Premium Essay

Sepsis a Case Study

In: Science

Submitted By davburton18
Words 3132
Pages 13
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,...

Similar Documents

Premium Essay

Case Study Sepsis

...my clinical area. An accurate handover of the clinical information was given in relevance to the patient’s continuity and safety of care. (Adams 2012). (Ref- Adams JM, Osbourne-Mckenzie T Advancing the evidence base for a standardized provider handover structure: using staff nurse description of information to deliver competent care. Journal of continuing Education in nursing 2012;43(6):261-6.) My case study is on a 59-year old lady( Appendix 1)who recently had been discharged after surgery on her left neck of femur fracture. This lady had been readmitted to our clinical area following her discharge due to signs of a UTI, fever and the wound site being very red and inflamed. Pam was showing all the signs and symptoms of a severe infection with a temperature ranging from 38.5 to 40 Celsius, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute and a white blood cell count greater than 12,000. These combined symptoms are known as the Systemic Inflammatory Response Syndrome (SIRS), this in addition to a confirmed infection is known as Sepsis. On arrival to our clinical area...

Words: 1259 - Pages: 6

Free Essay

Sepsis Prevalnce in Jimma

...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......

Words: 10476 - Pages: 42

Free Essay

Sepsis

...Sepsis An Overview Health And Social Care Essay ukessays.com /essays/health-and-social-care/sepsis-an-overview-health-and-social-careessay.php Sepsis is an infection of the bloodstream. The infection tends to spread quickly and often is difficult to recognize. One of our roles as a nurse is that of patient advocate, and as such we are closest to the patient, placing us in a key position to identify any subtle changes at their earliest onset and prevent the spread of severe infection. Knowledge of the signs and symptoms of SIRS, sepsis, and septic shock is key to early recognition. Early recognition allows for appropriate treatment to begin sooner, decreasing the likelihood of septic shock and life-threatening organ failure. Once sepsis is diagnosed, early and aggressive treatment can begin, which greatly reduces mortality rates associated with sepsis. sep•sis (ˈsep-səs) n. Sometimes called blood poisoning, sepsis is the body's often deadly response to infection or injury (Merriam-Webster, 2011) Sepsis is a potentially life-threatening condition caused by the immune system's reaction to an infection; it is the leading cause of death in intensive care units (Mayo Clinic Staff, Mayo Clinic 2010). It is defined by the presence of 2 or more SIRS (systemic inflammatory response syndrome) 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 infection trigger widespread......

Words: 3635 - Pages: 15

Premium Essay

Sepsis in the Ed

...Improving Outcomes in Sepsis Patients in the Emergency Department Sepsis is a left threatening illness that affects millions of people each year. The Center of Disease Control reports sepsis as the 10th leading cause of death in the United States (V). For adults age 65 and over hospital admission because of sepsis have increased 48%. The body’s immune system switches into “high gear” which overwhelms the body’s normal blood flow and oxygenation of tissues throughout the body. This process, if not treated in time, can quickly lead to organ failure and death. Approximately one third of people diagnosed with sepsis die from it. The role of emergency departments throughout the country has become vitally important to the early detection and treatment of sepsis. With the implementation of sepsis protocols in the emergency department the mortality of patients with sepsis admitted through the ED is significantly lower. The word sepsis is commonly used to diagnose patients, but the debate continues as to the true definition. The word sepsis comes from the Greek meaning decay or to putrefy.” (A). Sepsis is a general term that is applied to patients that develop clinical signs of infection. Unlike other diseases sepsis is not diagnosed by the location or type of microbe involved in the infection. Some of the criteria used to diagnose sepsis are abnormalities of body temperature, pulse, respirations, and white blood cell counts. Some symptoms that are common in septic......

Words: 1023 - Pages: 5

Free Essay

Sir Definition

...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......

Words: 1653 - Pages: 7

Free Essay

Instite of Medicine Impact , Sepsis

...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......

Words: 3904 - Pages: 16

Free Essay

Septic Shock

...Septic Shock Medical Careers Institute NUR 255 November 19, 2014 Instructor Y. Rogers Introduction Septic shock is the most common type of circulatory shock. Sepsis or septic shock is systemic inflammatory response syndrome (SIRS) secondary to a documented infection. This response is a state of acute circulatory failure characterized by persistent arterial hypotension despite adequate fluid resuscitation or by tissue hypoperfusion (manifested by a lactate concentration >4 mg/dL) unexplained by other causes. Sepsis can occur in stages that may progress from uncomplicated sepsis, to severe sepsis, to shock. Despite efforts to decrease shock with the use of antibiotics, the incidences continue. Septic shock is the leading cause of death in noncoronary ICU patients. More than 18 million cases of severe sepsis occur each year, this results in 1,400 deaths worldwide every day (Hinkle, 2014). Background In the past, the terms sepsis and septicemia have referred to several ill-defined clinical conditions present in a patient with bacteremia. These 2 terms have often been used interchangeably; however, only about half of patients with signs and symptoms of sepsis have positive results on blood culture. Serious bacterial infections at any site in the body, with or without bacteremia, are usually associated with important changes in the function of every organ system in the body. These changes are mediated mostly by elements of the host immune system against infection...

Words: 1327 - Pages: 6

Free Essay

Trali

...critical care review Transfusion-Related Acute Lung Injury* A Review Mark R. Looney, MD; Michael A. Gropper, MD, PhD, FCCP; and Michael A. Matthay, MD, FCCP Transfusion-related acute lung injury (TRALI) is an underreported complication of transfusion therapy, and it is the third most common cause of transfusion-associated death. TRALI is defined as noncardiogenic pulmonary edema temporally related to transfusion therapy. The diagnosis of TRALI relies on excluding other diagnoses such as sepsis, volume overload, and cardiogenic pulmonary edema. Supportive diagnostic evidence includes identifying neutrophil or human leukocyte antigen (HLA) antibodies in the donor or recipient plasma. All plasma-containing blood products have been implicated in TRALI, with the majority of cases linked to whole blood, packed RBCs, platelets, and fresh-frozen plasma. The pathogenesis of TRALI may be explained by a “two-hit” hypothesis, with the first “hit” being a predisposing inflammatory condition commonly present in the operating room or ICU. The second hit may involve the passive transfer of neutrophil or HLA antibodies from the donor or the transfusion of biologically active lipids from older, cellular blood products. Treatment is supportive, with a prognosis substantially better than most causes of clinical acute lung injury. (CHEST 2004; 126:249 –258) Key words: ARDS; lung injury; pulmonary edema; transfusion; transfusion-related acute lung injury Abbreviations: ALI acute lung......

Words: 7507 - Pages: 31

Premium Essay

Strategy Change at Minnesota Bio Labs

...Abstract Organizational change occurs when a company makes a transition from its current state to some desired future state. Managing organizational change is the process of planning and implementing change in organizations in such a way as to minimize employee resistance and cost to the organization while simultaneously maximizing the effectiveness of the change effort. This paper will present a case study of Minnesota Biolabs, a company that supplied rabbits to the producers of injectable devices and their move from injectable rabbits to Sepsis Detection Test (SDT). Instead of conducting tests in live rabbits, SDT used blood extracted from horseshoe crabs for the tests. After extraction, the crabs were returned to the ocean where they were able to regenerate lost blood. Organizational Change Companies large and small spend millions of dollars each year in order to make change initiatives a success, yet the results are frequently dismal. Changes fail to achieve their objectives, and leaders are left wondering what went wrong. Managers blame change-phobic employees, and employees say leaders didn't manage the change effectively. If you're responsible for driving change, you find all the finger-pointing frustrating and, frankly, unhelpful. If only you could pinpoint where the failure originates, perhaps you could head it off at the pass. Changes in the environment create new requirements for success in the marketplace as customers demand new......

Words: 1566 - Pages: 7

Free Essay

Septic Shock

...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......

Words: 1113 - Pages: 5

Free Essay

Sasda

... Recipient SU College Highest QPA Award, Senior Category (2003) Recipient College Internship – Leadership Award and Best in Clinical Practice (2003) Recipient Intel Fellows Achievement Award, 50th Intel – International Science and Engineering Fair held at Philadelphia, USA (1999) Nominee Worldwide Young Researchers for the Environment held at Hannover, Germany (1999) Recipient Young Achievement Award – Dumaguete Science High School PTA Association (1999) Recipient Outstanding Red Cross Youth Volunteer, Negros Oriental Chapter (1999) RESEARCHES 2012 A Comparison between APACHE II and SOFA Scoring Systems in Predicting Hospital Mortality Among Adult Patients with Sepsis at Chinese General Hospital and Medical...

Words: 556 - Pages: 3

Free Essay

Bladder Infection

...life. B. (Reason to Listen) Antibiotic treatment of children with urinary tract infections has almost eliminated the risk of death, which was approximately 20% among children hospitalized for severe kidney infections in the early 20th century. Some 50 years ago, one study described scarring found in the functional tissue of the kidney in 210 of 597 children treated for recurrent urinary tract infections. Another study in that era reported on an 11-to-27-year follow-up of 72 children hospitalized for urinary tract infections; 18% had died, 8% had progressive kidney damage, and 22% had persistent untreated or recurrent infection. C. (Speaker Credibility) The North American Pediatric Renal Trials and Collaborative Studies21 list primary diagnoses for 9854 children who had received transplants over the previous 20 years. D. (Preview) 1. First, I will discuss what’s the long term consequences a UTI can have if left untreated. 2. Second, I will cover the cause of a UTI. 3. Third, I will talk about how prevention of a bladder infection. II. Body A. (Significance) Newborn infants have a higher risk of kidney damage from a UTI, which can later result to kidney failure in severe cases and possibly death, if the bladder infection is left untreated. 1. Sub-point Approximately 60% of children with febrile urinary tract infections, if evaluated during or just after the...

Words: 955 - Pages: 4

Free Essay

Outline for Shock

...I. Introduction - Shock (Chapter 11) A. Review of anatomy and physiology B. Pathophysiology Initiation | * Decreased tissue oxygenation * Decreased intravascular volume * Decreased Myocardial contractility (cardiogenic ) * Obstruction of blood flow (obstructive) * Decreased vascular tone (distributive) * Septic (mediator release) * Neurogenic (suppression of SNS) | No observable clinical indications Decreased CO may be noted with hemodynamic monitoring | Compensatory | * Neural compensation by SNS * Increased HR and Contractiliy * Vasoconstriction * Redistribution of blood flow from nonessential to essential organs * Bronchodilation * Endocrine Compensation (RAAS, ADH, glucocorticoid release) * Renal reabsorption of sodium, chloride, and water * Vasoconstriction * Glycogenolysis | * Increased HR (EXCEPT NEUROGENIC) * Narrowed pulse pressure * Rapid, deep respirations causing respiratory alkalosis * Thirst * Cool,moist skin * Oliguria * Diminished bowel sounds * Restlessness progressing to confsion * Hyperglycemia * Increased specific gravity and decreased creatinine clearance. | Progressive | * Progressive tissue hypoperfusion * Anaerobic metabolism wih lactic acidosis * Failure of sodium potassium pump * Cellular edema | * Dysrhythmias * Decreased BP with narrowed pulse pressure * Tachypnea * Cold, clammy skin * Anuria * Absent bowel sounds * Lethargy......

Words: 12469 - Pages: 50

Premium Essay

Copd Case Study

...Airway/Breathing (Oxygenation) Pneumonia/Chronic Obstructive Pulmonary Disease Clinical Reasoning Case Study STUDENT Worksheet JoAnn Walker, 84 years old Overview This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Principles of spiritual care are also naturally situated in this scenario to provide rich discussion of “how to” practically incorporate this into the nurse’s practice. Concepts (in order of emphasis) I. Gas Exchange II. Infection III. Acid-Base Balance IV. Thermoregulation V. Clinical Judgment VI. Pain VII. Patient Education VIII. Communication IX. Collaboration I. Data Collection History of Present Problem: Pneumonia-COPD JoAnn Walker is an 84-year-old female who has had a productive cough of green phlegm 4 days ago that continues to persist. She was started 3 days ago on prednisone 60 mg po daily and azithromycin (Zithromax) 250 mg po x5 days by her clinic physician. Though she has had intermittent chills, she first noticed a fever last night of 102.0. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement. Therefore she called 9-1-1 and arrives at the emergency department (ED) by emergency medical services (EMS) where you are the nurse who will be responsible for her care. Personal/Social History: JoAnn was......

Words: 2774 - Pages: 12

Premium Essay

Phi 103 Week 5 Final Paper

...An Abortion Argument Barbara Santorelli PHI 103 Instructor Cornell Horn September 30, 2013 An Abortion Argument Abortion is a hot issue in the United States today. Abortion is currently legal in all 50 states however; some states have a 20-week ban law. This law bans all abortions after 20 weeks of a woman’s last menstrual period and only allows for exceptions in cases where a woman’s life is threatened. Folks on both sides of the isle on the abortion issue are extremely passionate about their views and opinions in regards to the right to abortions in our country. Although there are many individuals and groups that disagree on this issue, abortions should not be legal since the act of abortion is the killing of innocent human life and having an abortion is also a great risk to the health and life of the woman that is having the abortion. There has long been a big debate among abortion supporters and those who oppose abortions, as to just when it is considered that human life begins. It has been a question for centuries whether the unborn is truly a “person”. If we consider the unborn to be a “person” then the unborn should also have an inalienable right to life just as everyone else does. Human life has many stages; a human embryo and the human fetus are early stages of human life. According to Lugosi (2005) historically common law determined that when a pregnant woman feels “quickening” which is the movement of the baby, this is evidence of life (Para.......

Words: 1572 - Pages: 7