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.

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).

Furthermore, a multidisciplinary team meeting will be presented to identify the impact of different health care professionals such as a physiotherapist, an occupational therapist and a nurse have on a patient with complex need and how the patient receives the care needed due to the collaborative practice. In addition, a comparison between physiotherapy, occupational therapy and nursing practice will be outlined

As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the patient begins to show organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (e.g., renal failure, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs. Adventitious lung sounds occur throughout the lung fields, not just in the upper fields of the lungs.

With total U S hospitals costs of over $20 billion, sepsis is one of the most expensive health conditions treated in hospitals (1). According to the Centers for Disease Control and Prevention (CDC), sepsis affects more than 1.5 million people each year, proving fatal for approximately 250,000 of those individuals (2). The CDC estimates that one out of every three patient deaths in a hospital involves sepsis (2). While the incidence of sepsis is reportedly increasing (3, 4), it is difficult to obtain an accurate figure.

Knapp (2012) describes sepsis as the systemic inflammatory response to a pathogen. Sepsis can be a fatal condition which occurs when the body retaliates to an infection by attacking the body’s own tissues and organs. Sepsis has many symptoms that can be attributed to other illness such as flu, which can make it difficult to recognise and treat in time (CDC Sepsis 2016). Due to this every year in the UK there are 150,000 cases of sepsis, which leads to 44,000 deaths, in perspective sepsis results in more deaths than bowel, breast and prostate cancer collectively (Sepsis Trust, 2016). Sepsis costs the NHS £15.6 billion a year (Sepsis Trust 2016). As the NMC code of conduct describes, healthcare professionals have a ‘duty of condor’ to preserve the safety of patients, reducing the potentials of harm and mistakes to the service users (NMC Code of Conduct 2015), thus with improved management and early detection of sepsis e.g. beginning a course of antibiotics within the hour of detection, will not only save the NHS £2.8 billion a year but thousands of lives (Sepsis Trust 2016).

Not all bacteremias lead to sepsis. People have everyday bacteremia, particularly, from oral cavity, but sepsis develops rarely [27-31]. It occurs when the infection is resistant to host antibacterial defense. The latter is different in the bloodstream and tissues. If the infection develops locally (tissue, cavity, etc.) and then enters the bloodstream, there are two stages of sepsis: pre-septic (local) and septic (generalized). If infection enters the bloodstream directly from an external source (contaminated intravenous injection, bite, etc.), the pre-septic stage is absent. Local antibacterial defense is provided by phagocytosis (leukocytes and their local versions: resident macrophages), complement, NETs, etc., whereas in the bloodstream

Thirty to 50 percent of the 400,000 to 500,000 cases of sepsis in the United States each year are fatal, emphasizing the seriousness of this public health concern [2]. Recent research into possible alternative treatment options indicates that patients being treated with statin therapy are less likely to develop sepsis from a serious infection, die from sepsis or develop serious complications due to sepsis; however, the mechanism of action is unknown and therefore is the focus of this study [2, 6, 10-12]. Possible mechanisms of action include a direct interaction of the statin with the sepsis-causing organism, an interaction between the statin and the host immune system or a combination of the two [9, 14, 16-17]. Additionally, recent studies indicate that statins may have a direct antimicrobial effect and has suggested that statins may diminish the replication and infectivity of some pathogens responsible for sepsis [11, 14, 16-17]. Thus, we hypothesized that statins could benefit septic patients by

Sepsis and the lasting physiological effects of survivors are major concerns for the Center for Medicare/Medicaid Services (CMS),

When a patient has sepsis early symptoms will include those that define SIRS; abnormal body temperature, increased heart rate, increased respiratory rate, and/or abnormal white blood cell count. If these symptoms are left untreated, organ failure will start to occur. Signs of organ failure can include decreased urine output, sudden changes in mental status, difficulty breathing, decrease in platelets and abnormal heart rhythms. Decreased cardiac output and hypotension may also start to occur, which indicates septic

R.H. has a large, active family in the area who assist in his care and plan of treatment as much as possible, and provide daily visits. Prior to the most recent hospital admission, the family reports he was an active man who lived alone, and was quite capable of caring for himself and his house. He has a wife who suffers from dementia and is cared for by their children. He meets with his primary care doctor as well as a home health nurse frequently to monitor his condition and review treatment options. Additionally, the patient is a non-practicing Catholic, with a close group of friends and other support systems within the community. Even with the high level of support he has, the patient is still at an increased risk for ineffective coping due to the sudden onset of his symptoms. Due to his continued weakness and confusion related to high levels of pain medications, much of the decision making is left up to his family, particularly his eldest daughter causing stress for the whole family. Because of his self-care deficit, which will likely extend after discharge, he will likely require extensive rehabilitation as well as being required to live either with family members or in a care facility. The patient and family will need to be continually monitored for ineffective coping for the duration of his hospital stay, as well as following discharge.

According to the National Institute of General Medical Sciences severe sepsis strikes about 750,000 people in the United States each year and kills an estimated 28 to 50 percent of those individuals. The most vulnerable populations for sepsis are the elderly and newborns. After completing the whole eleven segments, I learned that anyone with an infection may be at risk for developing sepsis. The whole scenario helped me how to screen for sepsis and how important is to recognize and respond appropriately to early signs of sepsis in hospitalized patients. Once sepsis is diagnosed, early and aggressive treatment can begin which greatly reduces mortality rates associated with sepsis. After completing the whole scenario I learned how to approach

1 a.) I have been performing my fieldwork at Whittier Health Network in Haverhill, Massachusetts. There many different types of patients and clients receiving services at my fieldwork site, from patients receiving rehabilitation services, to residents receiving dialysis. Some of the patients that my fieldwork supervisor and I have been meeting with have ranged in age from mid-forties to late eighties, and have had various diagnoses. One patient that my supervisor and I have met with was a women in her mid-fifties. She has recently had knee surgery, and has been suffering from respiratory problems. She also has been experiencing high levels of anxiety, which appears to be due to her inability to breathe properly and easily. Another patient we have been seeing who has been experiencing difficulties with respiration and breathing is a man in his early seventies. He has been ill, and was experiencing difficulty with breathing. He is currently using a tracheostomy tube, which has allowed him to breathe, and make great progress throughout his stay at the facility. Another patient we have been seeing is a women in her mid-sixties. This patient had obtained an injury to the lumbar region of her spinal cord, and in turn has recently had spinal surgery. Other patients that we have seen have been experiencing various injuries that they are working on recovering from; are experiencing various ailments such as dementia, confusion, and Alzheimer’s; or are experiencing difficulties with

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