Nursing Case Study on Sepsis: Pathophysiology, Assessment, and Management

Running head: SEPSIS 1
Nursing Case Study
Student’s Name
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SEPSIS 2
Introduction
Mr.X is a 69-year-old male patient, admitted to the hospital with a history mild COPD
associated with coughing which had lasted for five days. The cough is characterized with yellow-
green sputum. Mr.X presented with complaints of pyrexia, poor appetite, rigors, increasing
breathing difficulties and mild chest pain secondary to sepsis. As per the patient, the cough and
fatigue started 5 days ago.
Shortly, the cough became productive with a yellow/green sputum and thereafter he
developed mild fever. Today, fever measurement was 1100F. He walked around his home
compound, he developed significant shortness of breath associated with minor exertion. Mr. X
recalls the development of cold-like symptoms a week before developing the cough and fatigue.
The productivity of Smith’s cough has increased progressively in the past two days. The
shortness of breath is aggravated by exertion and relieved by resting. Smith has been on albuterol
inhaler 2-3 times a day but he reports that it has minimally helped him.
Past Medical History
Mr.X has a positive history of COPD which he seems it to be mild and believed it is
treated with albuterol inhaler 2-3 times a week. He reports that he has had a treatment for
pneumonia and bronchitis with antibiotics almost every year. Mr.X has never been admitted for
pneumonia. He denies recent known sick contacts. He denies any swelling, weigh changes and
lower extremity pain. Additionally, Mr.X denies chest pain but admits chest tightness, shortness
of breath and increased heart rate when coughing.
Initial Observation and investigations

SEPSIS 3
Neurological observations revealed that Mr.X had an altered neurological status, was
confused and agitated with a Glasgow Comma Scale of 11/15. Cardiovascular observations
showed that he had hypotension with a blood pressure of 92/46mmHg, sinus tachycardia and a
heart rate of 136beats/minute. Respiratory observations indicated tachypnea with a respiration
rate of 34breaths per minute and reduced saturation while getting 6Litres of oxygen via Hudson
Mask. Metabolic observations showed that the patient was febrile with a temperature of 39.2
centigrade. Renal assessment revealed oliguria with a urine output of 20mls per hour and
indwelling catheter that had been inserted (Angus and Van der Poll, 2013).
Blood works for Mr.X revealed that he was suffering from hyperglycemia, hyperkalemia,
hypernatremia, poor creatinine, elevated levels of urea, low count of platelets and in increased
white blood cells. Arterial Blood Gas analysis was done and it revealed that Mr.X was having
both metabolic and respiratory acidosis. Finally, Mr.X was diagnosed with sepsis with a
complication of right middle lobe streptococcus pneumonia. Based on this, Mr.X needed to be
intubated and put on invasive ventilation support.
Pathophysiology of Sepsis
Sepsis refers to a dysregulated inflammatory response which is associated with severe
infection. The interchangeable definition of sepsis is Systemic Inflammatory Response syndrome
(SIRS) which results from a confirmed or suspected source of infections. The SIRS concept was
initially introduced by the American College of Chest Physicians (ACCP) and Society of Critical
Care Medicine (SCCM) in the year 1992. SIRS is characterized some of the following symptoms
(Angus and Van der Poll, 2013).

SEPSIS 4
These symptoms include: fever characterized by a temperature of more than 38 degrees,
hypothermia, tachypnea, tachycardia and partial pressure of arterial carbon dioxide (PaCO2)
below 32 mmHg. Additionally, there is a deranged count of white blood cells of more than
12,000/μL or below 4,000/μL. Associated with Smith’s manifestations, it is clearly evident that
he was experiencing sepsis. This is because Smith was febrile up to 39.2 degrees, had an
elevated respiratory rate of 34 breaths/minute, tachycardia with heart rate of 136 beats/minutes
and elevated level of leucocytes count of 14,000uL (Angus and Van der Poll, 2013).
These clinical manifestations are associated with the inflammation process in the body
which is often activated by the immune system of the body. Because of severe infection, many
proinflammatory mediators are in turn released in Extensive Tissue Damage and Serial
Inflammatory Reactions. Based on various reports, SIRS is associated with increased rate of
morbidity and mortality due to high occurrence of SIRS-induced Multiple Organ Dysfunction
Syndrome (MODS) (Angus and Van der Poll, 2013).
Pathophysiology of sepsis is complex and few important elements need to be addressed
and more emphasis put on them. These elements include inflammatory process, acute stress
response and cytokine storm. To begin with, Stress Response is considered as the acute phrase
reaction when the immune system of the body is making efforts to fight against pathogens or
threatening triggers. In other words, the triggers are described as “stresses”. Stress results from
events of daily life, physical illness and environmental factors. In Smith’s case, the stress
response is said to be triggered by infection (Angus and Van der Poll, 2013).