Premium Essay

Sepsis in the Ed

In: Other Topics

Submitted By jfrank1972
Words 1023
Pages 5
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 patients are fever, hypothermia, heart rate greater than 90 beats per minute, altered mental status, swelling of the extremities, and high blood glucose in diabetic patients. Sepsis is considered severe when there is organ dysfunction involved. Some examples of this kind of dysfunction are low oxygen level, low urine output; high levels of creatnine in the blood, absent bowel sounds, and low

Similar Documents

Premium Essay

Sepsis Case Study

...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....

Words: 517 - Pages: 3

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 25 Copyright...

Words: 3904 - Pages: 16

Premium Essay

Sepsis Sim

...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...

Words: 863 - Pages: 4

Free Essay

Ethics

...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...

Words: 508 - Pages: 3

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

Premium Essay

Dissemeniated Intravascular Coagulation

...CELLULAR AND IMMUNE CONCEPTS MARISA FRITKIN MED 3015A VICKI SWEET, INSTRUCTOR OCTOBER 22, 2012 I decided to write my paper about the coagulation system, including clot formation, but mainly about Disseminated Intravascular Coagulation. Disseminated Intravascular Coagulation, also known as DIC, is a pathological activation of blood clotting mechanisms that may happen in response to a variety of diseases, or illnesses. However, DIC, is most commonly observed in severe sepsis and septic shock. DIC is not a specific illness, rather it is a complication or an effect of the progression of other illnesses or diseases. (Porth, 2011). When the body becomes injured, certain proteins in your blood become activated and travel to the injury site to help stop bleeding and control hemostasis. Hemostasis is the normal process of sealing off a blood vessel to prevent blood loss and hemorrhage. It is abnormal when it fails to appropriately clot the blood, or when this clotting is insufficient to stop the bleeding. Following an injury, there is an immediate vessel spasm that promotes vasoconstriction, which tries to diminish the blood flow. Collagen from the damaged site, releases platelets which adhere to the damaged vessel, and there, they undergo degranulation and release cytoplasmic granules, ADP, Thromboxane A2, and Serotonin which is a vasoconstrictor. The ADP then attracts more platelets to the area, and the Thromboxane A2 promotes platelet aggregation, degranulation,...

Words: 762 - Pages: 4

Premium Essay

Overcrowded Er

...illness. The third cause of overcrowding is a shortage of staff. These major issues can delay staff from providing care to those who need it most. Although staff gives priority to patients who have a higher acuity of illness these patients often have to wait long periods of time before a bed becomes available. Overcrowding is serious issue in the ED and most of the contributing factors are beyond the control of the emergency department. The first cause of overcrowding in the ED is the misuse of the emergency room. More than 50% of emergency room visits are for non-urgent concerns and over 46% of these medical complaints could have been solved by a primary care physician (PCP). PCP’s sometimes fail to properly communicate with their patients which can lead to the anxiety that sends the patient to seek assistance in the emergency room. In many instances when a PCP unavailable for appointments they will suggest that their patient pursue help in the ED instead of referring them to urgent care which, in most cases, would be more suitable for the patients complaints. The popular search engine Google can also cause misuse of the ED when a patient attempts to find a solution to their problems by simply searching their symptoms....

Words: 927 - Pages: 4

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 determination...

Words: 10476 - Pages: 42

Premium Essay

Copd Case Study

...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 widowed 6 months ago after 64 years of marriage and resides in assisted living. She is a retired elementary school teacher. She called her pastor and he has now arrived and came back with the patient. The nurse walked in the room when the pastor asked Joan if she would like to pray. The patient said, “Yes, this may the beginning of the end for me.” What data from the histories is important...

Words: 2774 - Pages: 12

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 progressing...

Words: 12469 - Pages: 50

Premium Essay

Can I Live Without My Spleen

...Can I live without my spleen? The spleen is a lymphoid organ, part of the Lymphatic System. It is the size of a closed fist and lies just below the diaphragm, tucked against the top of the stomach on the left side of the abdominal cavity (Marieb & Hoehn, 2013). It is the first organ in the embryo to produce red blood cells (Turbyville, 2012) but, later in life, it functions as a filter to remove old or damaged red blood cells from circulation. It also stores about 250mL of blood which can be released into the blood circulation in emergencies (Marieb & Hoehn, 2013). As a part of the immune system, it stores and produces lymphocytes which produce essential antibodies and release these into circulation (Sherwood, 2010). If a child were born without a spleen, or without a functional spleen, such a child would have a very high risk of dying young as a result of overwhelming infection (Turbyville, 2012). How many children are born without a spleen is difficult to know, as many of these children have other problems and die of cardiovascular complications before they contract an infection (Turbyville, 2012). Adults who have a splenectomy, usually as a result of accidents which rupture the spleen, have a good chance of surviving, as the bone marrow and liver can take over some of the spleen’s functions (Children’s Hospital of Pittsburgh, 2012; Marieb & Hoehn, 2013). However, asplenic people are at greater than average risk of contracting and dying from infections. They...

Words: 437 - Pages: 2

Free Essay

Appendicitis

...A 42 year old female arrives in the emergency room with right lower quadrant pain. I begin my assessment by asking her the onset, duration, and frequency of the pain. I would also want to know if she has nausea and vomiting, diarrhea a change in her appetite, did she take any medication to address the pain, ask about change in elimination pattern, feeling of bloating or gas, or a change in weight. I would also ask when was the last time the patient had anything to eat or drink. While taking the history of the patient, I would want to know if they have a history of abdominal pain that could be unrelated to the current pain. Known risk factors would include peritonitis, sepsis, or even death related to the infected appendix. If appendicitis is even suspected, doctors tend remove the appendix to avoid its rupture. If the appendix has formed an abscess, you may have two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix. Physical assessment of the abdomen includes inspection, auscultation, percussion, and palpation (D’Amico). Percussion and palpation should be done last to avoid disturbing bowel sounds. Normal bowel sounds should occur from 5 to 30 times per minute. I would also take her temperature to see if there she has an elevated temperature. The following tests are usually used to make the diagnosis. Abdominal exam to detect inflammation Urine test to rule out a urinary tract infection Rectal exam Blood test to see...

Words: 465 - Pages: 2

Premium Essay

Hrm/531 Week 6 Journal

...a) The most beneficial to learn during my internship is the recognition and application of knowledge of the pathophysiology, clinical manifestations, assessment and management of specific diseases. For example, chest pain, is one the most common and alarming manifestation in the ED. Chest pain can indicate a STEMI, that requires immediate treatment, such as MONA (morphine, oxygen, nitrogen and aspirin). Therefore, as a nursing student I must recognize and have the knowledge behind this emergency management and other diseases. 3) Describe how effectively you use your time to meet your goals and objectives on a 0 to 4 scale (four is very or completely effective and zero is not at all effective). a) The Emergency Department is characterized by its chaotic environment and a helping hand is always wanted. I try to help and find things to do in the ED, such as 12 lead ECG, assessments, vital signs, IV access, obtain and send labs, discharge patients, and administer medications, among other things. But unfortunately, outside of the department I have difficulties to complete my goals and objectives. I found it hard to review pharmacotherapeutics, procedures and protocols according to the clinical presentations. Therefore, my score is a...

Words: 748 - Pages: 3

Premium Essay

Braden

...moisture,21,24 mobility, 21 and friction/shear24 have been found to be significant predictors of pressure ulcer development in ICU patients, the activity and nutrition subscales have not. Other factors not included in the Braden Scale may also increase a patient’s level of risk for pressure ulcers and thus be important determinants in adult critical care patients. Empirical evidence suggests that the following factors can be predictive of pressure ulcers in critical care patients: advanced age1,4,21,25,26; low arteriolar pressure27-29; prolonged ICU stay1,21,26,30; severity of illness as indicated by scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II1,31; comorbid conditions, including diabetes mellitus, sepsis, and vascular disease21,25,27; and iatrogenic factors, such as the use of vasopressor agents.1,25,2 Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence in intensive care patients: a cross-sectional study. J Eval Clin Prac. 2008;14:563-568. One criticism of this tool is the inability of staff to distinguish what is meant by some of the parameters. An example of this is the use of risk factors, such as ‘mobility and activity’, whereby the authors use the term ‘mobility’ to question if the patient is able to relieve pressure through movement? Whereas, the ‘activity’ parameter relates to the frequency and duration of a patient’s movement. So, in actual fact, the terms mean different things but further clarification...

Words: 600 - Pages: 3

Premium Essay

Failure to Rescue

...Researchers have used different sets of complications and deaths to define this measure. (Silber JH, Romano PS, Rosen AK, Wang Y, Even-Shoshan O, Volpp KG, 2007). This paper gives a description of failure to rescue, discusses the importance to nursing and nursing students, in regards to course studies and critical thinking skills. References for this paper are research studies that used the “original” FTR (using all deaths) description. Description Failure to Rescue is generally defined as the inability to save a hospitalized patient’s life when he/she experiences a complication. A complication is a condition that is not present on admission, such as cardiopulmonary arrest/shock, pneumonia, upper GI bleed, venous thromboembolism (VTE), and sepsis. Failure to rescue does not necessarily imply wrong doing. (Silber, JH, 2007) Importance to Nursing Patients that experience a complication are at risk for failure to rescue. Surgical and trauma patients are most vulnerable. Early warning signs include changes in vital signs; temperature, blood pressure, pulse, heart rate, and respiration rate, changes in oxygen saturation, and changes in mental status. Monitoring these represents the most basic nursing skill, yet essential for...

Words: 576 - Pages: 3