Oct 11, · Nursing assessments and recognition of risk factors aid prompt recognition and treatment. Sepsis is a life-threatening condition that occurs when the body’s response to infection causes organ injury. According to the Centers for Disease Control and Prevention, it affects approximately million adults each year in the United States and is a Jul 21, · Health Case Studies is composed of eight separate health case studies. Each case study includes the patient narrative or story that models the best practice (at the time of publishing) in healthcare settings. Associated with each case is a set of specific learning objectives to support learning and facilitate educational strategies and evaluation Essay on personal experience nursing Case study sepsis. Cover letter for library circulation clerk. Visiting citizen kane analytical essay cinema studies essay e filmbay iv 05 html partnership business plan legal structure are mobile phones dangerous essay best college essay editor site us theater studies proofreading website, sister essays
Anti-NMDA receptor encephalitis: a case study and illness overview
Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Sepsis is caused by many organisms including bacteria, viruses and fungi. Sepsis requires immediate treatment with intravenous fluids and antimicrobials, case study sepsis nursing.
Disease severity partly determines the outcome. In addition to symptoms related to the actual cause, case study sepsis nursing, people with sepsis may have a feverlow body temperaturerapid breathinga fast heart rateconfusionand edema. Signs of established sepsis include confusion, metabolic acidosis which may be accompanied by a faster breathing rate that leads to respiratory alkalosislow blood pressure due to decreased systemic vascular resistancehigher cardiac outputcase study sepsis nursing, and disorders in blood-clotting that may lead to organ failure.
The drop in blood pressure seen in sepsis can cause case study sepsis nursing and is part of the criteria for septic shock. Oxidative stress is observed in septic shock, with circulating levels of copper and vitamin C being decreased.
Infections leading to sepsis are usually bacterial but may be fungalparasitic or viral. After the introduction of antibiotics, gram-negative bacteria became the predominant cause of sepsis from the s to the s.
The most common causes for parasitic sepsis are Plasmodium which leads to malariaSchistosoma and Echinococcus. The most common sites of infection resulting in severe sepsis are the lungs, the abdomen, and the urinary tract. In one-third to one-half of cases, the source of infection is unclear. Early diagnosis is necessary to properly manage sepsis, as the initiation of rapid therapy is key to reducing deaths from severe sepsis. Within the first three hours case study sepsis nursing suspected sepsis, diagnostic studies should include white blood cell countsmeasuring serum lactate, and obtaining appropriate cultures before starting antibiotics, so long as this does not delay their use by more than 45 minutes.
At least one should be drawn through the skin and one through each vascular access device such as an IV catheter that has been in place more than 48 hours. If other sources of infection are suspected, cultures of these sources, such as urine, cerebrospinal fluid, wounds, or respiratory secretions, also should be obtained, as long as this does not delay the use of antibiotics.
Within twelve hours, it is essential to diagnose or exclude any source of infection that would require emergent source control, such case study sepsis nursing a necrotizing soft tissue infection, case study sepsis nursing, an infection causing inflammation of the abdominal cavity liningan infection of the bile duct case study sepsis nursing, or an intestinal infarction.
Previously, SIRS criteria had been used to define sepsis. If the SIRS criteria are negative, it is very unlikely the person has sepsis; if it is positive, case study sepsis nursing, there is just a moderate probability that the person has sepsis.
According to SIRS, there were different levels of sepsis: sepsis, severe sepsis, and septic shock. In a new consensus was reached to replace screening by systemic inflammatory response syndrome SIRS with the sequential organ failure assessment SOFA score and the abbreviated version qSOFA. Examples of end-organ dysfunction include the following: [37]. More specific definitions of end-organ dysfunction exist for SIRS in pediatrics.
Consensus definitions, however, continue to evolve, with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience. Biomarkers can help diagnosis because they can point to the presence or severity of sepsis, although their exact role in the management of sepsis remains undefined. The authors suggested that procalcitonin may serve as a helpful diagnostic marker for sepsis, case study sepsis nursing, but cautioned that its level alone case study sepsis nursing not definitively make the diagnosis.
The differential diagnosis for sepsis is broad and has to examine to exclude the non-infectious conditions that case study sepsis nursing cause the systemic signs of SIRS: alcohol withdrawalacute pancreatitisburnspulmonary embolismcase study sepsis nursing, thyrotoxicosisanaphylaxisadrenal insufficiencyand neurogenic shock.
In common clinical usage, neonatal sepsis refers to a bacterial blood stream infection in the first month of life, such as meningitispneumoniapyelonephritis case study sepsis nursing, or gastroenteritis[43] but neonatal sepsis also may be due to infection with fungi, viruses, or parasites.
Sepsis is caused by a combination of factors related to the particular invading pathogen s and to the status of the immune system of the host. On the other hand, systemic inflammatory response syndrome SIRS occurs in people without the presence of infection, for example, in those with burnspolytraumaor the initial state in pancreatitis and chemical pneumonitis.
However, sepsis also causes similar response to SIRS. Bacterial virulence factorssuch as glycocalyx and various adhesinsallow colonization, case study sepsis nursing, immune evasion, and establishment of disease in the host. This forced receptor interaction induces the production of pro-inflammatory chemical signals cytokines by T-cells, case study sepsis nursing.
There are a number of microbial factors that may cause the typical septic inflammatory cascade. An invading pathogen is recognized by its pathogen-associated molecular patterns PAMPs. Examples of PAMPs include lipopolysaccharides and flagellin in gram-negative bacteria, muramyl dipeptide in the peptidoglycan of the gram-positive bacterial cell wall, and CpG bacterial DNA. These PAMPs are recognized by the pattern recognition receptors PRRs of the innate immune system, which may be membrane-bound or cytosolic.
Invariably, the association of a PAMP and a PRR will cause a series of intracellular signalling cascades. Consequentially, transcription factors such as nuclear factor-kappa B and activator protein-1will up-regulate the expression of pro-inflammatory and anti-inflammatory cytokines, case study sepsis nursing. Upon detection of microbial antigensthe host systemic immune system is activated. Immune cells not only recognise pathogen-associated molecular patterns but also damage-associated molecular patterns from damaged tissues.
An uncontrolled immune response is then activated because leukocytes are not recruited to the specific site of infection, but instead they are recruited all over the body. Then, an immunosuppression state ensues when the proinflammatory T helper cell 1 TH1 is shifted to TH2, [51] mediated by interleukin 10case study sepsis nursing, which is known as "compensatory anti-inflammatory response syndrome".
Inflammatory responses cause multiple organ dysfunction syndrome through various mechanisms as described below. Increased permeability of the lung vessels causes leaking of fluids into alveoli, which results in pulmonary edema and acute respiratory distress syndrome ARDS. Impaired utilization of oxygen in the liver impairs bile salt transport, causing jaundice yellowish discoloration of the skin.
In case study sepsis nursing, inadequate oxygenation results in tubular epithelial cell injury of the cells lining the kidney tubulesand thus causes acute kidney injury AKI. Meanwhile, in the heart, impaired calcium transport, and low production of adenosine triphosphate ATPcan cause myocardial depression, reducing cardiac contractility and causing heart failure. In the gastrointestinal tractcase study sepsis nursing, increased permeability of the mucosa alters the microflora, causing mucosal bleeding and paralytic case study sepsis nursing. In the central nervous systemdirect damage of the brain cells and disturbances of neurotransmissions causes altered mental status.
The damaged endothelial surface inhibits anticoagulant properties as well as increases antifibrinolysiswhich may lead to intravascular clotting, the formation of blood clots in small blood vessels, and multiple organ failure.
The low blood pressure seen in those with sepsis is the result of various processes, including excessive production of chemicals that dilate blood vessels such as nitric oxidea deficiency of chemicals that constrict blood vessels such as vasopressinand activation of ATP-sensitive potassium channels.
Early recognition and focused management may improve the outcomes in sepsis. Current professional recommendations include a number of actions "bundles" to be followed as soon as possible after diagnosis. Within the first three hours, someone with sepsis should have received antibiotics and, case study sepsis nursing, intravenous fluids if there is evidence of either low blood pressure or other evidence for inadequate blood supply to organs as evidenced by a raised level of lactate ; blood cultures also should be obtained within this time period.
After six hours the blood pressure should be adequate, close monitoring of blood pressure and blood supply to organs should be in place, and the lactate should be measured again if initially it was raised. Apart from the timely administration of fluids and antibioticsthe management of sepsis also involves surgical drainage of infected fluid collections and appropriate support for organ dysfunction. This may include hemodialysis in kidney failuremechanical ventilation in lung dysfunction, transfusion of blood productsand drug and fluid therapy for circulatory failure.
Ensuring adequate nutrition—preferably by enteral feedingbut if necessary, by parenteral nutrition —is important during case study sepsis nursing illness. Two sets of blood cultures aerobic and anaerobic are recommended without delaying the initiation of antibiotics. Cultures from other sites such as respiratory secretions, urine, case study sepsis nursing, wounds, cerebrospinal fluid, and catheter insertion sites in-situ more than 48 hours are recommended if infections from these sites are suspected.
The choice of antibiotics is important in determining the survival of the person. Several case study sepsis nursing determine the most appropriate choice for the initial antibiotic regimen. These factors include local patterns of bacterial sensitivity to antibiotics, whether the infection is thought to be a hospital or community-acquired infection, and which organ systems are thought to be infected. Treatment duration is typically 7—10 days with the type of antibiotic used directed by the results of cultures.
If the culture result is negative, antibiotics should be de-escalated according to the person's clinical response or stopped altogether if an infection is not present to decrease the chances that the person is infected with multiple drug resistance organisms. In case of people having a high risk of being infected with multiple drug resistant organisms such as Pseudomonas aeruginosaAcinetobacter baumanniithe addition of an antibiotic specific to the gram-negative organism is recommended.
For Methicillin-resistant Staphylococcus aureus MRSAvancomycin or teicoplanin is recommended. For Legionella infection, addition of macrolide or fluoroquinolone is chosen. If fungal infection is suspected, an echinocandinsuch as caspofungin or micafunginis chosen for people with severe sepsis, followed by triazole fluconazole and itraconazole for less ill people.
Once-daily dosing of aminoglycoside is sufficient to achieve peak plasma concentration for a clinical response without kidney toxicity. Meanwhile, for antibiotics with low volume distribution vancomycin, teicoplanin, colistina loading dose is required to achieve an adequate therapeutic level to fight infections.
Frequent infusions of beta-lactam antibiotics without exceeding total daily dose would help to keep the antibiotics level above minimum inhibitory concentration MICthus providing a better clinical response. Crystalloid solution is recommended as the fluid of choice for resuscitation. Fresh frozen plasma transfusion usually does not correct the underlying clotting abnormalities before a planned surgical procedure.
Meanwhile, the blood purification technique such as hemoperfusionplasma filtration, and coupled plasma filtration adsorption to remove inflammatory mediators and bacterial toxins from the blood also does not demonstrate any survival benefit for septic shock. If the person case study sepsis nursing been sufficiently fluid resuscitated but the mean arterial pressure is not greater than 65 mmHg, vasopressors are recommended.
Norepinephrine is often used as a first-line treatment for hypotensive septic shock because evidence shows that there is a relative deficiency of vasopressin when shock continues for 24 to 48 hours. Although dopamine is useful to increase the stroke volume of the heart, it causes more abnormal heart rhythms than norepinephrine and also has an immunosuppressive effect. Dopamine is not proven to have protective properties on the kidneys.
The use of steroids in sepsis is controversial. During critical illness, a state of adrenal insufficiency and tissue resistance to corticosteroids may occur. This has been termed critical illness—related corticosteroid insufficiency. It should be suspected in those poorly responding to resuscitation with fluids and vasopressors. Neither ACTH stimulation testing [75] nor random cortisol levels are recommended to confirm the diagnosis. However, the Surviving Sepsis Campaign recommended to taper steroids when vasopressors are no longer needed.
High positive end expiratory pressure PEEP is recommended for moderate to severe ARDS in sepsis as it opens more lung units for oxygen exchange, case study sepsis nursing. Predicted body weight is calculated based on sex and height, and tools for this are available.
It is recommended that the head of the bed be raised if possible to improve ventilation. However, β2 adrenergic receptor agonists are not recommended to treat ARDS because it may reduce survival rates and precipitate abnormal heart rhythms. A spontaneous breathing trial using continuous positive airway pressure CPAPT piece, or inspiratory pressure augmentation can be helpful in reducing the duration of ventilation.
Minimizing intermittent or continuous sedation is helpful in reducing the duration of mechanical ventilation. General anesthesia is recommended for people with sepsis who require surgical procedures to remove the infective source. Usually, inhalational and intravenous anesthetics are used. Requirements for anesthetics may be reduced in sepsis. Inhalational anesthetics can reduce the level of proinflammatory cytokines, altering leukocyte adhesion and proliferation, inducing apoptosis cell death of the lymphocytes, possibly with a toxic effect on mitochondrial function.
Paralytic agents are not suggested for use in sepsis cases in the absence of ARDSas a growing body of evidence points to reduced durations of mechanical ventilationICU and hospital stays. When appropriately used, paralytics may aid successful mechanical ventilation, however, evidence has also suggested that mechanical ventilation in severe sepsis does not improve oxygen consumption and delivery.
Sepsis: Clinical Reasoning Case Study-Part 2/2
, time: 19:40Sepsis identification: a race against time - American Nurse
Aug 30, · One study suggested choosing concurrent IVIg ( g/kg per day for 5 days) and methylprednisolone (1 g/day for 5 days) over plasma exchange.3 If patients show minimal improvement, the next line of therapy is immunosuppression, using rituximab or cyclophosphamide, with continued immunosuppression (mycophenolate mofetil or azathioprine) for at Oct 11, · Nursing assessments and recognition of risk factors aid prompt recognition and treatment. Sepsis is a life-threatening condition that occurs when the body’s response to infection causes organ injury. According to the Centers for Disease Control and Prevention, it affects approximately million adults each year in the United States and is a McGloin s, McLeod A () Advanced Practice In Critical Care: A Case Study Approach. Wiley Blackwell: Oxford. Dunkley S, McLeod A () ‘Neutropenic Sepsis: Assessment, pathophysiology & nursing care’. British Journal of Neuroscience Nursing. Vol 11 (2) pp Surviving Sepsis Campaign () International Guidelines and
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