Sepsis Case Study

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.

Discuss the magnitude of bacteremia and sepsis in hospitalized patients and the relationship between these two diagnoses. (5 points)

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.

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.

The progress of my project to develop a nurse driven sepsis screening tool and an algorithm for implementation on the intensive care unit (ICU) for early identification and prompt treatment of septic patients has progressed remarkably well. I have been productive in gathering current guidelines for sepsis with the aid of my preceptor who is a critical care nurse practitioner on the ICU. With his help, I have been able to assemble key pieces of research to create a sepsis screening tool, and a treatment algorithm with sepsis resuscitation bundles. Extensive research has been conducted to integrate evidence-based practice in my project. I have also spent time with the unit educator, critical care intensivists, and my colleagues in brainstorming and collecting ideas about my project.

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

A methodical search was undertaken of the databases – PubMed, CINAHL and ScienceDirect to ascertain the most appropriate evidence. Search terms used were “Sepsis Prevention”, “Sepsis Management” “Sepsis Early Recognition” and “Sepsis Detection” and merged using Boolean Logic (Glasper and Rees,

Education interventions are very significant in the understanding of different stages of sepsis such as septic shock, uncomplicated sepsis, and severe sepsis. The progression of this disease varies from one person to another, and it can occur to some people through the three stages. Therefore, having a clear understanding of all the three phases that sepsis exists can help in the diagnosis of the diseases effectively. Additionally, education will provide an avenue and strategy of providing optimal care to the patient, and that will contribute to managing their condition. Sometimes the patients may not respond to the treatment administered, and as a result, they can develop multiple organ diseases. Hence, education will provide all the required knowledge to understand and know the various dynamic of the diseases and how it progress in a patient.

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 is a substantial health care condition. Jones et al. (2016) describes sepsis as the “11th leading cause of death in the United States ranking 10th in people 65 years of age and older” (p. 122). This impact of mortality from sepsis is devastating to many families in the United States. Facing the health care system also is the cost of septicemia. Septicemia was the most costly and most common reason for hospitalization, as reported by Jones et al (2016) “accounting for 1,094,000 hospital stays and $20.3 billion in aggregated hospital costs, the average cost for an admission for sepsis at $18,600” (p. 122).

Subsequently, additional studies and consortiums have produced an exhaustive list of screening criteria for the diagnosis of sepsis. In 2001, the International Sepsis Definitions Conference published an elaborate, collaborative criteria for sepsis involving general physiologic parameters, inflammatory

Sepsis is the body’s response to infection. The onset of sepsis is often undetected until the condition has become critical. Sepsis progresses into severe sepsis, septic shock, and eventually death; typically from organ failure. The condition affects over 500,000 individuals annually, has a mortality rate of over 25%, and presents a risk to patients in every inpatient setting regardless of acuity level (Whelchel et al., 2011). My first experience with sepsis was enlightening because it affected a patient under my care. I was surprised at the insidious onset of the symptoms, the rapid decline in the patient’s condition, and the missed opportunities that the healthcare team had to implement the recommended care bundle protocols.

(2015) created a nurse-driven sepsis protocol that included mandatory education for both nurses and providers. Understanding the sepsis protocol and roles of each team member is essential for the success of the proposed change. The development of a sepsis protocol was created with an interprofessional team and is initiated by the triage nurse when a patient presented to the ED with two or more signs of early sepsis. The triage nurse notifies the charge nurse and the covering provider when the sepsis protocol is initiated. The protocol allows for early sepsis intervention and enhanced interprofessional collaboration. This protocol could be easily adopted at SVMC since the triage nurse has access to the electronic health record (EHR) and the sepsis screening tool. The triage nurse also has access to order entry to start the protocol and establish “time zero”. The ultimate goal is to improve outcomes from patients and encourage collaborative

Gauer (2013) argues that treatment; within the first six hours of sepsis recognition reduces the risk of the in-hospitality mortality significantly. Early detection of sepsis is essential in saving lives. You have done a good job at identifying the underlying causes of the late recoginition of sepsis in the emergency room setting. Most importantly you identified which causes were most significant, which is vital because your action plan therefore, focuses on eliminating these causes. For example, on your fishbone diagram you identified “MD taking too long to put in order for fluids and antibiotics” as a barrier which coincides with your task, in your action plan to, “decide which standing orders to have the nurses put in” as part of a sepsis protocol. It is clear when reviewing your fishbone diagram and action plan, how your task will help assist in reducing the desirable outcome: delay in sepsis recognition and treatment. Good job!

According to the authors, Bernstein & Lynn (2013), “A common and devastating condition, sepsis has significant healthcare implication worldwide.” The authors elaborate on the different types of sepsis and the complications that arise from them along with the pathophysiology and risk factors. Bernstein and Lynn emphasized the importance of a proper nursing assessments, recognition of septic progression and nursing interventions.