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.
To maintain patient confidentiality any identifying features have been removed in keeping with the Nursing and Midwifery Council (NMC) Code of Professional Conduct (NMC, 2008) the patient will be referred to as Mr X.
Mr X was an 80-year-old male admitted to ITU, from the Medical Assessment Unit, with increasing respiratory failure.
His initial clinical observations were:
Systolic Blood Pressure: 100mmHg
MAP: 58mmHg
Heart Rate: 120 beats per minute
Lactate: 3.2mmol/l
Temperature: 38.6*
These clinical observations indicated that the patient was experiencing a systemic inflammatory response syndrome (SIRS) as the patient had a pyrexia above 38*C and a heart rate above 90 beats per minute.
The results of the blood cultures and chest radiograph indicated pneumonia. The patient’s condition was now treated as sepsis. Sepsis is characterized by SIRS, which is complicated by a severe infection (Neveire, Parsons and Wilson 2008).
The pathophysiology of systemic inflammatory response, experienced by Mr X is portrayed in Table 1:

Table 1
Morton et al 2005 Mediator | Source | Main Effect | Histamine | Mast Cells, Basophils,Platelets | Vasodilation, Increased Vascular Permeability | Nitric Oxide | Endothelial Cells, Macrophages, Platelets | Vasodilation | Cytokines e.g. IL 1&6 TNF | Macrophages, lymphocytes | Vasodilation, Fever, Lethargy, Attracts leucocytes | Bradykinin | Circulates inactive in Plasma, | Increased Vascular Permeability,