Nursing Interventions for Sepsis and Infection: A Case Study

Introduction
Sepsis refers to the presence of microorganisms in blood especially bacteria (Vincent, Martin and Levy 2016 pp.210). Presence of
these microorganisms in blood triggers immune response by the body which can lead to malfunctioning of various organs and may
even lead to shock and death. For sepsis to be diagnosed, an individual may present with the following signs and symptoms;
decreased urination, change in skin colour or patches of discoloured skin, abnormal hear functions chills and breathing problems.
The patient may present with these signs with other additional. Lab test is a confirmatory test and helps to identify the specific
microorganism causing the condition (Sinha et al 2018 pp.e00089-17). Some infections such as pneumonia can trigger sepsis
when the body’s immune system is working overtime to fight the infection.

Actual or Potential problem
The patient is having circulatory problem or impaired circulatory function. The blood pressure of the
patient is lower than the normal range of an adult that is between 120/80 and 140/90 mmHg (Gomez
and Kellum 2019 pp 524-533). When the body is infested by microorganisms, it response by
activation immune system to fight microorganisms back. The end result may lead to microorganism
clearing or an inflammatory response may be triggered through release of some chemicals and
inflammatory mediators such as histamine. This inflammation leads to decreased blood flow to vital
organs such as the kidneys, heart and the brain. This can lead to organ damage or even death.
Severe sepsis can also lead to extremely low blood pressure which can cause septic shock and even
death. The pulse rate is also higher than the normal range of between 60 and 100 beats per minute
in an adult. Tachycardia is a common feature in patients with sepsis (Koukonen et al 2015 pp 1629-
1638). This is because with decreased cardiac output, the amount of oxygen reaching tissues and
organs is reduced therefore increased heart rate is a compensatory mechanism to decrease amount
of carbon IV oxide in blood. Increased breathing rate is also a compensatory mechanism. Peripheries
are cool to touch signifying decreased blood flow to peripheral organs from decreased cardiac output
(Jiang, Tseng and Chang 2017 p 121).
SMART
nursing
goal(s)
Nursing interventions Rationale Strategies to
determine
effectiveness of

actions
The patient
shall
demonstrate
rise in blood
pressure to the
normal range
(120/80mmHg),
decreased heart
rate to normal
(72
beats/minute)
and warm
extremities by
the end of 24
hours.
1. Administration of intravenous fluids such
as normal saline or ringers lactate.
Administer 500mls of either normal saline or
ringers lactate every 2 hours while
monitoring blood pressure. Encouraging the
patient to drink a lot of water if she is able to
take orally (Acheampong and Vincent 2015
pp.251).
Fluid administration
increases extracellular
fluid volume. Therefore,
cardiac output is
increased and blood
supply to tissues and
organs increases. When
hemodynamic is achieved
since carbon IV oxide in
the tissues is effectively
eliminates, the body
control system restores
the vital signs to normal.
Plod pressure increases,
pulse rate decreases and
with normal strength and
finally respiratory rate is
also lowered to normal
range of between 16 and
20 breaths per minute.
The patient will be
monitored closely
and vital signs
taken more
frequently. Blood
pressure should be
taken hourly no
determine any
changes or
improvement and
assess the need of
whether to
continue with the
interventions or
change the
intervention being
used. There should
be increase or rice
in blood pressure
during subsequent

assessments. Pulse
rate should be
taken every 15
minutes and every
30 minutes once
the patient has
shown good
progress. This is
because of risk of
heart attack and
shock. Patients
output especially
urine output
should also be
monitored to
examine patients
progress. If the
patient is
improving, then
the interventions
should be
2. Administer appropriate medication as
prescribed for example midodrin and
fludrocortisone (Kunziewicz et al 2017
pp.365-373).
Fludrocortisone helps in
rising blood pressure by
promoting sodium
retention by the kidney.
Sodium retention
increases water
reabsorption from the
distal convoluted tubule.
This increases fluid in
blood than the amount
lost through urine. It
does not have any anti-
inflammatory effect and
therefore it causes some
swelling that can
increase peripheral
resistance and finally
raise blood pressure.
Midodrine is also another
drug which is important
in raising blood pressure.