Nsb236 Nursing Practice | Septic Assessment Answers

Answers:

Introduction

Septic shock is a condition that comes as result of the inflammatory system responding to infectious pathogens in the human organism. (Ferrer et al 2008). Septic shock is usually evident in patients with sepsis, and is considered as a life-threatening condition that is associated with high mortality rates across the world. The disease is characterized by an excessive inhibitory response towards pathogens, causing unprecedented changes to the functioning of key organs of the body, (Bakitas et al 2009). Because of this, cardiovascular dysfunction and respiratory distress syndrome (ARDS) symptoms are mainly associated with the disease. Related symptoms and complications of this condition include high fever, hypothermia and rapid heart rate. Severe septic shock can lead to organ damage, especially the brain, lungs or kidneys, (Inwald, Tasker,Peters & Nadel 2009). The pathogenesis of this disease can be a bacterial, viral, or fungal infection. Sepsis can originate from urinary tracts infections or digestive system infections. The following complications are also noticeable with severe sepsis(Jensen et al 2011):

1. Abnormal urination
2. Notable confusion
3. Dizziness
4. Severe breathing problems


Cyanosis
Low blood pressure
Fatigue

Diagnosis of heart failure is often observed in sepsis patients. The relationship between chronic kidney damage(CKD) and cardiovascular failure is a common phenomenon with sepsis patients. The patho-physiology between kidney failure and cardiovascular failure is complicated.  Patients characterized with heart failure often have a greater prevalence of heart failure risk factors, (Qazi & Stoll, B. J. (2009).

The objective of this paper is to analyze the health condition of a case study of a patient with sepsis, suggest an appropriate treatment plan and nursing interventions for the provided case study.

Diagnosis of Sepsis

Diagnosis of this conditions requires a subtle clinical approach since sepsis may manifest itself in myriad ways. The major identifying signs of acute sepsis include micro vascular and cellular changes which are not easily detected during a clinical examination. The process of clinical examination for diagnosis of this disease includes activation of coagulation and inflammatory cascades, vascular realignment, non-optimal utilization of oxygen in the cellular level,(Inwald, Tasker, Peters& Nadel2009). Additionally, pulse oximetry, monitoring of the cardiac muscles and blood pressure monitoring are recommended for patients with septic shock.

Rationale of the pathology results

Assessment of the patient shows a neutrophil accumulation of 0.9 %. This is because the blood stream has been invaded by pathogens, which has led to immense neutrophil accumulation. The pathogenesis of this condition is majorly brought about by the accumulation of polymer nuclear (PMNs) on the endothelial cells, which leads to the generation of oxidants that are rich in cationic nuclear histone which is highly toxic, (Pène et al 2008). Histone may cause considerable damage to the endothelial cells, which may eventually lead to death. ECG test shows the heart beat is very high. This is because heart failure condition that is one of the complications brought about by septic shock.(Zaidi et al 2011). The Glasgow Coma Scale (GCS) level of the patient is very high. Glasgow Coma Scale (GCS) is a very vital technique of measuring mental state, and can be a leading factor that may be used in the prediction of sepsis. The GCS of the patient in the cases study was 15/15, which translates to a SOFA score value of 4. This means that the sepsis of the patient must be very chronic.

Treatment Plan for the patient

Firstly, the patient will require to be retained in hospital admission, as patients with severe septic shock often require to be hospitalized, (Gaieski et al 2010). Initial treatment would often include support of the circulatory and respiratory functions. The treatment plan design of the patient will include the following approaches.

1. The source of infection should be established in order to start an antimicrobial therapy. Surgery may be required in some cases.
   
   
2. Commencement of antibiotics ministration which include spectrum. The patient will have to commence antibiotic therapy since this condition is as a result of bacterial infection
   
   
3. Secondly, she will have to be resuscitated from the septic by controlling of hypoxia, hypo perfusion and hypotension.

General Treatment Options

Cardiovascular failure and respiratory complications will need urgent interventions since they can worsen the state of the patient if not managed as soon as possible.  For acute respiratory failure, the major treatment approach would be to do a continuous ventilator support, whereby the patient will be under oxygen support coupled with treatment of the causative problem. Furthermore, there should be frequent and thorough respiratory assessment so as to monitor pulse oximetry. Additionally, bronchodilator drugs may be administered on the patient that will enhance the relaxation of smooth air muscles in order to improve the caliber of the airway, (Kelm et al 2015). Foe cardio-vascular problem, the patent will have to blood pressure inhibitor drugs so as to lower her blood pressure and reduce heart palpitations.

Priority of clinical care

According to the recent guidelines of the Surviving Sepsis Campaign guidelines, nurses play a vital role in enhancing effective care for patients with sepsis. The most recent guidelines in the campaign involve the following approaches, (Liberati et al 2009):

1. Recommendations for management of patients with severe sepsis cases
2. High priority care considerations
3. Pediatric interventions

A key requirement according to the current guidelines in the Surviving Sepsis Campaign is the resuscitation of sepsis invalids by using hypo perfusion, (Levy et al2010). Techniques of increasing perfusion should be carried out until the patient reaches hospital. This approach will help in nursing of patients in emergency rooms before they are admitted to the ICU. The Surviving Sepsis Campaign guidelines require that sepsis induced hyper pofusion for the first six hours should include the following (Rivers et al 2012):

1. Venous pressure (8–12 mm Hg).
2. Output of urine (≥0.5 mL/kg per hour).
3. Oxygen saturation 65%

Management of the patient

Management of the patient will include the following approaches:

1. Observation and assessment of the patient. The patient should be regularly assessed for indications of vital signs and monitoring of output of urine each hour.
   
   
2. Establishment of cause of infection. The patient should be thoroughly examined I order to identify the source of her infection that has caused the septic shock.
   Should the cause be identified, immediate action should be taken that is geared to eliminating the disease. Additionally, surgery to remove the infected tissue or for drainage of necrotic bowel may be necessary.
   
   
3. In case the patient gets worse, referral to HDU or ICU may also be necessary.

Nursing Interventions for Sepsis

Administration of IV antibiotics

Before the administration of antibiotics, measures should be put forth to establish the cause of the infection. After that, commencement of antibiotic therapies may be required.

Optimization of fluid –volume stats

Sepsis patients often are I need of an immense fluid resuscitation.

Assess and monitoring of the oxygen consumption

It is often the case that patients of sepsis require oxygen support ventilations, according to the severity of the condition.

Infection Prevention

This patient is already is already burdened with an inflammatory reaction and care should be taken not to worsen the situation. The septic patient needs asepsis in particular because of the aggressive nature of this condition.

Assessment and management of body Temperature

Patients of sepsis need delicate care when it comes to temperature control so as to avert extremes either in making their body systems too hot or too cold as this would do a serious harm to them.

Patient Education

Since sepsis is a serious disease, patients need care and support that is coupled with educating the patient step by step. The patients should build trust with their carers as this will increase their chances of survival and emotional, spiritual and physical wellbeing.

Conclusion

Treatment and management of sepsis requires a collaborative, multidisciplinary and purposed approach for its management and treatment. This paper has analyzed a given case study of a patient with advanced case of sepsis as indicated by pathological results. However, her situation is still manageable, with the treatment and management plan that has been recommended on her. Nurses play a very important role in the identification in its early stage, diagnosis, treatment and management of sepsis. Practical knowledge and guidelines on how to handle patients of sepsis can help reduce the prevalence of this disease. The new guidelines that have been laid down by the International Surviving Sepsis Campaign, if properly implemented by nurses, will help in promoting nursing best practices for patients of sepsis, and help reduce mortality rates as a result of this condition.

References

Bakitas, M., Lyons, K. D., Hegel, M. T., Balan, S., Brokaw, F. C., Seville, J., ... & Ahles, T. A. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. Jama, 302(7), 741-749.

Ferrer, R., Artigas, A., Levy, M. M., Blanco, J., González-Díaz, G., Garnacho-Montero, J., ... & Edusepsis Study Group. (2008). Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. Jama, 299(19), 2294-2303.

Gaieski, D. F., Mikkelsen, M. E., Band, R. A., Pines, J. M., Massone, R., Furia, F. F., ... & Goyal, M. (2010). Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Critical care medicine, 38(4), 1045-1053.

Inwald, D. P., Tasker, R., Peters, M. J., & Nadel, S. (2009). Emergency management of children with severe sepsis in the United Kingdom–the results of the Paediatric Intensive Care Society sepsis audit. Archives of disease in childhood.

Jensen, J. U., Hein, L., Lundgren, B., Bestle, M. H., Mohr, T. T., Andersen, M. H., ... & Tousi, H. (2011). Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Critical care medicine, 39(9), 2048-2058.

Kelm, D. J., Perrin, J. T., Cartin-Ceba, R., Gajic, O., Schenck, L., & Kennedy, C. C. (2015). Fluid overload in patients with severe sepsis and septic shock treated with early-goal directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock (Augusta, Ga.), 43(1), 68.

Levy, M. M., Dellinger, R. P., Townsend, S. R., Linde-Zwirble, W. T., Marshall, J. C., Bion, J., ... & Parker, M. M. (2010). The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive care medicine, 36(2), 222-231.

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., ... & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine, 6(7), e1000100.

Pène, F., Percheron, S., Lemiale, V., Viallon, V., Claessens, Y. E., Marqué, S., ... & Mira, J. P. (2008). Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Critical care medicine, 36(3), 690-696.

Qazi, S. A., & Stoll, B. J. (2009). Neonatal sepsis: a major global public health challenge. The Pediatric infectious disease journal, 28(1), S1-S2.

Rivers, E. P., Katranji, M., Jaehne, K. A., Brown, S., Abou Dagher, G., Cannon, C., & Coba, V. (2012). Early interventions in severe sepsis and septic shock: a review of the evidence one decade later. Minerva anestesiologica, 78(6), 712.

Zaidi, A. K., Ganatra, H. A., Syed, S., Cousens, S., Lee, A. C., Black, R., ... & Lawn, J. E. (2011). Effect of case management on neonatal mortality due to sepsis and pneumonia. BMC Public Health, 11(3), S13.