Sepsis Case Study

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%.

Sepsis is the number one cause of death in intensive care units in the U.S. More than 750,000 cases of sepsis occur each year and about one third of those patients die from it (McKinney, 2014; Ulloa, 2011). Sepsis is a serious condition that is a result of an inflammatory response to infection that can damage organs if left untreated. Severe sepsis occurs when the infection leads to organ dysfunction. Septic shock is when multiple organ failure occurs due to infection and is worse than sepsis and severe 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.,

There is a disease continuum with increasing severity if not treated or not responsive to treatment o 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 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.

Septic shock results from bacteria that multiply in the blood and then releases toxins that decrease blood pressure, thus, impairing blood flow to cells, tissues and organs. It is an acute infection, usually systemic, that overwhelms the body (toxic shock syndrome) (Huether & Mccance, 2012). This

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.

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

Sepsis is defined as the body’s inflammatory response to an infection and can quickly lead to multiple organ failure and death. Early, goal-directed therapy using the sepsis resuscitation bundle introduced in the “Surviving Sepsis Campaign” is the treatment used throughout the world for sepsis treatment (Winterbottom 2012, pp 247). There are approximately one million cases of sepsis in the United States annually and deaths total more than prostate cancer, breast cancer, and HIV/AIDS combined. Also, more than one-fourth of patients that develop sepsis will develop it on a medical-surgical unit and severe sepsis is the most common cause of

With sepsis becoming a growing concern with each passing day, we must develop new ways to combat it aggressively. With EMS becoming a more advanced, educated, and integral member of the health care team; there must be an inclusion of them into the early and advanced treatment of sepsis. According to a research team in the Netherlands 3.3 out of every 100 patients encountered by EMS in the United States have severe sepsis diagnoses, compared to only 2.3 per 100 for myocardial infarction and 2.2 per 100 for stroke (Van der Wekken et al., 2016). This is massive considering it is not considered a time critical diagnosis like myocardial infarction and stroke already are. The Revised Sepsis Syndrome Classification and Prehospital Sepsis Alert Score are the potential solution to these issues and look to increase rapid recognition, advanced treatment, and decrease mortality from this destructive and aggressive pathological process.

Neonatal sepsis is potentially fatal blood stream infection occurring in the first month of life (1). It causes long duration of hospital stay in neonatal intensive care unit (NICU) and associated with additional expenses, morbidity and long term adverse outcome.(2)

In the early 1990s at a conference convened by the American College of Chest Physicians and the Society of Critical Care Medicine modern definitions of “sepsis” were termed in detail. At that time, “sepsis” was described as a systemic response to a physiologic insult including infections and other etiologies that lead to the development of further organ injury, ultimately culminating in multiple organ dysfunction syndromes.

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.