NUR213-Sepsis - sepsis PDF

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Summary

Sepsis care Bundle within 6 hours-prescribed VASOPRESSORS for hypotension not responding to fluid replacement(Dopamine, Dobutamine + Epi)-Remeasure lactate levels if initial value was elevatedMAP should be > The recommendation is to provide initial fluid resuscitation rapidly; do not infuse ...

Description

SIRS, SEPSIS, SEVERE SEPSIS, SEPTIC SHOCK, MODS 1.

Define the illness/disease process in your own words

Sepsis occurs from any exposure to fungus, bacteria, or virus. It then escapes local control + enters the bloodstream which causes inflammation that effects tissues perfusion + organ function + gas exchange

-Immune system activated + cell mediators release Cytokines Inflammation becomes enemyleading to extensive hormonal + tissue vascular changes + oxidative stress that further impair gas exchange + tissue perfusion. Massive VASODILATION/pooling of blood + capillary leak cause inadequate perfusion **Potential life threatening

2.

Risk factors

Patients w/decreased immunitychemo, HIV/AIDS/elderly/newborn/pregnant/immunosuppressant drugs Co-morbiditiesdiabetes, kidney failure, wounds Invasive foreign devicescentral line IMMUNOCOMPROMISED + ELDERLY  3.

Methods of prevention -Sterile technique when inserting Central line -Aseptic technique when inserting IV + dressing changes -Taking proper precautions for those who are immunocompromised -Handwashing + hygiene + diet & exercise + skin & mouth care

National Patient Safety Goal IV antibiotic w/known gram – bacteria are given before organisms are identified, within 1 hour of sepsis diagnosis Occurs over hours to days

SIRS

SEPSIS

SEVERE SEPSIS

Key signs + symptoms

-Mild hypotension

Hypotension -lightheaded -tachycardia

Organ damage or dysfunction

How the illness/disease process is diagnosed

SIRS criteria is 2 or more:

(*widespread vasodilation + pooling)

-Low urine output (compensating) -Increased RR (compensating)

Temp >100.4 90 RR >20 PaCO2 12000 10% bands

Management: Medical + surgical + Nursing + nutrition + therapies INTERVENTION TO PREVENT WORSENING

-Rapid breathing (damage lungs) -Severe abdominal pain (bowel perforation) -Low urine output (damage to kidney)

SIRS + confirmed infection *(culture documented)* Blood, urine, sputum, wound drainage

SEPSIS + Show symptoms of Organ Dysfunction

-Hypotension -Hypoperfusion

*WBC count may no longer be elevated due to prolonged sepsis may have exceeded bone marrow ability to keep making mature Neutrophils

 Measure lactate levels  Obtain blood cultures  Admin. broad spectrum  *Condition is often missed or underdiagnosed due to subtle

*If identified + treated cycle of progression is stopped + GOOD OUTCOME

SEPTIC SHOCK Hypotension Despite Fluid Resuscitation!!!!!!!! -hypoperfusion -cool, clammy, pallor -cyanotic -confusion -lethargy -Weak + lightheaded

Sepsis + hypotension Despite Fluid Resuscitation

LABS LOOK LIKE** Lactate > 4 SBP 2 Platelet 1.5

MODS TOO LONG + TOO LATE

Severe Septic Shock + Multiple Organ failure *Liver failureThe body can’t clear toxins + begins to shut down

**Aggressive fluid resuscitation** – 30ml/kg crystalloid if hypotensive (or) lactate > 4mmol

as quick as possible (FLUID CHALLENGE)

Most often caused by gram – septicemia Gram + bacteria/virus -or unknown cause

IRREVERSIBLE

50kg=1500mL of fluids

**ORGAN DAMAGE CAN OCCUR, but it is REVERSIBLE @ THIS STAGE

Sepsis care Bundle1st 3 hours -Obtain serum lactate level -Blood culture (before ATB!!!) -Broad spectrum ATB given -– 30ml/kg crystalloid if hypotensive (or) lactate > 4mmol

*CAN NOT BE recovered

*Death rate at this stage is HIGH

*DEATH

Sepsis care Bundlewithin 6 hours -prescribed VASOPRESSORS for hypotension not responding to fluid replacement (Dopamine, Dobutamine + Epi) -Remeasure lactate levels if initial value was elevated MAP should be >65

• The recommendation is to provide initial fluid resuscitation rapidly; do not infuse using an IV pump. *For example, give 1-liter IV fluid over 15 minutes using a pressure bag. • More rapid administration and greater amounts of fluid may be needed in patients with sepsis-induced tissue hypoperfusion.

7. Collaborative problems Widespread infection due to inadequate immunity + Potential myocardial dysfunction due to inappropriate clotting, poor perfusion, and poor gas exchange

• Altered tissue perfusion (cerebral, peripheral, renal) r/t vasodilation secondary to sepsis • Impaired gas exchange r/t decreased C.O. & fever • Fluid volume deficit r/t prolonged fever...