Sepsis: Inflammation and White Cell Count Essay

Until recently it was not uncommon for patients admitted to an acute care facility to have an indwelling catheter anchored for unnecessary reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units nursing would also anchor indwelling catheters for multiple unnecessary reasons. These Catheters could be

The medical director ordered a postvoid catheterization, which yielded 100 mL of cloudy urine that had

On the early morning of August 17, 2002, James C., a patient in one of the wards under the supervision of Ellen Hughes Finnerty, RN, went into respiratory depression. Between 3:00 and 4:00 a.m., Ann Mugi, the patient’s primary nurse, sought the assistance of a respiratory therapist, Hiran Obeyesekere, to help her care for the patient. As Obeyesekere suctioned the patient airway, Mugi called the service of the patient’s primary care physician, Dr. Jackson, to report the changes in the patient’s respiratory status, e.g., respiratory rate of 40 breaths per minute and low urine output.

This is an 82-year-old gentleman, who was referred from Dr. Gretchen Marsh’s office because the patient’s BUN and creatinine were high, as he has acute kidney injury. The patient went to Dr. Marsh’s office yesterday and was having generalized weakness. He does not have any vomiting. No diarrhea. No fever. No cough with expectoration. No sharpness. No wheezing. No headache. No dizziness. No passing out. No rectal bleeding. No hematemesis. No abdominal pain. No sore throat. No stuffy nose. No cough with expectoration. No burning, frequency, or

Kacey, thank you for provide your insight on the framework for praxis discussion. Kacey, we have same phenomenon of interest (POI), which is sepsis prevention. Kacey, as you had stated that sepsis is a major issue in the emergency rooms (ERs). However, sepsis is also a major factor for the medical-surgical units and intensive care units (ICUs). Sepsis within the United Stated represent 2 % of patients admission to the hospitals, additionally, 10% of those admissions are treated in the ICUs. (Kleinpell & Schorr, 2014).

Sepsis is a condition of growing concern for nursing professionals, as the mortality rate has increased each year since its initial documentation in the early 1990s (Levy et al., 2012). Sepsis was first defined in 1991 as a systemic inflammatory response syndrome (SIRS). Since this time, improvements have been made in developing a worldwide definition of sepsis (Levy et al., 2012). Specifically, sepsis is considered to be a life-threatening dysfunction of the organs that results from the dysregulation of a host response to an infectious agent (American Association of Critical-Care Nurses, AACN, 2018).

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!

The patient is 65-year-old gentleman who presented to the emergency room with fever, urinary urgency, lower abdominal pain, no nausea no vomiting. The wife also reported that the patient had a leak from the Foley catheter. The patient this has a history of hypertension, dementia and enlarged prostate. He is been followed by urologist at St. Hackensack University Hospital and currently has a urinary retention with indwelling Foley catheter. He presents to our ED with a temp of 102.3, white count of 24.6 which goes up to 25.5 and the left shift. Urinalysis reveals him to be dehydrated with specific gravity greater than 1030, positive nitrates, positive large, leukoesterase, a large amount of blood and his cultures immediately grew Escherichia

Patient denies any history of syncope, seizures, transient paralysis, and paresthesia, black out spells. Cranial nerves assess no abnormalities assessed.

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).

Sepsis is one of the oldest diseases and has the most ambiguous and tricky syndromes in medicine. Hippocrates believed that sepsis was the case where the flesh gets deteriorated and decayed. Galen, a prominent Greek physician, surgeon and philosopher in the Roman Empire, considered sepsis an admirable event, which is crucial for the healing of wounds. After the germ theory was confirmed by Pasteur and others, sepsis definition shifted to a systemic infection which was defined as “blood poisoning”, and it was believed that sepsis was the result of invasion of a pathologic organism to a host and then its spread in the bloodstream. With the arrival of modern antibiotics, the germ theory was found that it did not fully explained the full pathogenesis of sepsis, and it was also found that many septic patients passed away despite the eradication of the pathogen. So the researchers suggested that the host and not the pathogen is responsible for driving the pathogenesis of sepsis.

Emily is an 83 year old mother of three who was admitted to the ICU for sepsis from a UTI. She has been in the ICU for two days. She has not been intubated during her stay, however her lactate level is rising. She is awake, alert and oriented. Daughter is at bedside. During catheter care using chlorhexedine wipes, she experienced increasing discomfort and complained of a strong burning sensation in between her legs and vaginal area. She was becoming distraught.

This is a 50-year-old gentleman with a history of urinary retention who had been placed on Flomax and intermittent catheterization once at night. He had video urodynamics done which showed a large volume in his bladder of 2340 mL. He had markedly decreased sensation to void, which occurred at 673 mL, and he had an urge to void at 1435 mL with a stronger urge at 1750 mL. However, he was unable to mount a contraction and the bladder neck and sphincter remained closed. The patient subsequently was able to void on his own and he was catheterized for a volume of 1140 mL.

He is afebrile. Vital signs are stable. Generally, this is a cachectic man sitting in a wheelchair. No acute distress. Skin is warm and dry. Head is normocephalic, atraumatic. Pupils are equal, round, reactive to light and accommodation. Sclerae is anicteric. Oral mucosa is moist without lesions. No JVD. No thyromegaly. Lymphatics: No cervical, supraclavicular, axillary, or inguinal adenopathy appreciated. Respiratory: Lungs are clear to auscultation bilaterally. Heart: Regular rate and rhythm. Abdomen: Soft, nontender. Positive bowel sounds. Liver and spleen not palpable. Strength is 5/5 throughout. Neurological exam is intact.

Sepsis is a systemic inflammatory response to infection agents (bacteria or fungi), which can lead to severe sepsis and septic shock that caused drop in blood pressure, ischemia, different organ damage, and death (Lagu T et al., 2012).