...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...
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...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 inflammation...
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...Diagnosis | Admitting Physicians | Today | S/P (Status/Post) R total knee replacement | McNasty Ortho surgeon | Scenario Data | Learning Objectives | Note: This simulation is part of a Microbiology course (MICRO 290). The main learning objective is to use a simulation of sepsis to facilitate student visualization and understanding of the mechanisms of key chemical and biochemical events in the human body during a human pathological scenarioBy the end of this scenario, the participant will be able to: 1. Observes and discusses the use of patient history and assessment data in the early identification and management of patients at risk for or with sepsis, septic shock and multi-system organ dysfunction (ANALYSIS). 2. Observes and discusses the possible diagnostic orders and therapies including medications for the management of patients with sepsis, septic shock and multi-system organ dysfunction. Uses factor analysis to calculate doses of medication (COMPREHENSION, APPLICATION). 3. Applies the microbiology concepts learned throughout the course to explain the physiological outcomes involved in sepsis (COMPREHENSION, APPLICATION, ANALYSIS). The microbiology concepts are the following: a. Sepsis and the immune system – Relate the signs (including labs) and symptoms to the processes in the immune system - Ex....
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...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....
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...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...
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...Sepsis Workflow The early recognition of sepsis is critical to the timely treatment and prevention of progression. According to Alsolamy et al. (2014), an electronic sepsis alert tool could help recognize early sepsis. Therefore, an understanding of the processes that surrounds the identification and management of sepsis can help electronic health record (EHR) designers, end-users, and quality auditors determine the most usable and efficient method. According to McGonigle and Mastrian (2015) workflow analysis involves the "observation and documentation to understand better what is happening in the current environment" (p. 266). This paper will examine the current early sepsis recognition process and determine if any opportunities for optimization...
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...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...
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...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 |...
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...sepsis is still one of the major causes of morbidity and mortality in neonates, in spite of recent advances in health care units [1]. More than 40% of under-five deaths globally occur in the neonatal period, resulting in 3.1 million newborn deaths each year [2]. The majority of these deaths usually occur in low-income countries and almost 1 million of these deaths are attributed to infectious causes including neonatal sepsis, meningitis, and pneumonia [3]. On the other hand, the survivors of neonatal sepsis are vulnerable to short- and long-term neurodevelopmental morbidity [4–6]. Neonatal sepsis is defined as a clinical syndrome in an infant 28 days of life or younger, manifested by systemic signs of infection and isolation of a bacterial...
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...What is Sepsis? Sepsis is the most common deadly diseases in the world. Sepsis is serious, often life-threatening illness that happens when an infection cause damage to your tissues and results in an overactive response from your body. Early detection and treatment came make all the difference in your chance of recovery. How can you get sepsis? Sepsis is a result of infection. Four types of infections that are often linked with sepsis are: lungs (pneumonia)kidney (urinary tract infection) skin gut The most frequently identified germs that cause infections that develop into sepsis include: Staphylococcus aureus (staph) Escherichia coli (E. coli) some types of Streptococcus ("What is sepsis?" January 23, 2018, direct quote) Instead of fighting the infection, your immune system response is to attack your body. Anyone can get an infection, and almost any infection can lead to sepsis. Certain people are at higher risk: Adults 65 or older. People with chronic medical conditions, such as diabetes, lung disease, cancer, and kidney disease People with weakened immune systems Children younger than one("What is sepsis?" January 23, 2018, direct quote)...
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...As stated earlier, sepsis is a worldwide problem. Sepsis strategies/guidelines are imperative to utilize to make a positive outcome. Becker and Dorman share that “sepsis affects more than 1 million patients a year in the United States and even more patients around the globe and is one the leading causes of death,” (2017, para 1 p 807). With these astounding statistics, it is prudent of nursing educators to perform their part in educating the nursing students on life saving strategies against sepsis. Proactive healthcare is one of the ways this author has grown through her discovery as being a leader in healthcare. Prevention to illnesses is preferred than reacting to the severity of illness. Although not all sepsis cases can be prevented,...
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...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...
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...contusion, fractured clavicle and ribs, and extensive abrasions on his arms, legs, side, back, and buttocks. He was tachycardic, hypotensive, unresponsive, and ventilating poorly when admitted. He was placed on a mechanical ventilator and given IV fluids for shock. C.C. responded well to fluids, with an increase in blood pressure and an improvement in urine output. 1. Based on his case history and responsiveness to fluid therapy, what type of shock was C.C. experiencing? Hypovolemic Shock 2. What other clinical findings would be helpful in confirming the type of shock? Low blood pressure, weak pulse, cyanosis of the lips and fingertips, shallow breathing 3. Because of his many open wounds and invasive lines, C.C. is at risk for sepsis and septic shock. What clinical findings would suggest that this complication has developed? Chills, light-headedness, little or no urine, palpitations, skin rash or...
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...ACUTE CARE ASSIGNMENT Introduction For this assignment I have chosen to use a patient on a Medical Rehab Ward that became acutely unwell very suddenly and was eventually diagnosed with Urinary Sepsis before being transferred to an Acute Medical Ward for further treatment. The purpose of this assignment is to show how I as the nurse, managed the situation in the assessing of the patient from the onset of their symptoms using the Airway, Breathing, Circulation, Disability framework. The planning and implementing of the care required and evalutaing constantly to ensure that the care provided is working and how I communicated with the relevent medical staff using the ISBAR tool of communication. The timeframe is over a 36 hour period from onset of symptoms to transfer. I will begin by giving a definition of Sepsis, discuss the ABCDE method of assessment and a brief background as to why the patient is in hospital as well as a brief past medical history. Sepsis, a potentially life-threatening complication of a localised infection, can rapidly lead to acute deterioration risking multi-organ failure and death. (Dellinger et al 2008) Sepsis is quite common and it is therefor imperative that every nurse on every ward be aware of the signs and symptoms of Sepsis and the appropriate measures to take to manage it should their patient become Spetic. Having an effective and proven assessment tool such as the ABCDE approach can help assess, treat and therefore improve the outcome for...
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...David A Daves SIM PREP…….. 02/22/13 Preparation Questions Differentiate the following terms: Systemic Inflammatory Response Syndrome (SIRS): Is aggressive widespread inflammatory response to infection (sepsis) or perceived invader. Also, ischemia, infarction and injury. Sepsis: Is a systemic inflammatory response in the presence of a documented infection. Severe sepsis: Is sepsis complicated by organ dysfunction, is diagnosed in more than 750,000 patients per year and has mortality rates as high as 28%-50%. Septic shock: Is the presence of sepsis with hypotension despite fluid resuscitation along with the presence of inadequate tissue perfusion. Multiple organ dysfunction syndrome (MODS): Is the failure of two or more organ systems in an acutely ill patient such that homeostasis cannot be maintained without intervention. Identify the nursing priorities in the care of the patient with sepsis and septic shock: Oxygenation -Provide supplemental O2 Intubation/mechanical ventilation, if necessary Monitor SvO2 or ScvO2 Circulation- Aggressive fluid resuscitation End points of fluid resuscitation: CVP 15 mm Hg Pawp 10-12 mm Hg Drug Therapies- Antibiotics as ordered Vasopressors (dopamine) Inotropes (dobutamine) Anticoagulants (low molecular –weight heparin) Drotrecogin alfa (xigris) for patients with high risk death Supportive Therapies- Obtain cultures (blood, wound ) before beginning antibiotics Monitor temperature Control...
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