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

The systemic inflammatory response is the next step in the continuum and is a nonspecific inflammatory state that may be seen with an infection. Sepsis is the presence of the systemic inflammatory response syndrome (SIRS) with evidence of infection. As the bacteria invade the bloodstream, they release endotoxins that damage the endothelial cell lining and impair the vascular system, coagulation mechanism, and immune system. These endotoxins also trigger the immune and inflammatory responses, which results in the activation of macrophages and CD4 cells that release proinflammatory cytokines to create a systemic inflammatory response to the pathogen. Hospitalized patients may quickly progress from bacteremia to sepsis and finally to septic shock, even with treatment.

Is aggressive widespread inflammatory response to infection (sepsis) or perceived invader. Also, ischemia, infarction and injury.

Recognition of Sepsis in the ED. It is well known within health care professionals as well as the general public that, in the first hours of a myocardial infarction or cerebral vascular accident, time is tissue. This is also the case in severe sepsis and because of this, early recognition of sepsis is vital to improving outcomes. SIRS is the first line diagnostic for the recognition of sepsis. If the patient meets SIRS criteria, the next line of diagnostics is to test the serum lactate. Lactate is believed to be due to decreased end-organ perfusion, leading to anaerobic glycolysis and lactate production. Serum lactate is commonly used as a prognostic test for illness severity in ED patients with sepsis (Green et al., 2011).

Overwhelming, deleterious host immune response to an infection due to release of chemicals to fight the infection 2• 1

This leads us to the next step in the pathophysiology of Sepsis. Stage 2 of sepsis, which is when SIRS plus the confirmation of an infection has been made. At this stage, the patient’s body has been continuously fighting something in their body and it is starting to have an effect on the patient. Signs and symptoms of sepsis are often nonspecific and include the following: Fever, chills, or rigors, Confusion, Anxiety, Difficulty breathing, Fatigue, malaise, Nausea and vomiting. It is important to identify any potential source of infection. Localizing signs and symptoms referable to organ systems may provide useful clues to the etiology of sepsis and are as follows: Head and neck infections: Severe headache, neck stiffness, altered mental

exists within the body (Neligan, 2006). When a pathogen is present in the bloodstream or

Sepsis is one of the leading causes of morbidity and mortality globally, the 10th leading cause of death in the United States and the second leading cause of death in non-cardiac intensive care units [1]. Each year between 400,000 and 500,000 cases of sepsis occur in the United States and the cost of caring for a septic patient is high, resulting in a national economic burden of almost 17 billion dollars per year [1-2]. Sepsis is a serious health concern and a better understanding of the causes and potential interventions is necessary. Since 1987, gram-positive bacteria have been the major causative agents of sepsis [1]. Staphylococcus aureus and Staphylococcus epidermidis are two of these causative agents and together cause the majority of nosocomial sepsis infections in United States hospitals [3]. Forty percent of the S. aureus strains, that cause an estimated 292,000 hospitalizations in the United States each year, are resistant to the first line option of antimicrobial therapy, methicillin/nafcillin (β-lactamase resistant penicillins), making them extremely difficult to treat [4].

Sepsis is listed among the causes of death in 2.4 million cases between 1999 and 2014 in the United State (Epstein, Dantes, Magill, & Fiore, 2016). The incidence of sepsis is increasing due to increase in the number of older population and people live with chronic illness and widespread use of immunosuppressive drugs, indwelling catheters, and mechanical devices (Munford, 2014).

Prerenal failure is one of the most developed causes of kidney failure in patients who are hospitalized. Most conditions, such as burns, long-term vomiting, bleeding, dehydration results in a decrease amount of blood flow to the kidney. Due to blockage or tightening of blood vessel carrying blood to the glomerular filtration rate, this may complicate fluid and electrolytes and result in excess fluid volume. According to Best Practice & Research (2007), “it may lead to ischemic tubular necrosis when the reduction in blood flow is sufficient to result in the death of tubular cells.” However, without sufficient fixation to prerenal failure, it may result in the next stage of intrarenal acute kidney failure.

The pathophysiology of acute renal failure is still uncertain though it is thought to be

multiple organ dysfunction syndrome (MODS) may be result from sepsis, which has a mortality rate of between 30% and 50% (Nesseler, 2012). when the vascular endothelium are damaged it causes edema and collection of neutrophils and macrophages.in the damage site, there isreduced in gas exchange, nutrients cannot reached into the tissues and waste products cannot diffuse out. An organ with significant damage to its vascular endothelium ends up poorly perfused and ischemic. Such an organ will function poorly (organ dysfunction) or it will fail altogether. As sepsis continues, it causes increasing organ dysfunction and then organ failure, and the risk of the patient dying doubles for each organ that fails

"The common clinical features among the case-patients included a prodromial illness of fever, chills, and myalgia. The prodrome was followed by dyspnea, cough, throbocytopenia, severe hemodynamic instability, neutrophilid with immature forms, atypical lymphocytes, elevated serum levels of lactate dehydrogenase. There was a high mortality rate, approximately eighty percent in the initial group of patients, the chest x-ray examinations revealed a diffuse, interstitial infiltrate that resembled that observed in patients with adult respiratory distress syndrome (ARDS), which is a common pattern in patients

Sepsis is a debilitating, potentially life threatening condition that has become a big burden on the health system worldwide. Early recognition and aggressive timely treatment have proven to be life saving interventions. South Miami Hospital (SMH) aims to provide safe care to our community by implementing and utilizing evidence –based guidelines and protocols. According to research, early identification of patients presenting with signs and symptoms of sepsis is crucial to patients’ survival. In order to achieve this goal SMH Emergency Department (ED) implemented a triage sepsis-screening tool, an intervention that as evidenced by research helps to recognize patients at risk for developing sepsis or presenting with this devastating disease.