Part II Perforated Bowel/Sepsis/ICU Case Study- Mary O'Reilly 55 years old, answered

Part II Perforated Bowel/Sepsis/ICU Case Study- Mary O'Reilly 55 years old, answered-Mary O’Reilly is a 55-year-old female with a prior history of partial colectomy w/colostomy who was admitted to the medical/surgical unit for small bowel obstruction. Yesterday she developed severe RLQ abdominal pain and CT revealed a perforated small bowel with free intraperitoneal air. Before she was brought to the operating room (OR) for an exploratory laparotomy, her lactate was 4.9, WBC 18.9, and her systolic BP began to drop to 65-75, with a mean arterial pressure (MAP) of 50-55. She received a total of 2500 mL of 0.9% NS preop and piperacillin-tazobactam 4.5 g. IVPB. Her last BP before she went to the OR was 94/52 w/MAP 65. Present Problem: Mary had an exploratory laparotomy that required extensive lysis of adhesions and was found to have a perforated jejunum with fecal peritonitis. Mary has a 7.0 mm endotracheal tube (ET) that is well secured, 23 cm at the lips. Current vent settings are: CMV/AC rate 12, TV 500 mL, PEEP +5, FiO2 35%. She has an arterial line placed in the right radial artery and a central line was placed in the right internal jugular (RIJ). Placement was confirmed by chest x-ray. Mary received 2.5 liters of LR during the case and had an estimated blood loss (EBL) of 375 mL. To maintain adequate perfusion during surgery, she required norepinephrine IV gtt, currently at 10 mcg. Her SBP was consistently in the 90- 100s during surgery with a mean arterial pressure (MAP) of 65-70 and CVP: 12. She has a wound VAC applied to her open abdominal incision with an intact dressing at 125 mm suction with no drainage and a 14 Fr. Salem Sump NG, 68 cm in the left nare