Sepsis: Early Detection and Implementation of Sepsis Resuscitation Bundle

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.

Management of the acutely ill adult is a complex and perplexed procedure. It requires underpinning knowledge of the pathophysiology of the disease currently affecting the patient, as well as ensuring that professionals are equipped to deal with the development of a rapid deterioration. The National Institute for Clinical Excellence (2007) explain that patients are sometimes inadequately treated due to staff not acting in a sufficient time manner, and so a systematic assessment of the patient recommended by the Resuscitation Council (2006) should initially be followed (Jevon, 2009).

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

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

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.

Aitken, L., Williams, G., Harvey, M., Blot, S., Kleinpell, R., Labeau, S., & ... Ahrens, T. (2011). Nursing considerations to complement the Surviving Sepsis Campaign guidelines. Critical Care Medicine, 39(7), 1800-1818.

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.

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.

Sepsis is a severe complication of an inflammatory response due to various pathogens with the mortality rates ranging anywhere between twenty-five to thirty percent (Epstein, Dantes, Magill, & Fiore, 2016). Sepsis can be precipitated by various infections including some of the most common ones, like urinary tract infections, pneumonia, and cellulitis. An early sepsis recognition is crucial in improving patient outcomes and decreasing mortality rate. Thus, it is very important for a health care provider to start the necessary diagnostics and implementation of fluids, antibiotics, vasopressors and other necessary treatments based on the

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

During the surveillance, data from nursing documentation, physician progress notes, laboratory results, and direct observations. Data was collected from the time of admission until the diagnosis of VAP was made. The patients who were discharged from the ICU and sent to a regular medical surgical floor were followed for an additional 48 to ensure that VAP would be detected that manifested after the discharge.

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.