Sepsis An Overview Health And Social Care Essay

Sepsis An overview Health And Social Care EssaySepsis is an transmittal of the bloodstream. The infection tends to spread quickly and often is difficult to recognize. One of our roles as a adjudge is that of patient advocate, and as such we are closest to the patient, placing us in a key position to identify any subtle salmagundis at their earliest onset and prevent the spread of wicked infection. Knowledge of the signs and symptoms of SIRS, kinfolksis, and purulent shock is key to ahead of time recognition. Early recognition allows for appropriate treatment to bug out sooner, decreasing the likelihood of septic shock and life-threatening organ failure. Once sepsis is diagnosed, early and aggressive treatment arse begin, which greatly reduces mortality come outs associated with sepsis.sepsis (sep-ss) n. Sometimes called blood poisoning, sepsis is the bodys often deadly response to infection or injury (Merriam-Webster, 2011)Sepsis is a potentially life-threatening conditio n taked by the resistive brasss reaction to aninfection it is the leading cause of death in intensive shell out units ( mayonnaise Clinic Staff, mayonnaise Clinic2010). It is defined by the social movement of 2 or more than SIRS (systemic inflammatory responsesyndrome) criteria in the setting of a documented or presumed infection (Rivers, McIntyre,Morro, Rivers, 2005 pg 1054). Chemicals that are released into the blood to fight infectiontrigger widespread dismission which explains why injury can bump to body tissues far fromthe original infection. The body may develop the inflammatory response to microbes in theblood, urine, lungs, skin and some other tissues. Manifestations of the systemic inflammatoryresponse syndrome (SIRS) include ab approach patternities in temperature, heart, respiratory rates andleukocyte counts. This is a severe sepsis that arises from a noninfectious cause. The conditionmay manifest into severe sepsis or septic shock.Severe sepsis is characterized by organ dysfunction, while septic shock directs when bloodpressure decreases and the patient becomes extremely hypotensive, even with the administrationof eloquent resuscitation (Lewis, Heitkemper, Dirksen, OBrien and Bucher (2007), pg 1778). Theinitial presentation of severe sepsis and septic shock is usually nonspecific. Patients admittedwith relatively benign infection can progress in a few hours to a more devastating form of thedisease. The transition usually occurs during the first 24 hours of hospitalization (Lewis, et al2007, pg 1779). Severe sepsis is associated with acute organ dysfunction as liberation may go in organ damage (mayonnaise Clinic Staff, Mayo Clinic 2010). As severe sepsis progresses,it begins to affect organ function and eventually can lead to septic shock a sometimes fatal dropin blood pressure.People who are most at risk of developing sepsis include the in truth young and the very old,individuals with compromised immune systems, very sick flock in the hospital and those whohave encroaching(a) devices, such as urinary catheters or public discussion tubes (Mayo Clinic Staff, MayoClinic, 2010). Black people are more likely than are white people to get sepsis and black menface the highest risk (Mayo Clinic Staff, Mayo Clinic 2010).Severe sepsis is diagnosed if at least one of the following signs and symptoms, which indicateorgan dysfunction, are noted areas of mottled skin, significantly decreased urine output, abruptchange in mental status, decrease in platelet count, difficulty breathing and abnormal heartfunction (Lewis et al, 2007 pg 1779). To be diagnosed with septic shock, a patient mustiness have thesigns and symptoms of severe sepsis plus extremely low blood pressure (Mayo Clinic Staff,Mayo Clinic 2010).Sepsis is usually treated in the ICU with antibiotic therapy and intravenous fluids. Thesepatients require preventative measures for deep vein thrombosis, stress ulcer and pressure ulcers.Hunter (2006) explains that the re ason why sepsis is rarely given sustainment and popularized forpublic information and attention is because it is not a disease in itself, just now a reaction of the bodyto a pooh-poohed immunological response.Sepsis is the leading cause of death in non-coronary intensive care units (ICUs) and the 10thleading cause of death in the United States overall (Slade, Tamber and Vincent, 2010, pg 2). The relative incidence of severe sepsis in the United States is between 650,000 and 750,000 cases. Over 10m grislyion cases of sepsis have been reported in the United States based on a 22-year period studyof discharge data from 750 million hospitalizations Annually, well-nigh 750,000 peopledevelop sepsis and more than 200,000 cases are fatal (Slade, et al 2010, pg 1). More than 70% ofthese patients have vestigial co-morbidities and more than 60% of these cases occur in those develop 65 years and older (Slade, et al 2010, pg 1). When patients with human immunodeficiencyvirus are excluded, the incidence of sepsis in men and women is similar. A greater number ofsepsis cases are caused by infection with gram-positive organisms than gram-negativeorganisms, and fungal infections now account for 6% of cases (Slade, et al 2010, pg 1). Afteradjusting for world size, the annualized incidence of sepsis is increasing by 8%. Theincidence of severe sepsis is increasing greatest in older adults and the nonwhite population. Therise in the number of cases is believed to be caused by the sum upd use of invasive proceduresand immunosuppressive drugs, chemotherapy, transplantation, and prosthetic implants anddevices, as well as the increasing problem of antimicrobial resistance (Slade, et al 2010, pg 1).Despite advances in critical care management, sepsis has a mortality rate of 30 to 50 percent andis among the primary causes of death in intensive care units ((Brunn and Platt, 2006, 12 10-6).It is believed that the increasing incidence of severe sepsis is due to the growing populationam ong the elderly as a result of increasing longevity among people with chronic diseases and thehigh prevalence of sepsis developing among patients with acquired immune deficiency syndrome(Slade, et al 2010, pg 1).During an infection, the bodys defense system is activated to fight the attacking pathogens.These encroaching(a) pathogens, especially bacteria, possess receptive lipopolysaccharide (LPS)coverings or release exotoxins and endotoxins that activate the T-cells and macrophages andtrigger the Toll-like receptors (TLRs) to respond by psychotherapeutic antibodies, eicosanoids andcytokines such as tumor necrosis factor (TNF) and interleukins. The antigens may also result inthe production of lysozymes and proteases, cationic proteins and lactoferrin that can recognizeand kill invading pathogens. Different microbes also induce various profiles of TNF andinterleukin to be released. These molecules results in a heightened inflammatory response of thebody and vascular dilation. The T LRs also affect a different cascade that involves coagulation piece of lands, which results in preventing the bleeding to occur at the area of infection. With toomuch molecular responses and signals, the recognition of the molecules sometimes fails andattacks even the bodys endothelial cells. These compounded immune and inflammatory actionsresult in the development of the symptoms of sepsis (Hunter, 2006 pg 668 Van Amersfoort,2001 pg 400). Brunn and Platt (2006) believes that events leading to breakdown of the tissuesuch as injuries or infection, that naturally results in the activation of the immune system, is amajor event that causes sepsis. During host infection, the release of tumor necrosis factor andinterlekin-1 signals the dilation of the arteries and inflammation. These released cytokines alsoactivate the coagulation pathway to prevent fibrinolysis but an increase in the concentration ofthese molecules may result in abnormalities in the hosts defense system (Gropper, 2004 pg 568).The common belief that sepsis is caused by endotoxins released by pathogens has fully beenestablished but genomic advancements is shedding light on current insights that sepsis can alsooccur without endotoxin triggers, that is even without microbial infections (Gropper, 2004 pg568).Diagnosing sepsis can be difficult because its signs and symptoms can be caused by otherdisorders. Doctors often order a battery of tests to try to pinpoint the underlying infection. Bloodtests and additional research laboratory tests on fluids such as urine and cerebrospinal fluid to check forbacteria and infections and wound secretions, if an open wound appears infected. In addition,imaging tests to visualize problems such as x-ray, computerized tomography (ct), ultrasound andmagnetic resonance imaging (mri) to locate the source of an infection are also ordered. Early,aggressive recognition boosts a patients chances of living(a) sepsis.Sepsis should be treated as a medical emergency. In other wor ds, sepsis should be treated asquickly and efficiently as possible as soon as it has been identified. This means rapidadministration of antibiotics and fluids. A 2006 study showed that the risk of death from sepsisincreases by 7.6% with every hour that passes before treatment begins. (Mayo Clinic Staff, MayoClinic 2010). Early, aggressive treatment boosts the chances of surviving sepsis. People withsevere sepsis require close monitoring and treatment in a hospital intensive care unit. Lifesavingmeasures may be needed to stabilize breathing and heart function. (Mayo Clinic Staff, MayoClinic 2010). People with sepsis usually need to be in an intensive care unit (ICU). As soon assepsis is suspected, broad spectrum intravenous antibiotic therapy is begun. The number ofantibiotics may be decreased when blood tests reveal which particular bacteria are make theinfection. The source of the infection should be discovered, if possible. This could mean moretesting. Infected intravenous lines or surgical drains should be removed, and any abscessesshould be surgically drained. Oxygen, intravenous fluids, and medications that increase bloodpressure may be needed. Dialysis may be necessary if at that place is kidney failure, and a breathingmachine (mechanical ventilation) if there is respiratory failure (Mayo Clinic Staff, Mayo Clinic,2010).While severe sepsis requires treatment in a critical care area, its recognition is often madeoutside of the Intensive Care Unit (ICU). With nurses universe at the side of a patient fromadmission to discharge, this places them in an ideal position to be first to recognize sepsis.Thorough assessments are crucial and creation able to recognize even the most minimal changes ina patient could be the difference between life and death.Once severe sepsis is confirmed, key aspects of nursing care are related to providingcomprehensive treatment. Pain relief and sedation are important in promoting patients comfort.Meeting the needs of patients f amilies is also an inbred component of care. Research on theneeds of patients families during critical illness supports provision of information as animportant aspect of family care (Gropper et al, 2004 pg. 569). Teaching patients and theirfamilies is also natural to ensure that they understand various treatments and interventionsprovided in severe sepsis.Ultimately, prevention of sepsis may be the single most important measure for control(Mayo Clinic Staff, Mayo Clinic, 2010). die washing remains the most effective way toreduce the incidence of infection, especially the transmission of nosocomial infections inhospitalized patients (Mayo Clinic Staff, Mayo Clinic, 2010. Good hand hygiene can beachieved by using either a waterless, alcohol-based product or antibacterial soap and water withadequate rinsing. Using universal precautions, adhering to infection control practices, andinstituting measures to prevent nosocomial infections can also help prevent sepsis (Lewis, et al2007, p g 248). Nursing measures such as oral care, proper positioning, turning, and care ofinvasive catheters are important in decreasing the risk for infection in critically ill patients(Fourrier, Cau-Pottier, Boutigny, Roussel-Delvallez, Jourdain, Chopin, 2005 pg 1730). Newlyreleased guidelines on the prevention of catheter-related infections stress the use of surveillance, cuticular antisepsis during care of catheter sites, and catheter-site dressing regimens tominimize the risk of infection (Fourrier, 2005 pg. 1731). Other aspects of nursing care such assending specimens for culture because of suspicious waste pipe or elevations in temperature,monitoring the characteristics of wounds and drainage material, and using astute clinicalassessment to recognize patients at risk for sepsis can contribute to the early detective work andtreatment of infection to minimize the risk for sepsis.Critical care nurses are the healthcare providers most closely involved in the daily care ofcritically il l patients and so have the opportunity to identify patients at risk for and to look forsigns and symptoms of severe sepsis (Kleinpell, Goyette, 2003 pg 120). In addition, critical carenurses are also the ones who continually monitor patients with severe sepsis to assess the effectsof treatment and to detect adverse reactions to various therapeutic interventions. Use of anintensivist-led multidisciplinary team is designated as the best-practice model for the intensivecare unit, and the value of team-led care has been shown (Kleinpell, et al 2003, pg 121). As keymembers of intensivist-led multidisciplinary teams, critical care nurses play an important role inthe detection, monitoring, and treatment of sepsis and can affect outcomes in patients with severesepsis (Kleinpell, et al 2003, pg 121).5 Priority Nursing DiagnosisDiagnosis 1 Deficient fluid volume related to vasodilatation of peripheral vessels leaking of capillaries. treatment 1 Watch for early signs of hypovolemia, including restlessness, weakness, muscle cramps, headaches, inability to concentrate and postural hypotension. .Rationale 1 Late signs include oliguria, abdominal or chest pain, cyanosis, cold wet skin, and confusion (Kasper et al, 2005).Intervention 2 Monitor for the existence of factors causing deficient fluid volume (e.g., vomiting, diarrhea, difficulty maintaining oral intake, fever, uncontrolled type 2 diabetes, diuretic therapy).Rationale 2 Early identification of risk factors and early intervention can decrease the occurrence and severity of complications from deficient fluid volume. The gastrointestinal system is a common site of abnormal fluid sacking (Metheny, 2000).Intervention 3 Monitor daily weight for sudden decreases, especially in the presence of decreasing urine output or active fluid loss. Weigh the client on the same scale with the same type of clothing at same time of day, preferably before breakfast.Rationale 3 Body weight changes reflect changes in body fluid volume ( Kasper et al, 2005). Weight loss of 2.2 pounds is equal to fluid loss of 1 liter (Linton Maebius, 2003).Diagnosis 2 Imbalanced nutrition less than body requirements related to anorexia generalized weakness.Intervention 1 Monitor for signs of malnutrition, including brittle hair that is easily plucked, bruise, dry skin, pale skin and conjunctiva, muscle wasting, smooth red tongue, cheilosis, flaky paint rash over lower extremities and disorientation (Kasper, 2005).Rationale 1 Untreated malnutrition can result in death (Kasper, 2005).Intervention 2 Recognize that severe protein calorie malnutrition can result in septicemia from impairment of the immune system or organ failure including heart failure, liver failure, respiratory dysfunction, especially in the critically ill client.Rationale 2 Untreated malnutrition can result in death (Kasper, 2005)Intervention 3 Note laboratory test results as available serum albumin, prealbumin, serum total protein, serum ferritin, transferring, hemo globin, hematocrit, and electrolytes.Rationale 3 A serum albumin level of less than 3.5 g/100 milliliters is considered and indicator of risk of brusk nutritional status (DiMaria-Ghalli Amella, 2005). Prealbumin level was reliable in evaluating the existence of malnutrition (Devoto et al, 2006).Diagnosis 3 Ineffective tissue perfusion related to decreased systemic vascular resistance.Intervention 1 If the client has a period of syncope or other signs of a possible transient ischemic attack, assist the client to a resting position, commit a neurological assessment and report to the physician.Rationale 1 Syncope may be caused by dysrhythmias, hypotension caused by decreased tone or volume, cerebrovascular disease, or anxiety. Unexplained recurrent syncope, especially if associated with structural heart disease, is associated with a high risk of death (Kasper et al, 2005).Intervention2 If the client experiences dizziness because of postural hypotension when getting up, teach methods to decrease dizziness, such as remaining seated for several minutes before standing, flexing feet upward several time while seated, move up slowly, sitting down immediately if feeling dizzy and trying to have someone present when standing.Rationale 2 Postural hypotension can be sight in up to 30% of elderly clients. These methods can help prevent falls (Tinetti, 2003).Intervention 3 If symptoms of a new cerebrovascular accident occur (e.g., slurred speech, change in vision, hemiparesis, hemiplegia, or dysphasia), notify a physician immediately.Rationale 3 New onset of these neurological symptoms can signify a stroke. If the stroke is caused by a thrombus and the client receives thrombolytic treatment within 3 hours, effects can often be reversed and function improved, although there is an increased risk of intracranial hemorrhage (Wardlaw, et al, 2003)Diagnosis 4 Ineffective thermoregulation related to infectious process, septic shock.Intervention 1 Monitor temperature every 1 to 4 hours or use continuous temperature monitoring as appropriate.Rationale 1 Normal adult temperature is usually identified as 98.6 degrees F (37 degrees C) but in actuality the normal temperature fluctuates throughout the day. In the early morning it may be as low as 96.4 degrees F (35.8 degrees C) and in the late afternoon or evening as high as 99.1 degrees F (37.3 degrees C). (Bickely Szilagyj, 2007). Disease injury and pharmacological agents may impair regulation of body temperature (Kasper et al, 2005).Intervention 2 Measure the temperature orally or rectally. Avoid using the axillary or tympanic site.Rationale 2 Oral temperature measurement provides a more exact temperature than tympanic measurement (Fisk Arcona, 2001 Giuliano et al, 2000). Axillary temperatures are often inaccurate. The oral temperature is usually accurate even in an intubated clients (Fallis, 2000). The SolaTherm and DataTherm devices correlated strongly with core body temperatures obtained from a pulmon ary artery catheter (Smith, 2004). A study performed in Turkey found that axillary and tympanic temperatures were less accurate than oral temperatures (Devrim, 2007).Intervention 3 view vital signs every 1 to 4 hours, noting changes associated with hypothermia first, increased blood pressure, pulse and respirations then decreased values as hypothermia progresses.Rationale 3 Mild hypothermia activates the consonant nervous system, which can increase the levels of vital signs as hypothermia progresses, the heart becomes suppress, with decreased cardiac output and lowering of vital sign readings (Ruffolo, 2002 Kaper et al, 2005).Diagnosis 5 jeopardy for impaired skin integrity related to desquamation caused by disseminated intravascular coagulation.Intervention 1 Monitor skin condition at least once a day for color or texture changes, dermatological conditions, or lesions. Determine whether the client is experiencing loss of sensation or pain.Rationale 1 Systemic command can identi fy impending problems early (Ayello Braden, 2002 Krasner, Rodeheaver Sibbald, 2001).Intervention 2 Identify clients at risk for impaired skin integrity as a result of immobility, chronological age, malnutrition, incontinence, compromised perfusion, immunocompromised status or chronic medical conditions such as diabetes mellitus, spinal cord injury or renal failure.Rationale 2 These client populations are known to be at high risk for impaired skin integrity (Maklebust Sieggreen, 2001 Stotts Wipke-Tevis, 2001). Targeting variables (such as age and Braden Scale Risk Category) can focus assessment on particular risk factors (e.g., pressure) and help guide the plan of prevention and care (Young et al, 2002).Intervention 3 Monitor the clients skin care practices, noting type of soap or other cleansing agents used, temperature of water and frequency of skin cleansing.Rationale 3 Individualize plan according to the clients skin condition, needs, and sense of taste (Baranoski, 2000).As a nursing student with a strong interest in working with trauma patients, I am intrigued bythe fact that as to why some trauma patients are more susceptible to contracting sepsis thanothers. Therefore my suggestion for future research would be to determine if there is anunderlying factor that we, as healthcare professionals are overlooking. Apparently, I am notalone in my thinking and in performing additional reading on sepsis I was pleasantly surprised tolearn that an investigation into this matter is underway. Hinley (2010), a staff writer for MedicalNews Today, reports how an emergency room nurses curiosity close why some trauma patientsdevelop sepsis while others dont has led to an expanded career as a researcher studying thesame, burning question.Dr. Beth NeSmith, assistant professor of physiological and technological nursing in theMedical College of Georgia School of Nursing received a three-year, $281,000 NationalInstitutes of Health grant in September, 2010 to show risk f actors for sepsis and organ failurefollowing trauma. Based on her own research, Dr. NeSmith concluded that trauma kills morethan 13 million Americans annually and sepsis is the leading cause of in-hospital trauma deaths,yet little data existed to explain differences in population vulnerability to these deadly outcomes.NeSmith believes lifetime chronic stress may be the perpetrator and a simple test on hair may identifythose at risk. Her theory is that a person who grows up with chronic stress, such as socio-economic stress or abuse, will have a different response to trauma in terms of their inflammationprofile, NeSmith said. Inflammation is a normal body response to trauma, but if it gets out ofhand its dangerous. The only care for it is supportive until if the body gets better. (Hinley,P., Medical News Today, 2010)As the trauma clinical nurse specialist at MCG Health System from 1997-2003, NeSmith wasintrigued by the limited treatment options available for sepsis. Her grant will allow her to test thetheory that people with existing chronic stress respond differently physiologically to trauma thannon-stressed individuals. NeSmith spends three days a week in the lab working with underlyingscience research techniques.Nurses play a critical role in improving outcomes for patients with sepsis. To save the lives ofthose with sepsis, all nurses, no matter where they work, must develop their skills forrecognizing sepsis early and initiating appropriate therapy. With nurses dedicated tounderstanding and stopping this deadly disorder, the goal of reducing mortality will be realized.