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When did Texas win their Independence from Mexico
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- A client with diabetes and an infected heel ulcer is transferred to the intensive care unit because of deteriorating condition. Based on the admission assessment, what does the nurse identify as the most likely condition'? Click the exhibit button for additional informationExhibit:Vital signs at 1000Temperature 102.8 F (39.3 C)Blood pressure 80/60 mm HgHeart rate 110/minRespirations 36/min. laboredSp02 89%Admission notes1000 Client is lethargic and difficult to arouse. Large amount of purulent drainage noted from left heel ulcer. Wound culture positive for Staphylococcus aureus and serum lactate level elevated. Second fluid challenge, 0.9% normal saline solution infusing at 1000 mL/hr. CVP 2 mm Hg, PAWP 3 mm Hg. Will continue to monitor._________________________, RN1. Multiple organ dysfunction syndrome (MODS)2. Sepsis3. Septic shock4. Systemic inflammatory response syndrome (SIRS)