A 10-year-old girl named Ariana presents to the emergency department with a fever, sore throat, and weakness after recently completing chemotherapy treatment for acute lymphoblastic leukemia. Initial assessments show signs of sepsis including a high fever and low blood pressure. Laboratory results reveal low white blood cell and platelet counts. The pediatric sepsis protocol is initiated, including rapid fluid resuscitation and antibiotics. Ariana's condition improves with treatment and she is transferred to the pediatric intensive care unit.
A 20-year-old college student fell from a balcony after drinking at a party. She is unresponsive with unequal pupils, low blood pressure, and irregular breathing. Tests show a head injury, leg fracture, and signs of shock. The patient requires intubation and surgery to relieve pressure on the brain and fix the leg fracture. Post-surgery monitoring in the ICU focuses on maintaining adequate blood pressure and oxygen levels to support the injured brain.
1. The child has relapsed acute lymphoblastic leukemia (ALL) and underwent reinduction chemotherapy.
2. Following the first cycle of reinduction therapy, laboratory tests show: a white blood cell count of 21,900, uric acid level of 9, and LDH level elevated.
3. These laboratory abnormalities indicate tumor lysis syndrome, a potential complication of effective chemotherapy in patients with high tumor burden. Urgent intervention is needed to prevent renal failure and other complications.
The document discusses an ED and trauma symposium presentation on sepsis. The presenter reviews updated sepsis definitions, principles of early severe sepsis management, pearls and tips for sepsis management, common pitfalls to avoid, and implications of recent literature. Key points from sepsis management include early recognition, fluid resuscitation, early antibiotics within 1 hour, source control, vasopressors like norepinephrine as first choice, and attempting to normalize lactate levels. Dynamic measures like ultrasound and passive leg raises can help guide fluid administration.
The document discusses an ED and trauma symposium presentation on sepsis management. The presentation covers updated sepsis definitions, principles of early severe sepsis management, tips for sepsis care, common pitfalls to avoid, and implications of recent literature. Key points include early recognition and treatment of sepsis, initial fluid resuscitation, early antibiotics, source control, hemodynamic support and lactate monitoring to guide resuscitation and improve outcomes.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
The document presents a case study of a 24-year-old female patient who was found unresponsive. Initial examination found the patient to have a Glasgow Coma Scale of 10/15, tachycardia, hypertension, and signs of respiratory distress. Laboratory tests revealed metabolic acidosis, elevated white blood cell count and creatinine, and rhabdomyolysis. Ultrasound showed signs of pregnancy. The patient was treated for pre-eclampsia with magnesium sulfate and antihypertensives, intubated, and underwent termination of pregnancy. She was admitted to the ICU and later discharged in good condition.
A 60-year-old female with diabetes and hypertension presented with altered mental status and fever for 3 days. On examination, she had a high heart rate, low blood pressure, high respiratory rate, and high blood glucose. Initial lab work showed high lactate, low platelets, and signs of infection on urine and blood tests. This patient is showing signs of sepsis such as altered mental status, hypotension, and elevated lactate. The initial response should be rapid fluid resuscitation with crystalloids, broad-spectrum antibiotics, and vasopressors if needed to maintain blood pressure. Close monitoring and treatment based on sepsis guidelines is needed in the first critical hours to prevent further organ dysfunction.
This document discusses the management of two pediatric COVID-19 patients admitted to the hospital.
For the first 11-year-old patient, the document outlines their presenting symptoms and initial treatment including oxygen supplementation and medications. It then discusses monitoring parameters, criteria for weaning oxygen, and important considerations for daily rounds.
For the second 9-year-old patient presenting with increased respiratory distress, the document discusses admitting them to the COVID ICU and initiating treatments like high flow nasal oxygen, dexamethasone, LMWH, and considering prone positioning or remdesivir. It also outlines how to prepare for and manage high flow nasal oxygen therapy.
The document continues discussing both patients' deteriorating conditions and considerations for
A 20-year-old college student fell from a balcony after drinking at a party. She is unresponsive with unequal pupils, low blood pressure, and irregular breathing. Tests show a head injury, leg fracture, and signs of shock. The patient requires intubation and surgery to relieve pressure on the brain and fix the leg fracture. Post-surgery monitoring in the ICU focuses on maintaining adequate blood pressure and oxygen levels to support the injured brain.
1. The child has relapsed acute lymphoblastic leukemia (ALL) and underwent reinduction chemotherapy.
2. Following the first cycle of reinduction therapy, laboratory tests show: a white blood cell count of 21,900, uric acid level of 9, and LDH level elevated.
3. These laboratory abnormalities indicate tumor lysis syndrome, a potential complication of effective chemotherapy in patients with high tumor burden. Urgent intervention is needed to prevent renal failure and other complications.
The document discusses an ED and trauma symposium presentation on sepsis. The presenter reviews updated sepsis definitions, principles of early severe sepsis management, pearls and tips for sepsis management, common pitfalls to avoid, and implications of recent literature. Key points from sepsis management include early recognition, fluid resuscitation, early antibiotics within 1 hour, source control, vasopressors like norepinephrine as first choice, and attempting to normalize lactate levels. Dynamic measures like ultrasound and passive leg raises can help guide fluid administration.
The document discusses an ED and trauma symposium presentation on sepsis management. The presentation covers updated sepsis definitions, principles of early severe sepsis management, tips for sepsis care, common pitfalls to avoid, and implications of recent literature. Key points include early recognition and treatment of sepsis, initial fluid resuscitation, early antibiotics, source control, hemodynamic support and lactate monitoring to guide resuscitation and improve outcomes.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
The document presents a case study of a 24-year-old female patient who was found unresponsive. Initial examination found the patient to have a Glasgow Coma Scale of 10/15, tachycardia, hypertension, and signs of respiratory distress. Laboratory tests revealed metabolic acidosis, elevated white blood cell count and creatinine, and rhabdomyolysis. Ultrasound showed signs of pregnancy. The patient was treated for pre-eclampsia with magnesium sulfate and antihypertensives, intubated, and underwent termination of pregnancy. She was admitted to the ICU and later discharged in good condition.
A 60-year-old female with diabetes and hypertension presented with altered mental status and fever for 3 days. On examination, she had a high heart rate, low blood pressure, high respiratory rate, and high blood glucose. Initial lab work showed high lactate, low platelets, and signs of infection on urine and blood tests. This patient is showing signs of sepsis such as altered mental status, hypotension, and elevated lactate. The initial response should be rapid fluid resuscitation with crystalloids, broad-spectrum antibiotics, and vasopressors if needed to maintain blood pressure. Close monitoring and treatment based on sepsis guidelines is needed in the first critical hours to prevent further organ dysfunction.
This document discusses the management of two pediatric COVID-19 patients admitted to the hospital.
For the first 11-year-old patient, the document outlines their presenting symptoms and initial treatment including oxygen supplementation and medications. It then discusses monitoring parameters, criteria for weaning oxygen, and important considerations for daily rounds.
For the second 9-year-old patient presenting with increased respiratory distress, the document discusses admitting them to the COVID ICU and initiating treatments like high flow nasal oxygen, dexamethasone, LMWH, and considering prone positioning or remdesivir. It also outlines how to prepare for and manage high flow nasal oxygen therapy.
The document continues discussing both patients' deteriorating conditions and considerations for
The document provides protocols and guidelines for the Department of Obstetrics including definitions, classifications, investigations, and management guidelines for various obstetric conditions. It covers protocols for pre-eclampsia and eclampsia, liver diseases in pregnancy, deep venous thrombosis in pregnancy, preterm labour, preterm PROM, breech presentation, APH, induction of labour, normal labour and delivery, PPH, umbilical cord prolapse, Rh prophylaxis, and GDM. The department aims to provide high quality, empathetic and research-based care through comprehensive training and by reviewing and creating protocols according to population needs.
Sepsis is leading cause of death in children. septic shock and multi organ dysfunction is final common pathway for death in various infections. We discuss here evidence based management of sepsis and septic shock in children.
This document reviews the key changes in the 8th edition of the Neonatal Resuscitation Program (NRP) guidelines in Canada. It discusses updated recommendations for umbilical cord clamping and cutting, sustained lung inflation, and epinephrine dosing based on the latest scientific evidence. It also notes administrative changes like the new Essentials and Advanced course formats, online learning assessments, and the transition timeline for Canada. Overall, the 8th edition aims to optimize neonatal resuscitation based on continual reviews of clinical trials and quality improvement initiatives.
This document provides an overview of treating sepsis in 8 steps:
1) Rapidly assess for critical instability and signs of organ dysfunction
2) Administer empiric fluids and perform ultrasound exams to identify potential infection sources
3) Administer early, broad-spectrum antibiotics within 1 hour
4) Identify and control infection sources
5) Understand appropriate vasoactive medications
6) Recognize patients that deteriorate rapidly
7) Use lactate levels to guide resuscitation but recognize limitations
8) Optimize hemodynamics prior to intubation for shock patients
Two case studies are then presented and managed using the stepwise approach.
This document summarizes several medical journal articles from 2013-2014. It finds that restrictive fluid and salt management for heart failure patients in the hospital is not beneficial. A trial on patients with upper GI bleeding showed no benefit to transfusion unless hemoglobin is below 7. Another study found that monitoring gastric residuals when tube feeding ICU patients did not reduce pneumonia rates compared to symptom monitoring alone. The document also discusses overtreatment of diabetes in older patients and risks of using new oral anticoagulants in patients with mechanical heart valves.
Background: It is often difficult to predict which newborn with HIE will develop neurological sequlae so there is an urgent need for predictors for adverse neurological outcomes in these infants. Aim of Study: To evaluate the serum levels of serum amyloid A (SAA) protein in newborns with HIE during the first week of life and after 3 and 6 months of follow up to assess its correlation with degree of HIE neurological sequlee. Patients and Methods; This case-control study was conducted on 72 infants; group (1) included 36 full term neonates diagnosed as HIE and group (2)included 36 age and sex matched, infants as a control group, Serum amyloid A by ELIZA technique was measured at post natal age of 1 and 7 days, CT scan was done in justified cases .with follow up at age of 3 and 6 months for neurological sequlee. Results: SAA protein level was elevated in the asphyxiated group in comparison to the control group at day 1 and day 7, SAA level was significantly correlated to the Sarnat scoring system of HIE. SAA level significantly differ on follow up of developmental milestone at age of 3 and 6 months. ROC curve for validity of SAA for severity of HIE at cut off point > 25μg/ml at day 1 and at cut off point > 20 μg/ml at day 7 of HIE diagnosis reported sensitivity 100% and specificity 100% .Conclusion: SAA correlates with the severity of HIE and higher SAA expression is a prognostic marker for morbidity in these infants.
Back to the Bedside: Internal Medicine Bedside Ultrasound ProgramAllina Health
David Tierney, MD. How bedside ultrasound is changing the practice of medicine and how Abbott Northwestern Hospital has become a national leader in integrating bedside ultrasound in its Internal Medicine Residency Program. "As internal medicine physicians, we are finding that everything we do with our hands, eyes and stethoscopes can be done a little better with ultrasound. That means our physical exam, which we consider our bread and butter, has more sensitivity and specificity. This gives us better diagnostic ability and results in earlier and more appropriate treatment."
The document provides nursing questions and answers related to cardiovascular health. Question 139 discusses discharge instructions for a client with infective endocarditis, with the correct answer being to notify healthcare providers of the history before any invasive procedures. Question 140 discusses avoiding use of the knee gatch on a post-cardiac surgery client's bed to prevent venous stasis. Question 141 lists appropriate activity limitations for the first 6 weeks after cardiac surgery discharge.
A client is receiving an IV infusion of 1000 mL of 5% dextrose in water plus 40 mEq of potassium chloride. Tall, peaked T waves on the cardiac monitor would indicate the presence of hyperkalemia. ST-segment depression is seen in hypokalemia. The document provides rationales and questions regarding cardiac monitoring findings, client teaching, and risk factor assessment.
For more course tutorials visit
www.newtonhelp.com
Max Points: 20.0
The case scenario provided will be used to answer the discussion questions that follow.
Case Scenario
A registered nurse will provide pre-procedure and post-procedure care for patients undergoing cardiac catheterization. The nurse is responsible for preparing the patient by obtaining consent, assessing vitals and health history, reviewing medications and lab results, and ensuring fasting status. After the procedure, the nurse monitors the patient's condition, assesses the access site, and watches for potential complications. The nurse educates the patient and family on post-procedure care before discharge.
This document describes a case study of a neonatal baby presenting with signs of sepsis. The baby is pale, floppy and has cool peripheries. Initial management involves resuscitation and investigations including blood cultures, urine culture, full blood count and C-reactive protein. Antibiotics are started for suspected early onset sepsis. Blood cultures later grow Group B Streptococcus. The baby requires intubation for respiratory support. Treatment is continued with antibiotics targeting GBS. The parents are informed of the diagnosis and prognosis, and told the baby is currently responding well to targeted treatment.
The patient is a 14-month-old female admitted with rectal bleeding, anemia, and colon polyps. She has a history of colonic polyposis, dependence on blood transfusions and albumin infusions. A recent colonoscopy found 16 polyps of various sizes, some with active bleeding. Laboratory results show improving but still low hemoglobin, hematocrit, and platelets. The primary problems are anemia and colon polyps.
The document summarizes key points from the Neonatal Resuscitation Program (NRP) 8th edition. It discusses improvements to teamwork and communication during resuscitation. It provides clinical guidance on ventilation, temperature management, medications and other aspects of resuscitation. The document emphasizes preparation, effective communication, and ongoing quality improvement to optimize neonatal outcomes.
This document discusses community acquired pneumonia (CAP). It begins by defining CAP and discussing its epidemiology and classification. It then covers the incidence, clinical presentation, radiological manifestations, and typical microbiological findings of CAP. It discusses specific investigations and pathogens involved in severe CAP. Scoring systems for assessing CAP severity, including PSI, CURB-65 and CRB-65, are outlined. Guidelines are provided on treatment based on severity, including empiric antibiotic choice. Risk factors for drug-resistant pathogens and tuberculosis are noted. The document concludes with recommendations for empiric treatment of severe CAP patients admitted to the ICU.
paediatric-septic-shock is a very sever and dangerous for pediatricSudhaYadav664582
The document discusses paediatric septic shock, including definitions, risk factors, clinical manifestations, investigations, and management. It defines the progression from systemic inflammatory response syndrome to sepsis to severe sepsis to septic shock. It emphasizes early recognition and goal-directed resuscitation including fluid boluses, antibiotics, and vasoactive drugs. Controversies around hydrocortisone and activated protein C are discussed. Studies supporting goal-directed therapy and extracorporeal membrane oxygenation for refractory shock are summarized.
Capnography: Discover Patient Safety Secrets Right Under Your NoseChristina Mason
This document discusses the importance and benefits of capnography monitoring in healthcare. Capnography provides immediate and accurate information about a patient's ventilation status and response to interventions in a noninvasive way. It can be used for patients of all ages and in many clinical situations, such as procedural sedation, opioid administration, assessing ventilation during cardiac arrest or CPR, and guiding ventilator management. The document recommends capnography monitoring as it can help detect complications early, guide treatment, and improve patient outcomes and safety.
Quality Improvement Sepsis Recognition & TreatmentJoseph Di Genova
Problem:
-Delayed sepsis recognition/treatment in other hospitals
Solutions/Compliance:
-Utilize EMR system (BPA alert) & standard protocol to provide prompt recognition/treatment
Improving Outcomes:
-Adequately train staff and enforce/audit usage and patient outcomes
Maintaining Progress:
-Continually review & study implementation of BPA alert
-Seek ways to critique/improve recognition of potentially septic patients (algorithm used by EMR system)
The document provides instructions for writing a 250-300 word paragraph analyzing a specific point from Okakura Kakuzō's essay "The Range of Ideals" to explain why his thesis that "Asia is one" is problematic. The paragraph should directly engage with one point Okakura makes, provide specific details on its logical or factual mistakes, acknowledge the diversity of Asian nations and cultures, and cite the specific page(s) being referred to.
Ralph Waldo Emerson was an American essayist and philosopher born in 1803 who is considered the father of American literature. He developed the philosophy of transcendentalism and emphasized nonconformity, self-reliance, and finding inspiration from nature. Emerson had a profound influence on writers like Thoreau, Whitman, Hawthorne, Poe, and Dickinson and developed a complicated relationship with Thoreau as his former student and friend.
The document provides protocols and guidelines for the Department of Obstetrics including definitions, classifications, investigations, and management guidelines for various obstetric conditions. It covers protocols for pre-eclampsia and eclampsia, liver diseases in pregnancy, deep venous thrombosis in pregnancy, preterm labour, preterm PROM, breech presentation, APH, induction of labour, normal labour and delivery, PPH, umbilical cord prolapse, Rh prophylaxis, and GDM. The department aims to provide high quality, empathetic and research-based care through comprehensive training and by reviewing and creating protocols according to population needs.
Sepsis is leading cause of death in children. septic shock and multi organ dysfunction is final common pathway for death in various infections. We discuss here evidence based management of sepsis and septic shock in children.
This document reviews the key changes in the 8th edition of the Neonatal Resuscitation Program (NRP) guidelines in Canada. It discusses updated recommendations for umbilical cord clamping and cutting, sustained lung inflation, and epinephrine dosing based on the latest scientific evidence. It also notes administrative changes like the new Essentials and Advanced course formats, online learning assessments, and the transition timeline for Canada. Overall, the 8th edition aims to optimize neonatal resuscitation based on continual reviews of clinical trials and quality improvement initiatives.
This document provides an overview of treating sepsis in 8 steps:
1) Rapidly assess for critical instability and signs of organ dysfunction
2) Administer empiric fluids and perform ultrasound exams to identify potential infection sources
3) Administer early, broad-spectrum antibiotics within 1 hour
4) Identify and control infection sources
5) Understand appropriate vasoactive medications
6) Recognize patients that deteriorate rapidly
7) Use lactate levels to guide resuscitation but recognize limitations
8) Optimize hemodynamics prior to intubation for shock patients
Two case studies are then presented and managed using the stepwise approach.
This document summarizes several medical journal articles from 2013-2014. It finds that restrictive fluid and salt management for heart failure patients in the hospital is not beneficial. A trial on patients with upper GI bleeding showed no benefit to transfusion unless hemoglobin is below 7. Another study found that monitoring gastric residuals when tube feeding ICU patients did not reduce pneumonia rates compared to symptom monitoring alone. The document also discusses overtreatment of diabetes in older patients and risks of using new oral anticoagulants in patients with mechanical heart valves.
Background: It is often difficult to predict which newborn with HIE will develop neurological sequlae so there is an urgent need for predictors for adverse neurological outcomes in these infants. Aim of Study: To evaluate the serum levels of serum amyloid A (SAA) protein in newborns with HIE during the first week of life and after 3 and 6 months of follow up to assess its correlation with degree of HIE neurological sequlee. Patients and Methods; This case-control study was conducted on 72 infants; group (1) included 36 full term neonates diagnosed as HIE and group (2)included 36 age and sex matched, infants as a control group, Serum amyloid A by ELIZA technique was measured at post natal age of 1 and 7 days, CT scan was done in justified cases .with follow up at age of 3 and 6 months for neurological sequlee. Results: SAA protein level was elevated in the asphyxiated group in comparison to the control group at day 1 and day 7, SAA level was significantly correlated to the Sarnat scoring system of HIE. SAA level significantly differ on follow up of developmental milestone at age of 3 and 6 months. ROC curve for validity of SAA for severity of HIE at cut off point > 25μg/ml at day 1 and at cut off point > 20 μg/ml at day 7 of HIE diagnosis reported sensitivity 100% and specificity 100% .Conclusion: SAA correlates with the severity of HIE and higher SAA expression is a prognostic marker for morbidity in these infants.
Back to the Bedside: Internal Medicine Bedside Ultrasound ProgramAllina Health
David Tierney, MD. How bedside ultrasound is changing the practice of medicine and how Abbott Northwestern Hospital has become a national leader in integrating bedside ultrasound in its Internal Medicine Residency Program. "As internal medicine physicians, we are finding that everything we do with our hands, eyes and stethoscopes can be done a little better with ultrasound. That means our physical exam, which we consider our bread and butter, has more sensitivity and specificity. This gives us better diagnostic ability and results in earlier and more appropriate treatment."
The document provides nursing questions and answers related to cardiovascular health. Question 139 discusses discharge instructions for a client with infective endocarditis, with the correct answer being to notify healthcare providers of the history before any invasive procedures. Question 140 discusses avoiding use of the knee gatch on a post-cardiac surgery client's bed to prevent venous stasis. Question 141 lists appropriate activity limitations for the first 6 weeks after cardiac surgery discharge.
A client is receiving an IV infusion of 1000 mL of 5% dextrose in water plus 40 mEq of potassium chloride. Tall, peaked T waves on the cardiac monitor would indicate the presence of hyperkalemia. ST-segment depression is seen in hypokalemia. The document provides rationales and questions regarding cardiac monitoring findings, client teaching, and risk factor assessment.
For more course tutorials visit
www.newtonhelp.com
Max Points: 20.0
The case scenario provided will be used to answer the discussion questions that follow.
Case Scenario
A registered nurse will provide pre-procedure and post-procedure care for patients undergoing cardiac catheterization. The nurse is responsible for preparing the patient by obtaining consent, assessing vitals and health history, reviewing medications and lab results, and ensuring fasting status. After the procedure, the nurse monitors the patient's condition, assesses the access site, and watches for potential complications. The nurse educates the patient and family on post-procedure care before discharge.
This document describes a case study of a neonatal baby presenting with signs of sepsis. The baby is pale, floppy and has cool peripheries. Initial management involves resuscitation and investigations including blood cultures, urine culture, full blood count and C-reactive protein. Antibiotics are started for suspected early onset sepsis. Blood cultures later grow Group B Streptococcus. The baby requires intubation for respiratory support. Treatment is continued with antibiotics targeting GBS. The parents are informed of the diagnosis and prognosis, and told the baby is currently responding well to targeted treatment.
The patient is a 14-month-old female admitted with rectal bleeding, anemia, and colon polyps. She has a history of colonic polyposis, dependence on blood transfusions and albumin infusions. A recent colonoscopy found 16 polyps of various sizes, some with active bleeding. Laboratory results show improving but still low hemoglobin, hematocrit, and platelets. The primary problems are anemia and colon polyps.
The document summarizes key points from the Neonatal Resuscitation Program (NRP) 8th edition. It discusses improvements to teamwork and communication during resuscitation. It provides clinical guidance on ventilation, temperature management, medications and other aspects of resuscitation. The document emphasizes preparation, effective communication, and ongoing quality improvement to optimize neonatal outcomes.
This document discusses community acquired pneumonia (CAP). It begins by defining CAP and discussing its epidemiology and classification. It then covers the incidence, clinical presentation, radiological manifestations, and typical microbiological findings of CAP. It discusses specific investigations and pathogens involved in severe CAP. Scoring systems for assessing CAP severity, including PSI, CURB-65 and CRB-65, are outlined. Guidelines are provided on treatment based on severity, including empiric antibiotic choice. Risk factors for drug-resistant pathogens and tuberculosis are noted. The document concludes with recommendations for empiric treatment of severe CAP patients admitted to the ICU.
paediatric-septic-shock is a very sever and dangerous for pediatricSudhaYadav664582
The document discusses paediatric septic shock, including definitions, risk factors, clinical manifestations, investigations, and management. It defines the progression from systemic inflammatory response syndrome to sepsis to severe sepsis to septic shock. It emphasizes early recognition and goal-directed resuscitation including fluid boluses, antibiotics, and vasoactive drugs. Controversies around hydrocortisone and activated protein C are discussed. Studies supporting goal-directed therapy and extracorporeal membrane oxygenation for refractory shock are summarized.
Capnography: Discover Patient Safety Secrets Right Under Your NoseChristina Mason
This document discusses the importance and benefits of capnography monitoring in healthcare. Capnography provides immediate and accurate information about a patient's ventilation status and response to interventions in a noninvasive way. It can be used for patients of all ages and in many clinical situations, such as procedural sedation, opioid administration, assessing ventilation during cardiac arrest or CPR, and guiding ventilator management. The document recommends capnography monitoring as it can help detect complications early, guide treatment, and improve patient outcomes and safety.
Quality Improvement Sepsis Recognition & TreatmentJoseph Di Genova
Problem:
-Delayed sepsis recognition/treatment in other hospitals
Solutions/Compliance:
-Utilize EMR system (BPA alert) & standard protocol to provide prompt recognition/treatment
Improving Outcomes:
-Adequately train staff and enforce/audit usage and patient outcomes
Maintaining Progress:
-Continually review & study implementation of BPA alert
-Seek ways to critique/improve recognition of potentially septic patients (algorithm used by EMR system)
The document provides instructions for writing a 250-300 word paragraph analyzing a specific point from Okakura Kakuzō's essay "The Range of Ideals" to explain why his thesis that "Asia is one" is problematic. The paragraph should directly engage with one point Okakura makes, provide specific details on its logical or factual mistakes, acknowledge the diversity of Asian nations and cultures, and cite the specific page(s) being referred to.
Ralph Waldo Emerson was an American essayist and philosopher born in 1803 who is considered the father of American literature. He developed the philosophy of transcendentalism and emphasized nonconformity, self-reliance, and finding inspiration from nature. Emerson had a profound influence on writers like Thoreau, Whitman, Hawthorne, Poe, and Dickinson and developed a complicated relationship with Thoreau as his former student and friend.
Raising Minimum An explanation of the its.docxbkbk37
This document discusses the key components of an essay arguing for or against raising the minimum wage. The essay would provide an explanation of the controversy around raising the minimum wage, including the background and current state of the issue. It would articulate a clear position and support that position with reasons backed by evidence from research. The essay would also have to address counterarguments and refute them with detailed rebuttals. It would conclude by restating the main argument and possibly suggesting a solution or policy. Sources would need to be cited in MLA style and include at least 5 non-internet sources.
Rail Project A goal of the Obama administration.docxbkbk37
The Obama administration promoted high-speed rail projects across major US states to adopt more environmentally friendly transportation initiatives and improve infrastructure. California accepted billions in federal grants to begin developing a high-speed rail line, though critics argue the projected ridership and costs make the project economically unfeasible, especially given California's budget issues. Supporters counter that large public works projects can have broader economic and social benefits beyond just transportation.
Racism toward Indigenous peoples in Canada.docxbkbk37
The document outlines requirements for an 8-page research paper examining racism toward Indigenous peoples in Canada. It must be in Chicago style with footnotes and bibliography, and discuss the prevalence of racism today, key contributing factors, and the concepts of meritocracy and white privilege in developing the thesis. Specifically, it should consider how beliefs about meritocracy factor into racist attitudes, the lack of understanding of white privilege and its impact, and how understanding these concepts could foster more inclusive attitudes. Five sources are required including the article by Brockham and Morrison.
This document provides instructions for a social issue paper on class, race and gender. Students must write a thesis statement and support it using at least 3 sources from the provided additional material. The paper must be formatted in MLA style and clearly relate to topics covered in the course.
The document discusses whether the Responsibility to Protect (R2P) doctrine could justify international intervention in Syria. Some argue multilateral attacks on Syria could be legitimate under R2P based on the requirements being met. However, many UN member states remain suspicious of R2P due to concerns it could be used to justify improper unilateral military action.
This article discusses racial disparities in hospital segregation in Jackson, Mississippi in the 1960s. It describes how the city's black community organized protests and filed lawsuits to desegregate white hospitals and gain equal access to healthcare. While progress was made through these efforts, racial inequities still persisted in the quality of facilities and treatment between black and white patients. The article provides insights into the political and social challenges of promoting desegregation and reducing healthcare disparities during the Civil Rights era.
Race alone is an inadequate category for studying labor histories because it does not account for other factors like gender. When telephone operator jobs transformed from predominantly white to black workers, African American women faced discrimination and stereotyping in their roles. Bell System's hiring policies and perceptions of black women were guided by wider societal racism and sexism. Bell publications portrayed African Americans in stereotypical, demeaning ways. The New York Telephone Company initially refused to hire African Americans in 1920 due to concerns about customer prejudice, and again in the 1930s during a period of high unemployment that exacerbated racial tensions. Prior to 1940, AT&T had very limited hiring of African American women for telephone operator jobs. The Civil Rights era prompted changes to Bell
QuickBooks uses windows API to follow orders to get updates.docxbkbk37
QuickBooks uses the Windows API to connect to Intuit servers to receive updates and data. Error code 12057 can occur if QuickBooks is unable to connect to the Intuit servers. This error may be caused by issues with the internet connection, outdated SSL settings, or incorrect date/time settings. The document provides steps to resolve this error such as checking internet options settings, updating the system date and time, installing Windows and QuickBooks updates, repairing the QuickBooks installation, and running QuickBooks as an administrator. Customer support should be contacted if the error persists after trying these troubleshooting steps.
Questions What are the purposes of Just.docxbkbk37
Offenders' cognitions serve to both make themselves feel better and balance their interactions with others and environments. Childhood trauma can influence offenders' distorted views of social reality. The psychological source of mental conflicts is examined. Prejudice is discussed as influencing criminal behavior, and whether one is prejudiced towards sex offenders. The main assessment activities and issues in correctional counseling are outlined. Issues in the termination stage and types of questions to avoid in assessment are identified. The importance of helping clients with feelings and defining beneficence vs. nonmaleficence are discussed. The benefit of motivational interviewing is also examined.
Questions to Each group you read about is.docxbkbk37
Several immigrant groups in 19th century America felt anxiety over changes brought by new immigrants. Mexicans/Tejanos, Texans, and Americans feared losing land and political power to increasing numbers of newcomers. Irish, German, and Chinese immigrants also faced xenophobia and fears that they would take economic opportunities and alter American culture. These documents from the Age of Expansion show prevalent fears and distrust of foreigners among native-born Americans.
Questions that must be answered in your plus other.docxbkbk37
This document outlines 4 questions to answer in a book report: 1) The 4 big ideas in the book. 2) How the book got its title. 3) What happens to the main character at the end. 4) What is liked most about the book. It provides guidance on the content to include in the writeup.
This woman finds meaning and purpose in her family and faith. She draws strength from her family, friends, and faith in God. She believes things happen for a reason and has hope for the future. She serves on the board of her church and a cemetery organization, which she finds rewarding as it allows her to help others and make a positive difference. Her most important belief is her faith in God, and she prays daily and is thankful for her blessings. She has tried to pass on her faith and values to her daughter.
Question Libya recently announced that it is claiming a.docxbkbk37
Libya claimed a 200-mile territorial sea zone, placing armed ships to enforce the claim and calling it a "line of death." The UN Security Council condemned Libya's actions as violating international law, which only recognizes 12 nautical miles of territorial waters. Authorized by Congress, the US sent ships and jets to patrol the 200-mile zone. After a Libyan ship fired at a US jet, US forces returned fire and destroyed two Libyan ships.
Question Use the Internet or the IGlobal Resource.docxbkbk37
This document provides instructions for two questions. Question 1 asks the reader to research scientific testing procedures and write the steps to provide evidence for a scientific claim. Question 2 asks the reader to watch a NASA video about detecting methane on Mars, discuss the challenges of collecting data on Mars, and how NASA is working to overcome these challenges. The reader is instructed to submit their responses in a Word document before a deadline.
Question Please define motivation and discuss why it is.docxbkbk37
Motivation is an important factor in educating adult learners because it influences their willingness to learn. Sociocultural factors like cultural conditions can impact adult learners' needs, with some conditions more significant than others. Adults choose to learn based on access and opportunity, which influence their learning along with enhancing formal and non-formal learning activities. Neuroandragogy and andragogy are approaches to adult learning, with neuroandragogy incorporating brain research which is important to understanding adult learning and development.
Question share your perspective on personal data as a.docxbkbk37
Personal data has become a product that is collected and sold by companies, but individuals should maintain ownership over their own data. While data collection can enable useful services, people should give informed consent and have transparency about how their information is used. There are ongoing debates around balancing corporate interests, individual privacy and control, and developing policies that ensure data is handled ethically.
The document asks the reader to write a 1000+ word paper in APA format that supports the death penalty for certain crimes like rape of children, kidnapping, and torture. The paper must use at least 3 academic sources and include a word count. The reader is asked to argue that they agree with using the death penalty in cases involving those severe crimes.
Question In your what are the main workforce.docxbkbk37
The main workforce challenges facing the United States are adequate healthcare staffing and shortages of skilled professionals. The COVID-19 pandemic has exacerbated longstanding shortages and strained hospital resources. A future model of care delivery in the US must ensure adequate financing and a skilled mobile healthcare workforce. Mobile health clinics and teams of clinicians and health coaches could help increase access to affordable, tailored care that responds to community needs. However, this requires sufficient training and funding support to be successful.
Presentation by Rebecca Sachs and Joshua Varcie, analysts in CBO’s Health Analysis Division, at the 13th Annual Conference of the American Society of Health Economists.
FT author
Amanda Chu
US Energy Reporter
PREMIUM
June 20 2024
Good morning and welcome back to Energy Source, coming to you from New York, where the city swelters in its first heatwave of the season.
Nearly 80 million people were under alerts in the US north-east and midwest yesterday as temperatures in some municipalities reached record highs in a test to the country’s rickety power grid.
In other news, the Financial Times has a new Big Read this morning on Russia’s grip on nuclear power. Despite sanctions on its economy, the Kremlin continues to be an unrivalled exporter of nuclear power plants, building more than half of all reactors under construction globally. Read how Moscow is using these projects to wield global influence.
Today’s Energy Source dives into the latest Statistical Review of World Energy, the industry’s annual stocktake of global energy consumption. The report was published for more than 70 years by BP before it was passed over to the Energy Institute last year. The oil major remains a contributor.
Data Drill looks at a new analysis from the World Bank showing gas flaring is at a four-year high.
Thanks for reading,
Amanda
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New report offers sobering view of the energy transition
Every year the Statistical Review of World Energy offers a behemoth of data on the state of the global energy market. This year’s findings highlight the world’s insatiable demand for energy and the need to speed up the pace of decarbonisation.
Here are our four main takeaways from this year’s report:
Fossil fuel consumption — and emissions — are at record highs
Countries burnt record amounts of oil and coal last year, sending global fossil fuel consumption and emissions to all-time highs, the Energy Institute reported. Oil demand grew 2.6 per cent, surpassing 100mn barrels per day for the first time.
Meanwhile, the share of fossil fuels in the energy mix declined slightly by half a percentage point, but still made up more than 81 per cent of consumption.
Presentation by Julie Topoleski, CBO’s Director of Labor, Income Security, and Long-Term Analysis, at the 16th Annual Meeting of the OECD Working Party of Parliamentary Budget Officials and Independent Fiscal Institutions.
Causes Supporting Charity for Elderly PeopleSERUDS INDIA
Around 52% of the elder populations in India are living in poverty and poor health problems. In this technological world, they became very backward without having any knowledge about technology. So they’re dependent on working hard for their daily earnings, they’re physically very weak. Thus charity organizations are made to help and raise them and also to give them hope to live.
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Health Insurance Coverage for the U.S. Population, 2024 to 2034
Leukemia Pediatric.pdf
1. Discussion: Leukemia Pediatric
Discussion: Leukemia Pediatric ON Discussion: Leukemia PediatricAnswer all questions in
the Ariana Case Study. Ensure that all questions are correctly answered and the provided
tables are filled. Ensure that all questions are accurate and follow the provided rubric
Discussion: Leukemia PediatricThe attached materials and the “Maternal-Newborn Nursing:
The Critical Components of Nursing Care” should be of assistance in answering
itariana_case_study_quizez.docxariana_case_study_rubrUnformatted Attachment
PreviewPediatric Case Study Name_____________________________ Purpose: The purpose of this
assignment is to help you to achieve the following Course Student Learning Outcomes. You
will review Situation Awareness and Antibiotic Stewardship principles and put them into
action in the service of a pediatric patient. Program SLOs 1 PatientCentered Care Course
SLOs 1.1 Uses components of the nursing process appropriate to the health care needs of
the pediatric patient and family. 1.4* Provides holistic care that addresses the needs of
diverse pediatric populations. 2 Professionalism 2.2 Demonstrates an awareness of the
professional standards of practice that apply to the practice of pediatric nursing. 3
Leadership 3.2 Demonstrates critical thinking and problem-solving process when caring for
a pediatric patient. 7 Teamwork & 7.6* Functions competently within own scope of practice
as a student member of Collaboration the healthcare team. 8 Safety 8.1 Identifies factors
involved in prevention of infection, injury, and errors in the pediatric setting. 10 Evidence-
based 10.1 Uses Evidence-Based Practice (EBP) as it pertains to patient care. Practice *
Clinical Student Learning Outcomes Situation: Ten-year-old Ariana Merchante’s parents
bring her to the Emergency Department (ED). They report to the triage nurse that for the
last 24 hours Ariana has had a sore throat and a fever. The parents appear to be anxious and
very concerned about their daughter. Because Ariana’s attempts at movement were weak
and uncoordinated, her father used a hospital wheelchair to bring her into the ED from the
car. 1. What are your first thoughts about Ariana’s situation? A. SITUATION AWARENESS:
PERCEPTION1: The Triage Nurse collects more information from the parents. Ariana’s fever
has been as high as 100.4?F (38?C). She has taken acetaminophen 325 mg by mouth every 6
hours since the onset of her fever, but it has not had any effect. Ariana was diagnosed with
Acute Lymphoblastic Leukemia (ALL) three months ago, and she has been receiving
chemotherapy. Her last treatment in the Remission Induction Phase was completed ten
days ago. She has a Central Venous Access Device (CVAD) in place for the delivery of her
chemotherapy. Her chemotherapy drugs include Cyclophosphamide, Methotrexate, and
Cytarabine. Ariana is 51.5 inches tall and weighs 52 pounds (23.6 kg). BMI 13.8 is at 3rd
2. percentile for age. Discussion: Leukemia PediatricShe has no known allergies to
medications. Vital signs are: TPR: 101.5?F orally (38.6?C)/112/24 BP 102/54. Lungs clear
bilaterally, nonlabored respiratory effort. Oxygen saturation 96% on room air. Skin pale,
cool. Capillary refill is 4 seconds on chest. Pedal pulses 2+ and equal. Three 1-to 2-
centimeter inflamed lesions in the mouth and oropharynx. CVAD site: no redness, swelling,
exudate or lesions. The nurse notes these behaviors: Lethargic, slumped position in
wheelchair. “Can’t walk. No strength.” Confused and drowsy. Parents answer questions.
Voided 80 mL on arrival. Last void was 4 hours ago, per mother. COMPREHENSION1: The
Triage Nurse has just completed training on the ED’s new Sepsis Protocol, and quickly
identifies aspects of Ariana’s assessment that strongly suggest the presence of sepsis. 2. On
the Sepsis Algorithm, highlight any of Ariana’s assessment data that you find there. 3. What
elements of Ariana’s history indicate high risk for sepsis? History Significance to Risk for
Sepsis 4. List here the assessment data that you have circled on the Sepsis Algorithm. From
the Algorithm, state why these assessments are significant for the presence of sepsis. I’ve
done the first one for you. Assessment Data Oral Temp 38.6? C Significance for Presence of
Sepsis A temperature of < 36?C or > 38.3?C is a criteria for Systemic Inflammation
Syndrome (SIRS) – precursor to Sepsis. PROJECTION1: 5. What is the likely outcome of this
situation if appropriate action is not taken? DECISION/ACTION1: The Triage Nurse fast-
tracks Ariana’s admission to the ED. In collaboration with Ariana’s primary nurse and the
ED physician, the decision is quickly made to implement the Pediatric Sepsis Protocol. 6.
Finish the table with the two remaining rescue interventions from the Initial Stabilization
Phase of the PALS Septic Shock Protocol. State the goals of care for these elements from the
PALS Protocol. Intervention Monitor and Airway, Breathing, and Circulation. Monitor
heart rate, blood pressure, and pulse oximetry. Establish vascular access. Goal Assure
adequate oxygenation and circulation. Monitor patient’s response to therapy and quickly
identify deterioration of her condition. Monitor patient’s response to therapy and quickly
identify deterioration of her condition Allow drawing of blood cultures and other labs. –
ideally before starting rescue interventions, but do not delay these interventions.
PERCEPTION2/COMPREHENSION2: 7. Lab results are quickly available. Analyze the results
in the usual way. Discussion: Leukemia PediatricTest CBC WBCs Neutrophils Bands ANC*
Hemoglobin Hematocrit Platelets Electrolytes Sodium Potassium Renal Function BUN
Creatinine ABGs pH PaCO2 HCO3 Other Glucose ALT PT INR Lactate Urinalysis Specific
Normal Range Result 4.5-11/mm3 40-60% 3-5% > 1500 Critical <500 12-16 g/dL 36-40%
150-450k/µL 7.4 28% 78K 136-145mEq/L 3.5-5.0 mEq/L 150 3.5 7-25 mg/dL 0.6-1.2
mg/dL 26 1.4 7.35-7.45 35-45 22-26 7.2 30 20 70-110 mg/dL 8-20U/L 11-13.5 sec <1.1 < 2
mmol/L 74 22 12.5 1.0 2.2 1.015-1.030 1.5 20 4 360 1.042 Discussion If abnormal – Reason
for abnormal results. If normal, what is ruled out? gravity Reference: * ANC = ABSOLUTE
NEUTROPHIL COUNT CHECK OUT THIS ARTICLE ON NEUTROPENIC FEVER! 2 2 2 2
COMPREHENSION /PROJECTION /DECISION /ACTION : 8. Highlight any of Ariana’s lab
results that you find on the Sepsis Algorithm. 9. Fill in the table for these three high-priority
problems identified by the laboratory results. Problem Lab Result Sodium Urine SG WBC’s
Neutrophils ANC Platelets 150 1.042 1.5K 20% What could happen? (Worst case scenario.)
What action should be taken? 360 78K Physician Orders: 10. On the order table below,
3. answer the questions in the right column. Pediatric Sepsis Protocol Orders Order May use
CVAD for IV fluids & blood draws Fluid boluses: 20 mL/kg rapid infusion over 10 minutes.
Assess effect and repeat as needed. No response required. Calculate the fluid volume for a
single bolus for Ariana. Why do we use the “pull-push” method for delivery? After fluid
bolus completion, IV D5NS at 2 mL/kg/hour Obtain cultures before starting antibiotics if
possible: Throat CVAD Blood Urine Cefepime IV 50 mg/kg/every 8 hours. Infuse over 20
minutes. First dose STAT after cultures obtained. Vancomycin IV 40 mg/kg/day divided
every 6 hours Infuse over 60 minutes. First dose STAT after 1st Cefepime dose. Transfer
patient to Pedi ICU or Pedi Oncology Unit ASAP Calculate the rate for Ariana in mL/hour.
Neutropenic Precautions Define Neutropenic Precautions and describe protective
interventions. Discussion: Leukemia PediatricIf getting the cultures drawn/collected first
would delay fluid and antibiotic deliver beyond the recommended one-hour window, what
would you do and why? Calculate the dose for Ariana. The dose is mixed in 50 mL NS.
Calculate the IV rate in mL/hour. Calculate the dose for Ariana. The dose is mixed in 100 mL
NS. Calculate the IV rate in mL/hour. What is the rationale for moving Ariana out of the ED
as soon as possible? B. Continued Situation Awareness Physician’s Orders include
interventions to monitor for change in status. We expect status improvement as the patient
responds to protocol interventions. We are also constantly vigilant for indications that the
patient is not responding, or that her status is worsening. 11. The tables below shows the
nurse’s assessment of Ariana before and after the first and second fluid bolus. Each time,
you must decide whether Ariana needs another fluid bolus (based on the nurse’s
assessment) or if we should begin to deliver the maintenance IV solution at the ordered
rate. Be specific about which assessment data influenced your decision! Normal vital signs
for a 10-year-old child are as follows (per PALS): Heart rate: 75-118 Respiratory rate: 18-25
Blood Pressure: 97-115/57-76 Temperature: < 38?C O2 sat: ? 94% on room air Urine
output: ? 24 mL/hour Peripheral pulses: 3+ st Assessments before 1 bolus Assessments
after 1st bolus TPR: 38.3?C/120/26 BP 96/54 TPR: 38.1?C/110/22 BP 102/52 EKG – Sinus
tachycardia EKG – Sinus tachycardia O2 sat – 92% on O2 @ 2L/min O2 sat – 96% on 2L/min
O2 Central cap refill 4 seconds Central cap refill 4 seconds Peripheral pulses 1+ Peripheral
pulses 2+ Urine Output – 4 mL/15 min Urine Output – 5 mL/15 min Neuro – lethargic,
confused Neuro – drowsy, intermittently alert and confused. Lungs CTA Lungs CTA
Evaluation Improving/Stable/Worsening (Circle one) Plan: (Select one and give rationale.)
___Repeat fluid bolus – why? ___Begin maintenance fluids – why? (The presence of a 2nd
table should not be taken to mean that a 2nd bolus is required. Base your evaluation on the
post-bolus assessment.) Discussion: Leukemia PediatricAssessments before 2nd bolus TPR:
38.1?C/110/22 BP 102/52 EKG – Sinus tachycardia O2 sat – 96% on 2L/min O2 Central cap
refill 4 seconds Peripheral pulses 2+ Urine Output – 5 mL/15 min Neuro – drowsy,
intermittently alert and confused. Lungs CTA Assessments after 2nd bolus TPR:
37.8?C/98/18 BP 112/60 EKG – Normal Sinus Rhythm O2 sat – 96% on room air Central
cap refill 3 seconds Peripheral pulses 3+ Urine Output – 7 mL/15 min Neuro –alert and
oriented. Evaluation Improving/Stable/Worsening (Circle one) Lungs CTA ___Begin
maintenance fluids – why? Plan: (Select one and give rationale.) ___Repeat fluid bolus –
why? (The absence of a 3rd table should not be taken to mean that a 3rd bolus is not
4. required. Base your evaluation on the post-bolus assessment.) Resolution: The team has
successfully implemented the PALS plan for the first hour response to pediatric sepsis, and
Ariana is well on her way to recovery. Fluids were started within 15 minutes of recognition
of sepsis, and antibiotics were initiated within the first hour. Ariana has been transferred to
the Pediatric ICU, and her parents are now with her. Antibiotic Stewardship: Forty-eight
hours after they were collected, the culture results are back. The team holds an “Antibiotic
TimeOut” meeting. 12. a. What is the purpose of this discussion? b. Why is it so important to
Ariana’s outcome? c. What does de-escalation mean in this context? Cultures reveal the
presence of strep pharyngitis that will respond to Cefipime. In consultation with Ariana’s
oncologist, the team decides it is safe to de-escalate Ariana’s treatment by stopping the
Vancomycin and continuing with Cefipime IV for a total of 7 days of therapy. Psychosocial
Concerns: Imagine that Ariana is your child. You have always been transparent with her and
provided as much developmentally appropriate information as possible. During the
induction phase of her chemotherapy, Ariana appeared to understand that because the
chemotherapy drugs would cause her white blood cell count to be very low, she would be at
risk for a serious infection. Your family has observed the precautions necessary to reduce
her risk, but she became seriously ill nonetheless. 13. Now that she’s feeling better, Ariana
asks you (her parent – not her nurse!), Discussion: Leukemia Pediatric“This has been so
scary. What’s going to happen to me?” After reading “What to tell your child” from
Childhood Leukemia: A Guide for Families, Friends, and Caregivers, compose a response to
your child’s question. Ariana Case Study Rubric Student________________________ Criteria Initial
Appraisal of the Situation 1 State your initial appraisal based on limited information and
cues available. Perception1 and Comprehension1 2 Identify data relevant to a Sepsis
diagnosis & highlight it on the Sepsis Algorithm 3 Identify history data relevant to Sepsis
diagnosis and state the significance of the data. 4 Identify assessment data relevant to
Sepsis diagnosis and state the significance of the data. Projection1/Decision1/Action1 5
Project the likely outcome of this situation. 6 Fill in the two PALS Septic Shock Protocol
essential rescue interventions and state the goals of these actions. Perception2 and
Comprehension2 7 a. Identify what normal lab findings rule out. b. Explain the cause of
abnormal lab results within the context of the patient’s situation and condition. 8 Highlight
abnormal results on the Sepsis Algorithm. 2 2 2 Pts. /4 /4 /6 /6 /4 /8 /10 /4 2
Comprehension /Projection /Decision /Action 9 Identify the patient’s three highest-priority
problems ed by the laboratory results, project their potential outcomes, and state actions
required to avert the projected outcomes. Physician’s Orders Comprehension 10 Answer
questions regarding physician’s orders which are essential elements of the Sepsis Protocol.
Implementation of Fluid Resuscitation 11 Evaluate the patient’s response to each fluid bolus
and decide if an additional bolus is needed. Give your rationale for the decision. Antibiotic
Stewardship 12 a. Define Antibiotic Timeout b. Explain why it is so important in Ariana’s
situation. c. Explain De-escalation. Psychosocial Concerns 13 Compose an effective and
compassionate response to Ariana’s question using the principles advanced in the required
reading. Writing Mechanics Complete sentences Cohesive paragraphs Correct grammar,
spelling Scholarship Sufficient In-text citations in APA format Bibliography in APA format
Total /10 /10 /10 /6 /10 /4 /4 /100 Notes