Alma Bobzien is an 82 year old female who was brought into the ER in acute respiratory distress. She was showing signs of sepsis including hypotension, tachycardia, and temperature of 101.4 degrees F. Her lactic acid level and white blood cell (WBC) count came back elevated. She was admitted to the ICU with a diagnosis of severe sepsis secondary to pneumonia. She was put on antibiotics. On day 2, Alma needed to be intubated. During the afternoon assessment on day 2 , the nurse noticed hematuria, petechiae, bruising on all extremities, blood oozing from her IV sites, fingers and toes were cold and pale and several toes were starting to turn purple, coarse lung sounds with blood tinged secretions, and was still hypotensive and tachycardic.
What are the most significant clinical manifestations? Why are they significant?