Urosepsis

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    Location: In hospital

    His temperature is 39.4 C (103 F), blood pressure is 90/62 mmHg, pulse is 110/min, and respirations are 18/min.

    A 70-year-old white male is admitted to the hospital for resection of a superficial bladder carcinoma through cystoscopy. Postoperatively, he had mild bleeding and he has a Foley catheter for continuous bladder irrigation. The next day, the nurse called you because the patient is having a high-grade fever, chills, and became hypotensive. He is also feeling nauseous.

  1.   IV access, stat
  2.   Pulse oximetry, stat (Result: 98% on room air)
  3.   Genera Examination :Patient is having shaking chills.
  4.   Order:
  5.   Normal saline, IV, bolus
  6.   Normal saline, IV, continuous
  7.   D/C Foley catheter
  8.   Continuous cardiac monitor
  9.   UA, stat many bacteria, many WBC, positive nitrite, positive esterase, and few RBC
  10.   Urine C & S, stat
  11.   Blood cultures, stat
  12.   CBC with diff, stat. CBC shows a WBC count of 13,000 with 10% bands
  13.   BMP, stat
  14.   Ceftriaxone, IV, stat, continuous (order only after ordering blood and urine cultures)
  15.   Transfer to ICU
  16.   Order:
  17.   ICU vitals
  18.   Pulse oximetry, every 4 hours
  19.  CXR, Portable, PA, stat (result: normal)
  20.   Acetaminophen (Tylenol), oral, continuous
  21.   Pneumatic compression stockings
  22.   NPO
  23.   Bed rest
  24.   Urine output
  25.   *Advance the clock for one hour and check BP
  26.   *If his BP is still low despite the giving of IV fluids, he should be started on IV dopamine infusion.
  27.   *Once the BP is stable and he is afebrile:
  28.   Shift to ward
  29.  D/C IV normal saline
  30.   D/C ceftriaxone
  31.   Check the urine and blood cultures (usually after 24-hours)
  32.   Change to appropriate oral antibiotic (Mostly oral Bactrim (TMP-SMX) or ciprofloxacin)