Sepsis Case Studies

The aim of the essay is to analyse the care of a septic patient. While discussing the relevant physiological changes and the rationale for the treatment the patient received, concentrating on fluid intervention. I recognise there are other elements to the Surviving Sepsis Bundles, however due to word limitation; the focus will be on fluid intervention. The essay will be written as a Case Study format.

The aim of this assignment is to critically discuss the nursing assessment individualised care and nursing interventions of the acutely ill patient. The patient discussed developed severe sepsis due to a urinary tract infection and her condition deteriorated during the recovery process in the nurse’s care. Lovick (2009) defines sepsis ‘as a known or suspected infection accompanied by evidence of two or more of the SIRS criteria’. SIRS is outlined as a ‘systemic inflammatory response’ consisting of two or more of the following symptoms ‘temperature >38 degrees Celsius or 90 beats per minute, respiratory rates greater than 20 breaths per minute and white blood count higher than 12,000 cells per microliter or lower than 4000 cells per

Septic shock is the leading cause of death for patients in intensive care units and is the final stage in a continuum of infectious and inflammatory processes. This continuum begins with bacteremia, which is the presence of bacteria in the blood. Normally the body’s immune system can fight off a localized infection caused by a small amount of bacteria in the blood and the person will remain asymptomatic. However, a hospitalized patient could be immunocompromised, have a

Is sepsis complicated by organ dysfunction, is diagnosed in more than 750,000 patients per year and has mortality rates as high as 28%-50%.

The number of documented cases has been rising every year. “This may be due to the aging population, the increased longevity of people with chronic disease, the spread of antibiotic-resistant organisms, an upsurge in invasive procedures and broader use of immunosuppressive and chemotherapeutic agents” (National Institute of General Medical Sciences, 2014). The mortality rate for sepsis ranges from about thirty percent for patients with sepsis to fifty percent in patients who develop septic shock. Mortality rate varies as to how many organs have been affected. Twenty percent mortality for one organ failure, forty percent for two organs failing, sixty-five to seventy percent for three failed organs, and seventy-five to eighty-five percent when four or more organs have failed. The cost related to sepsis is about seventeen billion dollars per year (about twenty-two thousand dollars per patient), which is six times greater than the cost of patients without sepsis.

Sepsis is defined by the Surviving Sepsis Campaign (SSC) as “the presence (probable or documented) of infection together with systemic manifestations of infection” (Dellinger et al.,

Sepsis is a very serious condition with a high mortality rate that ranges from 28-50%. 9

Under the Core measures, Sepsis is one of the problem-focused trigger for systemic infection and if untreated which can lead to death. In United States, it is the 11th leading cause of death and consumes the large amount of costs about $20.3 billion in 2011 (Jones et al.,2016). According to Centers for Disease Control and Prevention (CDC), more than 1.5 million people diagnosed with sepsis, and at least 250,000 patients die from that yearly (CDC, 2017). The evidence-based research revealed with results of certain pre existing conditions, pathophysiological studies, preventive measures and sepsis bundle for treating and preventing sepsis to save the life of the patients.

According to information published by the Mayo Clinic, sepsis has three stages: sepsis, severe sepsis and septic shock. The mortality rate for septic shock is nearly 50 per cent, and an episode of severe sepsis increases the risk of future infections. Severe sepsis causes blood flow to the vital organs, such as the brain, heart and kidneys, to become impaired. Sepsis can also cause blood clots to form in organs and extremities such as arms, legs, fingers and toes, which can lead to organ failure and tissue death (gangrene).

The evolution of this project cultivated from the need of improvement for patients suffering from sepsis at MacNeal Hospital. Sepsis is a potentially fatal host response to infection that occurs as a systemic inflammatory response syndrome (Schub & Schub, 2013). I felt it was very important to re-evaluate what I can do as a nurse to improve the expected outcomes of sepsis patients and decrease their length of hospitalization. If a patient is admitted with severe sepsis, it places the patient at a higher level of risk than if he/she was admitted with an acute myocardial infarction or acute stroke (Robson & Daniels, 2013). I became interested in sepsis as my project when I became informed that MacNeal had started a Patients With Sepsis Orders Daily Reports, I decided I could enhance and develop an educational tool to help the case managers, emergency room nurses, and staff nurses with early recognition of sepsis and decreasing the length of stay. Angus and Van der Poll (2013) stated that the United States reported 2% of patients that were admitted to the hospital suffered from severe sepsis.

The set of diagnostic procedures and the necessary treatment within this bundle is based on the EBP suggested guidelines. By following the recommended guidelines, I can assure the improvement of quality of care by providing my patient with the best current practice. According to the randomized study over a 12-month period conducted in the Emergency Departments (ED) in New Wales, Australia the introduction of sepsis guidelines in ED improved the early assessment and management of septic patients including reduction in time to antibiotic administration by 230 minutes and the improved urgent triage time by 49.1 % (Romero, Fry, & Roche, 2017).

Hadjiliadis, D. (2012, January 2). Septic Shock. New York Times. Retrieved November 23, 2013, from http://www.nytimes.com/health/guides/dise

et al., 2008). Sepsis is a frequent cause of admission to intensive care units (ICUs) and it

The exact definitions, stratification, and approach to diagnosis of the sepsis spectrum has been a persistent, yet seemingly productive, endeavor for many years1,5,16. Multiple consortiums have addressed the approach to diagnosing sepsis. In 1992, a consortium, comprised of the American College of Chest Physicians and the Society of Critical Care Medicine, instituted the Systemic Inflammatory Response Syndrome (SIRS) criteria which established the fundamental screening tool for identifying individuals with an inflammatory immune response (Table 1)5. A patient exhibiting two or more of the SIRS criteria combined with the presence or suspicion of infection was the fundamental criteria for sepsis diagnosis5. Although this approach is of merit, it is too broad. Patients recovering from surgery or suffering from various non-infectious processes would meet the criteria for sepsis under SIRS17,18. An exhaustive list of exogenous and endogenous processes may generate a SIRS-inclusive response in the absence of infection18. A criteria with greater specificity was greatly needed.

Sepsis, a potentially life-threatening complication of an infection, occurs when chemicals are released into the bloodstream to fight infection. These chemicals trigger inflammatory responses throughout the body (Mayo Clinic Staff, 2016). Sepsis can be triggered by any type of infection: bacterial, viral, or fungal. Contrary to popular belief, sepsis is responsible for a great number of deaths in the United States alone. Sepsis kills more than 258,000 Americans per year, is the number one cause of death in hospitals, and kills more Americans than prostate cancer, breast cancer, and acquired immunodeficiency syndrome (AIDS) combined. (Rory Staunton Foundation for Sepsis Prevention, n.d.) As cited in nursing journal, “Sepsis: Diagnostic and Therapeutic Challenges,” ‘One of the