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Mr. F, a 75-year-old man, was admitted to the high-acuity unit with a diagnosis of pneumonia. He was placed on IV hydration and antibiotics. Twenty-four hours later, he complains of shortness of breath and difficulty breathing. His blood pressure is 80/60 mmHg, pulse 125 beats/min, respirations 30 breaths/min, temperature 39°C (102.4°F). A chest x-ray reveals diffuse bilateral infiltrates. Arterial blood gas results on 2 liters nasal cannula are pH 7.45, PaCO2 45, PaO2 44, SaO2 82%. He is intubated and transferred to the ICU. His urine output for the past 24 hours is 400 mL, and his morning serum laboratory results are as follows:

 

What are Mr. F’s risk factors for developing SIRS?
What conditions does Mr. F have that meet the criteria for SIRS?
Based on the data given, what organ systems appear to be injured? Give data to support your answer.
Do you believe Mr. F, now in the ICU, has MODS? Explain your answer.
What is the pathophysiologic basis for MODS in this patient? How can a pulmonary infection on admission progress to MODS 48 hours later?
Should the nurse be concerned about Mr. F’s hyperglycemia? Explain your answer. 

Wagner et al., Instructor’s Resource Manual for High-Acuity Nursing, 7th Edition

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