1. Humulin 5 units
2. Piperacillin tazobactam 2.25 mg
3. Carvedilol 6.25g
4. Atorvastatin 4g
5. Salbutamol 1 neb
6. Paracetamol
7. Omeprazole 40mg
8. Tramadol
9. Amlodioine
10. Clonidine
11. Levofloxacin
 SURGICAL MANAGEMENT
IDEAL MEDICAL MANAGEMENT FOR SEPTIC SHOCK
 Surgery may be performed to remove a source of infection

IDEAL MEDICAL MANAGEMENT FOR DIABETES MELLITUS

 Islet transplantation and pancreas transplantation

IDEAL MEDICAL MANAGEMENT FOR KIDNEY FAILURE

 Renal Transplant

ACTUAL MANAGEMENT
 NO SURGERY IS PERFORMED
 NURSING MANAGEMENT
IDEAL MANAGEMENT OF SEPTIC SHOCK:
 Monitor vitals
 Monitor and manage blood sugar
 Assess cardiopulmonary system: Auscultate heart and lungs for abnormal sounds
o Fluid retention from improper glomerular filtration may collect in the myocardium resulting in stress on the heart and in the lungs. Listen for friction rub and
pulmonary crackles or congestion
 Monitor lab/diagnostic studies: Glomerular Filtration Rate (GFR) <60 indicates kidney disease, <15 indicates kidney failure, CT / Ultrasound Kidney biopsy (if
necessary)
 Evaluate mental status
 Monitor I & O
 Insert indwelling catheter as appropriate
 Palpate abdomen
 Restrict fluids
 Nutrition education
o A renal diet is low in protein and sodium.
 Assess the patient’s history.
 Assess physical condition.
 Assess the patient’s blood pressure while sitting and standing to detect orthostatic changes.
 Assess the body mass index and visual acuity of the patient.
 Perform examination of foot, skin, nervous system and mouth.
  Laboratory examinations.
 Infection control.
 Collaboration.
 Management of fever.
 Pharmacologic therapy.
 Monitor blood levels.
 Assess physiologic status.

ACTUAL MANAGEMENT OF SEPTIC SHOCK

 Monitor vitals
 Provide early intubation and mechanical ventilator
 Inserted foley catether
 Monitor and manage blood sugar
 Monitor I & O
 Assess the patient’s history.
 Assess physical condition.
 Assess the patient’s blood pressure while sitting and standing to detect orthostatic changes.
 Laboratory examinations.
 Infection control.
 Management of fever.
 Pharmacologic therapy.
 Administered Medications
 Provide safety measures