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Pathophysiology of sepsis. case study
Sepsis patient scenarios
Sepsis patient scenarios
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Sepsis: Early Detection and Implementation of Sepsis Resuscitation Bundle
Introduction
Sepsis is defined as the body’s inflammatory response to an infection and can quickly lead to multiple organ failure and death. Early, goal-directed therapy using the sepsis resuscitation bundle introduced in the “Surviving Sepsis Campaign” is the treatment used throughout the world for sepsis treatment (Winterbottom 2012, pp 247). There are approximately one million cases of sepsis in the United States annually and deaths total more than prostate cancer, breast cancer, and HIV/AIDS combined. Also, more than one-fourth of patients that develop sepsis will develop it on a medical-surgical unit and severe sepsis is the most common cause of death among patients in non-coronary critical units (Bernstein 2013, pp 24-25).
Education of all nurses, not just critical care nurses, of the early signs and symptoms of sepsis and quickly implementing the sepsis resuscitation bundle is crucial to decreasing the mortality rate of sepsis.
Literature Review
“Early Recognition and Treatment of Sepsis in the Medical-Surgical Setting,” focuses on the nurse’s role in being able to identify early signs of sepsis and initiating the sepsis bundle quickly. In the article, “Nurses’ Critical Role in Identifying Sepsis and Implementing Early Goal-Directed Therapy,” it explains how the interventions in the sepsis bundle have decreased mortality from 37% to 30.8% in a two year study conducted in 165 different health care sites. This article also details clinical guidelines and timelines for implementing the sepsis bundle. Early stages of sepsis and clinical manifestations are discussed in the article, “Helping Patients Survive Sepsis,” with emphasis on the i...
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...urses are at the bedside 24 hours a day they can greatly impact patient outcomes and decrease the overall mortality rate of sepsis by using the evidence-based practices outlined in the Surviving Sepsis Campaign.
Reference Page
Bernstein, M., & Lynn, S. (2013). Helping patients survive sepsis. American Nurse Today, 8(1), 24-28. Retrieved from http://www.americannursetoday.com/article.
Gobel, B., & Peterson, G. J. (2010). Sepsis and septic shock. Clinical Journal Of Oncology Nursing, 14(6), 793-797. doi:10.1188/10.CJON.793-797.
Tazbir, J. (2012). Early recognition and treatment of sepsis in the medical-surgical setting. MEDSURG Nursing, 21(4), 205-209.
Winterbottom, F. (2012). Nurses’ critical role in identifying sepsis and implementing early goal- directed therapy. The Journal of Continuing Education in Nursing, 43(6), 247-248. Doi:10:3928/00220124-20120523-33.
Sepsis is defined as an exaggerated, overwhelming and uncontrolled systemic inflammatory response to an initially localised infection or tissue injury, which may lead to severe sepsis and septic shock if left untreated (Daniels, 2009; Robson & Daniels, 2013; Dellinger et al, 2013; Perman, Goyal & Gaieski, 2012; Vanzant & Schmelzer, 2011). Septic shock can be classified by acute circulatory failure as a result of massive vasodilation, increased capillary permeability and decreased vascular resistance in the body, causing refractory hypotension despite adequate fluid resuscitation. This leads to irreversible tissue ischaemia, end organ failure and ultimately, death (McClelland & Moxon, 2014; Sagy, Al-Qaqaa & Kim, 2013, Dellinger et al, 2013).
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
Although nurses do not wield the power of doctors in hospital settings, they are still able to effectively compensate for a doctor’s deficits in a variety of ways to assure patient recovery. Nurses meet a patient’s physical needs, which assures comfort and dignity Nurses explain and translate unfamiliar procedures and treatments to patients which makes the patient a partner in his own care and aids in patient compliance. Nurses communicate patient symptoms and concerns to physicians so treatment can be altered if necessary and most importantly, nurses provide emotional support to patients in distress.
Sepsis is a problem of bacterial, parasitic and fungal infection. Due to this the body develops a systemic immune response to get rid of the infection or tissue damage. This causes inflammation throughout the body mainly found in small blood vessels or it leads to septicaemia which is where microbes or infections are found in the blood this can also be called blood poisoning. Septic shock is a life-threatening condition were hypotension occurs as blood pressure drops to a dangerously low level after an infection. In septic shock the patient may experiences tachyeordia this is where there is a greater heart beat than normal (90 heart beats a minute) and tachypnae were the patient is breathing faster than the normal rate (12-20 breathes per minute).
With patient safety always being the number one priority FTR is the worst case scenario for the hospitalized patient. In an article titled “Failure to Rescue: The Nurse’s Impact” from the Medsurg Nursing Journal author Garvey explains ways FTR can occur “including organizational failure, provider lack of knowledge and failure to realize clinical injury, lack of supervision, and failure to get advice.” Nurses are problem solvers by nature, they heal the sick and help save lives. FTR is a tragic experience for everyone involved. The recent surge in this happening across the country has given FTR cases widespread media coverage. Hospitals are trying to figure out what the root cause is and how they can be prevented. Fortunately, with the advancement of technology and extensive research many hospitals have developed action plans and procedures to help prevent the early warning signs from being
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
CLABSIs are not confined to one unit of nursing care and there are many precipitating factors that may contribute to the development of a CLABSI. Often times these lines are placed in emergent situations in the emergency department (ED) and there may be a break in sterile technique. However a study conducted by Smith, Egger, Franklin, Harbrecht, and Richardson (2011) found a higher incidence of CLABSIs among intensive care unit (ICU) patients compared to those patients whose CLs were placed either in the ED or operating room (OR). This indicates further education for ICU s...
Many great historical figures of the scientific community have written on the subject of the same perplexing disease over the centuries (Angus, van der Poll, Finfer, Vincent 2013). Sepsis has been given many names, origins, and etiologies. In the 4th century, Hippocrates declared the disease the cause of organic decomposition, wound festering, and swamp gas (Angus et al. 2013). During the 19th century, Louis Pasteur theorized the disease was the outcome of a pathogenic microorganism in the bloodstream, which resulted in a body-wide infection (Angus et al. 2013). In the 21st century, the medical community made a breakthrough with the discovery of the disease’s link to the inflammatory response system and devised a plan of action to combat the high mortality rates among those infected (Angus et al. 2013). According to Hotchkiss, Monneret, & Payen (2013) the effects of sepsis are well documented, while the molecular processes it utilizes are still being explored; however, new studies are helping to expand our understanding of the centuries old disease.
Emergency room nursing is a very rewarding job. Unlike other specialty nursing units in the emergency room the nurse never aware of what might walk in the door next. This can be scary and for the adrenaline junkie exciting. With the fact the nurse never know what might walk in the emergency room nurse needs to have a large knowledge base. This includes that of infection control.
A study conducted by the Centers for Disease Control and Prevention shows that “annually approximately 1.7 million hospitalized patients acquire infections while being treated for other medical conditions, and more than 98,000 of these patients will die as a result of their acquired infection” (Cimiotti et al., 2012, p. 486). It was suggested that nursing burnout has been linked to suboptimal patient care and patient dissatisfaction. Also, the study shows that if the percentage of nurses with high burnout could be reduced to 10% from an average of 30%, approximately five thousand infections would be prevented (Cimiotti et al., 2012). In summary, increasing nursing staffing and reduction burnout in RNs is a promising strategy to help control urinary and surgical infections in acute care facilities (Cimiotti et al.,
Sepsis is defined as a systemic inflammatory response caused by an infective process such as viral, bacterial or fungal (Holling, 2011). Assessment on a patient and starting treatment for sepsis is based on identifying several factors including the infective source, antibiotic administration and fluid replacement (Bailey, 2013). Because time is critical any delay in identifying patients with sepsis will have a negatively affect the patients’ outcome. Many studies have concluded every hour in delay of treatment mortality is increased by 7% (Bailey, 2013). Within this assignment I will briefly discuss the previous practice and the recent practice including the study based on sepsis. I will show what enabled practice to change and I will use the two comparisons of current practice and best practice.
Nurses form an important role in influencing patient safety from everyday tasks and gradually obtaining the patient vital signs have increasingly been seen as a chore instead of collecting clinical evidence. This then creates an extreme danger to patient’s as irregular monitoring of vital signs prevented early detection of deterioration in a patient’s condition, which postpones transfer to intensive care unit ( Kyriacos U et al 2011; Boulanger, 2009). Due to this, a...
The nursing discipline embodies a whole range of skills and abilities that are aimed at maximizing one’s wellness by minimizing harm. As one of the most trusted professions, we literally are some’s last hope and last chance to thrive in life; however, in some cases we may be the last person they see on earth. Many individuals dream of slipping away in a peaceful death, but many others leave this world abruptly at unexpected times. I feel that is a crucial part to pay attention to individuals during their most critical and even for some their last moments and that is why I have peaked an interest in the critical care field. It is hard to care for someone who many others have given up on and how critical care nurses go above and beyond the call
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).
“ Sepsis” according to the International Surviving Sepsis Campaign, is defined as the presence of infection together with systemic manifestations of infection (Dellinger et al., 2013) In todays modern society sepsis still accounts for 15% of maternal deaths a year worldwide (Dolea & Stein, 2003). Despite medical advances, aseptic technique, and antibiotic use, sepsis is the most common cause of direct maternal death in the UK. According to the CMACE report the maternal mortality rate increased from 0.85 deaths per 100,000 maternities in 2003–05 to 1.13 deaths in 2006–08 (Harper, 2011). Puerperal sepsis has a long history within obstetrics and midwifery, and yet despite this knowledge it has become, yet again, the leading cause of direct maternal death. Therefore due to the increased maternal mortality, I have chosen to focus on the care of a woman within ...