...Sepsis Alert and Importance of Rapid Treatment for Sepsis Patients Brooke Blackstock Delaware Technical Community College Sepsis remains a huge source of morbidity and mortality in the United States. Although, the mortality rate from severe sepsis was noted to decrease from 39% in 2000 to 27% in 2007 in the United States, more patients required discharge to a long-term care facility. (Kumar, et al., 2011) Due to it’s high morbidity and mortality rate along with the cost for prolonged treatments a number of efforts have now been directed towards improving patient outcomes. Early intervention/treatment for patients suspected of shock is crucial in order to ensure the optimal outcome for the patient. “Early-goal directed” therapy such as patient specific sepsis bundles ordered by physicians, as well as standardized sepsis order sets has been consistently shown improvement in areas such as: time to antibiotics, time to fluid resuscitation, lactate clearance, and mortality. Ensuring that the administration of the appropriate broad-spectrum antibiotics is another important factor that has also decreased mortality. (Hayden, et al., 2016) In order to recognize the need for these interventions in a timely manner, the sepsis alert or “best practice alert” system is implemented into the electronic charting systems used by the facility. This alert system is programed into the hospital’s patient charting system to screen each electronic medical record for patients presenting with...
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...0 ANCC CONTACT HOURS AFFECTING MILLIONS OF people worldwide, sepsis is a systemic response to an overwhelming inflammatory process caused by an infection. Approximately one in four people who develop sepsis will die.1 In January 2013, the international Surviving Sepsis Campaign Guidelines Committee published its 2012 surviving sepsis guidelines (SSG), an update to the 2008 guidelines for early identification and management of sepsis in adults.1 The guidelines highlight the importance of screening every potentially infected patient for sepsis and providing best-practice interventions for managing sepsis, severe sepsis, and septic shock. This article provides an overview of care for the adult patient with sepsis, focusing on sepsis identification and the first 6 hours of goal-directed treatment according to current guidelines. Defining sepsis Sepsis is the presence of infection along with systemic manifestations of infection. If sepsis isn’t recognized and treated early, it progresses rapidly to severe sepsis, defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion. Sepsis-induced tissue hypoperfusion is defined as infection-induced hypotension, elevated lactate level, or oliguria.1 24 l Nursing2014 l April Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. www.Nursing2014.com D VOUGAO/iSTOCK sepsis www.Nursing2014.com April l Nursing2014 l 25 Copyright...
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...contusion, fractured clavicle and ribs, and extensive abrasions on his arms, legs, side, back, and buttocks. He was tachycardic, hypotensive, unresponsive, and ventilating poorly when admitted. He was placed on a mechanical ventilator and given IV fluids for shock. C.C. responded well to fluids, with an increase in blood pressure and an improvement in urine output. 1. Based on his case history and responsiveness to fluid therapy, what type of shock was C.C. experiencing? Hypovolemic Shock 2. What other clinical findings would be helpful in confirming the type of shock? Low blood pressure, weak pulse, cyanosis of the lips and fingertips, shallow breathing 3. Because of his many open wounds and invasive lines, C.C. is at risk for sepsis and septic shock. What clinical findings would suggest that this complication has developed? Chills, light-headedness, little or no urine, palpitations, skin rash or...
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...Sepsis is an infection caused when bacteria enter an individual’s blood stream. The common signs and symptoms of the disease include increased heart rate, fever, increased breathing rate, and confusion. The physician would choose this infection due to the symptoms the patient presents. Pulmonary Arterial Hypertension, PAH This disease does not produce symptoms until it is too late and the symptoms that are seen are not immediately identifiable with the disease. As such, the symptoms may grow worse gradually thereby making diagnosis more difficult. Pulmonary arterial hypertension is characterized by shortness of breath. The blood vessels and arteries that carry blood into and through the lungs make breathing possible. PAH makes it difficult for the lungs to carry out the inhale-exhale routine which helps in quickly bringing in oxygen-rich air and expel oxygen-depleted air. Due to the increased pressure in the heart, the heart’s...
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...According to Urden, Stacy, and Lough (2006), shock is a life-threatening condition that can lead to ineffective tissue perfusion or may further progress to multiple organ dysfunction and death. The different types of shock include hypovolemic shock, cardiogenic shock, anaphylactic shock, neurogenic shock, and septic shock (Urden, Stacy, & Lough, 2006). This essay will analyze septic shock based on the analysis of a presented case study. To further understand this concept, a review of treatment and management of septic shock as used in the writer’s practice setting will be discussed. The writer chooses the “case study one” as an issue of septic shock because Karen’s vital signs, physiological and behavioral symptoms are clear indicators of septic shock. Septic shock is described as the body’s inflammatory response to overwhelming infection (Urden, Stacy & Lough 2006). It is also classified as existence of an infection with hypotension despite fluid replacement along with the presence of tissue perfusion abnormalities (Urden, Stacy & Lough 2006). According to Bench (2004), the diagnostic criteria for septic shock include a heart rate greater than 90 beats per minute, a respiratory rate greater than 20 beats per minutes, an increased white cell count, hypotension, and temperature greater than 38 degrees or less than 36 degrees. Karen met these criteria with an increased temperature of 41 degrees which is usually an indicator of infection, increased heart rate and respiratory...
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...ACUTE CARE ASSIGNMENT Introduction For this assignment I have chosen to use a patient on a Medical Rehab Ward that became acutely unwell very suddenly and was eventually diagnosed with Urinary Sepsis before being transferred to an Acute Medical Ward for further treatment. The purpose of this assignment is to show how I as the nurse, managed the situation in the assessing of the patient from the onset of their symptoms using the Airway, Breathing, Circulation, Disability framework. The planning and implementing of the care required and evalutaing constantly to ensure that the care provided is working and how I communicated with the relevent medical staff using the ISBAR tool of communication. The timeframe is over a 36 hour period from onset of symptoms to transfer. I will begin by giving a definition of Sepsis, discuss the ABCDE method of assessment and a brief background as to why the patient is in hospital as well as a brief past medical history. Sepsis, a potentially life-threatening complication of a localised infection, can rapidly lead to acute deterioration risking multi-organ failure and death. (Dellinger et al 2008) Sepsis is quite common and it is therefor imperative that every nurse on every ward be aware of the signs and symptoms of Sepsis and the appropriate measures to take to manage it should their patient become Spetic. Having an effective and proven assessment tool such as the ABCDE approach can help assess, treat and therefore improve the outcome for...
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...Learner 2 ECS® Program for Nursing Curriculum Integration (PNCI®) Sepsis, Septic Shock and Multiple Organ Dysfunction Syndrome © 2008 METI, Sarasota, FL; Original Authors: Jami Nininger and Dawn Hughes, Mount Carmel College of Nursing, and Thomas J. Doyle, METI. Reviewer: Jami Nininger, Mount Carmel College of Nursing v.4 August 2008 References 1. Differentiate the following terms: • Systemic Infl ammatory Response Syndrome (SIRS) • Sepsis • Severe sepsis • Septic shock • Multiple Organ Dysfunction Syndrome (MODS) 2. Identify the nursing priorities in the care of the patient with sepsis and septic shock. 3. What class of bacteria is responsible for more than one half of the cases of septic shock? What are some common causes of this? 4. Explain why myocardial depression is almost always present in a patient with septic shock despite an initial rise in cardiac output. 5. Discuss the cascade of host infl ammatory responses that produce the major detrimental effects seen in sepsis due to gram-negative bacteria. 6. What is early goal directed therapy in the management of sepsis? 7. Identify the treatment guidelines currently recommended for the management of sepsis and septic shock. 8. Discuss how the drug dobutamine affects cardiac output. Identify the nursing implications with the administration of this drug. 9. Discuss how norepinephrine works and its indications for use. Identify the nursing implications with the administration of this drug. 10. Discuss...
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...Case Study Three 1. What is the definition of ARDS? Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function. Acute Respiratory Distress Syndrome (ARDS) is also known as shock lung, wet lung, post perfusion lung and a variety of other names related to specific causes. What are the associated clinical indicators? The first signs and symptoms of ARDS are feeling like you can't get enough air into your lungs, rapid breathing, and a low blood oxygen level. Other signs and symptoms depend on the cause of the ARDS. They may occur before ARDS develops. Sometimes, people who have ARDS develop signs and symptoms such as low blood pressure, confusion, and extreme tiredness. This may mean that the body's organs, such as the kidneys and heart, aren't getting enough oxygen-rich blood. 2. What conditions did this patient experience that are common risk factors ssociated with ARDS? Brain present with near drowniess syndrome that lead to his diagnosis of ARDS. 3. Describe the major pathophysiological alterations in ARDS. Increased capillary permeability is the hallmark of ARDS. Damage of the capillary endothelium and alveolar epithelium in correlation to impaired fluid remove from the alveolar space result in accumulation of protein-rich fluid inside the...
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...Sepsis is a complication caused by a serious response to infection, which can lead to multiple issues including death. Physicians have a difficult time diagnosing sepsis because it happens fast, and it can be very easily confused with other conditions that are present. According to a new vital signs report released by the CDC, 7 in 10 patients with sepsis had used healthcare services recently or had chronic diseases that required frequent medical care. These represent opportunities for healthcare providers to prevent, recognize, and treat sepsis long before it can cause life-threatening illness or death. Sepsis mortality rate is as high as 50% in patients with septic shock and can increase by 7.6% per hour if the appropriate treatment is not started (CDC, 2016). Physicians fully understand the devastating consequences of patients who contract sepsis. The severity of sepsis and the increasing mortality rate have led to vast amounts of clinical and statistical research. In today’s healthcare industry, advances in medicine and technology have helped create more effective ways to prevent, recognize, and respond to those who contract this potentially deadly infection....
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...Prevalence, outcome and prognostic factors of sepsis in Jimma Specialized Hospital. By Dr Tadiwos Hailu (M.D) A Proposal Submitted to the Department of Internal Medicine, Jimma University, in Partial Fulfillment of The Requirement for a Specialty Certificate in Internal Medicine. September, 2012 Jimma, Ethiopia Prevalence, outcome and prognostic factors of sepsis in Jimma specialized hospital. Dr Tadiwos Hailu By Advisors: 1-Dr.Daniel yilma [M.D] 2-Birtukan Tsehayneh [Bsc. Msc.] September, 2012 Jimma Ethiopia i Abstract summary Background: Sepsis is a final pathway of infectious disease in critically ill patients. It is highly fatal condition. Though many researches are undertake in pathophysiology, epidemiology and management of sepsis in developed nation ,very limited information is available in low incomes countries where infections are prevalent. Objective: The objective of the study was to determine the prevalence and outcome of sepsis and its prognostic factors in patients admitted to Jimma University Specialized Hospital. Method: Patients with systemic inflammatory response due to infections were studied using prospective cohort study design for four month period in Jimma University hospital. A structured questioner was used to collect data on socio demographic feature of the patient and clinical feature, outcome and prognostic factors . Data was cleaned, edited and entered to SPSS window for analysis. The survival analysis and determination...
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...Definitions of systemic inflammatory response syndrome (SIRS), sepsis, septic shock, and multiple organ dysfunction syndrome Systemic inflammatory response syndrome Two or more of the following clinical signs of systemic response to endothelial inflammation: • Temperature > 38°C or < 36°C x Heart rate > 90 beats/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 ⋅ 109/l or < 4 ⋅ 109/l or the presence of more than 10% immature neutrophils In the setting (or strong suspicion) of a known cause of endothelial inflammation such as: • Infection (bacteria, viruses, fungi, parasites, yeasts, or other organisms) • Pancreatitis x Ischaemia x Multiple trauma and tissue injury x Haemorrhagic shock x Immune mediated organ injury x Absence of any other known cause for such clinical abnormalities Sepsis Systemic response to infection manifested by two or more of the following: • Temperature > 38°C or < 36°C x Raised heart rate > 90/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 × 109/l or < 4 × 109/l or the presence of more than 10% immature neutrophils Septic shock Sepsis induced hypotension (systolic blood pressure < 90 mm Hg or a reduction of >40 mm Hg from baseline) despite adequate fluid resuscitation Multiple organ dysfunction syndrome Presence of altered organ...
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...David A Daves SIM PREP…….. 02/22/13 Preparation Questions Differentiate the following terms: Systemic Inflammatory Response Syndrome (SIRS): Is aggressive widespread inflammatory response to infection (sepsis) or perceived invader. Also, ischemia, infarction and injury. Sepsis: Is a systemic inflammatory response in the presence of a documented infection. Severe sepsis: 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%. Septic shock: Is the presence of sepsis with hypotension despite fluid resuscitation along with the presence of inadequate tissue perfusion. Multiple organ dysfunction syndrome (MODS): Is the failure of two or more organ systems in an acutely ill patient such that homeostasis cannot be maintained without intervention. Identify the nursing priorities in the care of the patient with sepsis and septic shock: Oxygenation -Provide supplemental O2 Intubation/mechanical ventilation, if necessary Monitor SvO2 or ScvO2 Circulation- Aggressive fluid resuscitation End points of fluid resuscitation: CVP 15 mm Hg Pawp 10-12 mm Hg Drug Therapies- Antibiotics as ordered Vasopressors (dopamine) Inotropes (dobutamine) Anticoagulants (low molecular –weight heparin) Drotrecogin alfa (xigris) for patients with high risk death Supportive Therapies- Obtain cultures (blood, wound ) before beginning antibiotics Monitor temperature Control...
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...improved care of sepsis patients the Interprofessional Sepsis Workgroup suggests the following strategy for change: Request support from the CNO, CMO and executive leadership to implement the needed changes to improve sepsis bundle compliance. Sepsis Education for providers, nurses, and allied health staff. Develop an automated screening tool and dashboards in the EHR to alert nurses and providers of potential sepsis Develop algorithms, nurse-initiated protocols, and order sets to facilitate care interventions. Engage the Rapid Response Team (RRT) RN’s to act as Sepsis Experts to assist staff and encourage best-practice. Stock common antibiotics to the ED to prevent delays in administration....
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...sepsis is still one of the major causes of morbidity and mortality in neonates, in spite of recent advances in health care units [1]. More than 40% of under-five deaths globally occur in the neonatal period, resulting in 3.1 million newborn deaths each year [2]. The majority of these deaths usually occur in low-income countries and almost 1 million of these deaths are attributed to infectious causes including neonatal sepsis, meningitis, and pneumonia [3]. On the other hand, the survivors of neonatal sepsis are vulnerable to short- and long-term neurodevelopmental morbidity [4–6]. Neonatal sepsis is defined as a clinical syndrome in an infant 28 days of life or younger, manifested by systemic signs of infection and isolation of a bacterial...
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...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 |...
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