Sepsis In Critically Patient

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

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.

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.,

Sepsis is a very serious condition with a high mortality rate that ranges from 28-50%. 9

Due to weaken immune system, declining organ function, poor sensory perception, and multiple prescribed and over the counter medications, and comorbidities elderly patients are at risk for infections. For many elderly patients the possibility of developing an infection is extremely high, on account of hospitalization or living in long-term care facilities. The most common type of infection acquired in these facilities is urinary tract infections. A urinary tract infection most likely affects the bladder or urethra; more serious urinary tract infections occur in the kidneys. There may be symptoms such as urinary urgency or frequency, but in other cases there are no symptoms at all. This urine infection is caused by gram-negative sepsis.

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

The priority assessment for sepsis is identifying patients at highest risk for sepsis, although all patients should be monitored for clinical manifestations. Patients at increased risk include those with chronic illnesses, under one year old or older than 85 years old, the immunosuppressed, postoperative patients, and those debilitated or with poor nutrition (Bernstien 2013, pg 25). To identify sepsis early the nurse will need to look for a respiratory rate of >20, heart rate >90, temperature >100.4 or < 96.8*F, and a white blood cell count of >12,000 cells/mm3 or < 4,000 cells/mm3. Assessments after the resuscitation bundle has begun would include respiratory, cardiovascular, integumentary, urinary, and neurological systems, as well as laboratory values. Respiratory would be assessed for rate and oxygen saturation. Central venous pressure, mean arterial pressure, systolic blood pressure, pulse quality and peripheral pulses would be assessed for the cardiovascular system. Skin would be assessed for warmth, color, and whether it is clammy or dry. Skin would also be assessed for petechiae, ecchymosis, or bleeding of mucous membranes to ensure disseminated intravascular coagulation (DIC) has not begun. Urinary output would be monitored to ensure adequate perfusion to the kidneys and for signs of urinary tract infections. Neurological would be assessed for any changes from baseline mental status. The most important

Early identification of sepsis is crucial when caring for patients at risk for sepsis. The

Around 750,000 of sepsis are present in the United States every year. It constitutes around 2% of all hospitalizations, where of these cases are treated in the ICU (representing 10% of all ICU unit). It is estimated that in year 2020, 1 million cases of sepsis will be present every year. Hospital mortality for septic patients ranges from 18% to 30%, and 215,000 deaths (9.3% of all deaths) in the united states occurred in septic patients (O’Brien et al., 2007). Another article shows that for the older adults, sepsis is among the five admitting diagnoses (Englert, Ross, 2015)). Sepsis occurs as a result of both community-acquired and health care-associated infections.

          If one believes that someone has Sepsis, then it is strongly recommended to visit the doctors for medical assistance. If one has been diagnosed with Sepsis, then the doctor present will inject antibiotics into the patients bloodstream, noted from healthline.com. Of course, he or she will be closely monitored until it has been ruled out. Once finished, the person who had Sepsis will have to do a checkup to make sure it does not come back. When it is over, the person will be able to go home and get a goods nights rest.