Analysis of Sepsis and Septic Shock Studies

This assignment requires an in-depth analysis of various studies related to sepsis and septic shock. The studies include a multicenter randomized control trial on polymyxin B hemoperfusion, a patient-level meta-analysis on early goal-directed therapy for septic shock, and an epidemiology study on severe sepsis and septic shock in intensive care units. Additionally, the assignment involves analyzing the clinical criteria for septic shock according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The analysis should provide a comprehensive understanding of the research findings and their implications for patient care.

SEPTIC SHOCK

Table of Contents
INTRODUCTION..........................................................................................................................1
MAIN BODY ..................................................................................................................................1
PART 1............................................................................................................................................1
1. Signs and symptoms leading to clinical deterioration.............................................................1
PART 2............................................................................................................................................2
2. Clinical care plan and nursing intervention............................................................................2
CONCLUSION................................................................................................................................4
REFERENCES................................................................................................................................5

INTRODUCTION
Septic shock can occur in a human as a result of infection and can cause substantial
changes in the body. The disease can be very dangerous and also possess a threat to life. It is
mainly faced by those individuals who have weak immune system. Report will include primary
pathophysiology of patient related to case study which shows that the service user is restless and
anxious. Also, medical record interprets that the patient is been suffering from hypotension.
Study is based on 33 year old man Jedda Merindah who has been suffering from acute myeloid
leukaemia and due to infection, it has been developed into septic-shock.
Essay will include signs and symptoms of clinical deterioration. It will also comprise
clinical care plan in order to improve condition of service user. Assignment will consist of
nursing interventions that will assist in analysing and addressing clinical priority. The main
objective of the report is to describe how nursing intervention can help in improving patient
outcome.
MAIN BODY
PART 1
1. Primary diagnosis of pathophysiology
Primary diagnosis
Medical record of Jedda Merindah shows that, he has been admitted to haematology unit
for hypotension. Patient has also been receiving chemotherapy for his acute myeloid leukaemia.
Moreover, he was taking Citalopram 10mg daily to treat his depression and has ones tried to
attempt suicide due to drug over dose in 2003. On assessment, he has observed by health-care
professionals as anxious and restless (Stilgenbauer et.al., (2016). ECG reveals symptoms of atrial
fibrillation (Shlush et.al., (2014). Blood pressure of patient has been analysed at 92/65mmHg
which is quiet low than normal. It interprets that service user is being suffering from
hypotension. Also, respiratory rate is recorded at 28 breathe per minute. A normal breath rate of
adult is 12-18 per minute which denotes that Jedda is also experiencing high respiratory rate
(Kirschbaum et.al., (2014).
Pathophysiology
The blood pathology of Jedda shows his haemoglobin rate is 89 g/l which is quiet low in
comparison to normal HB rate of adult man which should lie between 130-180 g/l. Low
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haemoglobin is one of the major cause for development of infection which further leads to
sepsis. Further, septic shock can also be one of the reason behind low haemoglobin in patient.
White blood cell count was recorded at 3.4 whereas normally it lies between 4-11. Low count of
WBC develop various bacterial infection in person's body. It can further develop into severe
chronic disease like septic shock. Urea has been noted at 11.2 and creatinine at 138 which
indicates renal problem (Hills et.al., 2014). Medical chart of Jedda shows albumin at 31 and
lower albumin is a sign of inflammatory disease such as septic shock. Potassium and sodium in
patient’s body is seemed to be normal. However, platelet count is at 114 which is very low in
comparison to normal that lies in between 150-300 (Bassetti, et.la., (2014).
Signs and symptoms of clinical deterioration
It can be analysed by the case study that high respiratory rate is one of the reason for
diminishing health of Jedda. It indicates tachypnea which results in hampering the wellness of an
individual. Restlessness in patient is also one of the sign of clinical deterioration. (Topp et.al.,
2015).
PART 2
2. Clinical care plan and nursing intervention
Septic shock is sepsis with chemotherapy that prevail after resurgence with intravenous
liquids. It points failure of physiological contraption of haemostasis resulting in infection which
further develops into severe sepsis and septic shock.
Clinical priority
The clinical priority set by nurses will be curing infection. (Ng et.al., 2016).
Rationale
It is marked as priority because it is one of the major cause of fluctuating pathology
results. It can make a service user more weak and restless. This can also weaken their immune
system.
Nursing care plan
Assessment of patient-
Physiological condition of service user has interpreted that he has been suffering from
leukaemia which has been further developed into infection. Jedda has been admitted to oncology
department for hypotension. Medical record of patient shows that he has also undergone
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chemotherapy and has high respiratory rate. Temperature of service user is recorded at 38.8
degree Celsius which indicates high fever (Apperley, 2015). Potassium and sodium balance is
appropriate. Peripheral capillary oxygen saturation is more than 95% which is also normal. Jedda
has low white blood cell which is the one of the reason behind developing septic shock. He also
suffered from Acute Rheumatic Fever during childhood which made his immune system quiet
weak. Thus, this is the major reason why Jedda is prone to developing infections (Leukemia care
at Mayo Clinic, 2018).
Patient is also suffering from respiratory problem like increase in breathing rate. Main
reason behind clinical deterioration of patient going through septic shock are high respiratory
rate and low count of white blood cells. Medical history shows that mild dilation of the left
ventricle indicates that ability to pump blood is lessened (Tabe & Konopleva, 2014).
Psychological condition of patient reveals that he is also suffering from depression and for this
he is in-taking medicine citalopram 10 mg on daily basis (Ishitsuka, & Tamura, 2014). Also,
Jedda has found to be anxious and restless in numerous situation which is not normal. Patient has
also tried to do suicide in past by overdosing drug Hypercholesterolemia – Atorvastatin 40mg
(Angus, et.al., (2015).
The nursing care plan is designed in response of particular needs which are identified
from the assessment. This plan aim at promoting the patient outcome and identifying the side
effects which can be occurred due to infection. This plan support patient by preparing them
physically and psychologically for medical aid. Also, aim at promoting physical and
psychological comfort and compliance (Singer, et.al., (2016).
Outcome of patient
The main objective of care providers will be removing of the infection which is
developing into septic shock. Nurses expect that the therapy given and care provided by them put
patient in a better condition. The main aim of intervention provided by nurses is to improve
patient’s health outcome. For this they will analyse and assess the service user conditions
properly. Nurses must have keen knowledge about the past medical history of patient and present
condition (Fabbri & Dalla-Favera, 2016). The clinical priority is to treat and cure infection which
has been developed after septic shock in order to improve the well-being of Jedda Merindahis.
For this health-care professionals will implement certain intervention that includes:
Nursing interventions
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Collaborative intervention
Interdisciplinary collaboration: The nurses should assure that patient who have
developed infection due to septic shock have full knowledge about it and is also comfortable
after undergoing treatment. The prehabilation related to septic-shock includes multi-disciplinary
approach which supports them in preparing patients for the challenges that can be faced during
treatment. At this point medications should be reviewed in order to get ensure optimisation and
adherence to medications. They should make sure that no vital signs of changes after chemo-
therapy has been faced by service user. Nurses have duty to make them understand about the
adverse side effects of chemotherapy and take steps to minimize these effects (Prost et.al.,
(2015).
Evaluation and assessment: From the intervention it has been evaluated that the physical
and psychological assessment which has been done at this stage can be beneficial to patients.
This can help them in improving their well-being (Shankar-Hari, et.al., (2016).
Evidence: It has been found that interdisciplinary collaboration has increased the strength
and ability of patient to overcome the disease. Also, care has been more effective because of
inclusion of multi-disciplinary team, so it can be said that intervention has been successful.
Nurse initiated intervention
Theory of preventive care- Nurses should be involved in providing emotional support to
patient who has been going through infection due to septic shock. The want which can be raised
at this time can include emotional support from nurses for dealing with distress. The oncology
department nurses are advised to keenly monitor and observe service user after they have
undergone treatment related to septic(Asfar, et.al., (2014). They should also encourage them to
have healthy diet and assess the adequacy of his nutrition intake. Health-care professionals must
direct Jedda Merindahis to have high fibre diet as it can help in making his immune system
strong (Asfar et.al., (2014).
Evaluation and assessment – It has been evaluated that supportive care can help health-
care professionals in better understanding the patient, their need and demands which has assisted
them in improving their outcomes.
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Evidence- After getting supportive care from nurses for curing infection, it has been
noted that they were better able to understand the patient needs. Thus, it can analysed that
intervention has been successful.
Pharmacological intervention
Therapy- There are several levels of infection. If Jedda is suffering from infection at low
level than oral therapy like macrolide or doxycycline can be given to him. At high level of
infection amoxycillin or amoxycillin/ potassium clavulanate or roxithromycin or doxycycline can
be provided to him.
Evaluation and assessment- It has been evaluated that providing therapy to patients can
help nurses in building relationship with patients which makes them better understand their
situation and provide effective care to service users. Also, it helps nurses in knowing cultural
values and beliefs of patient which makes their diagnosis more effective.
Evidence- Providing support in way of therapy has helped them in creating bond of trust
and honesty. This has improved the quality of care given by nurses. Hence, it can be interpreted
that intervention has been successful.
Rationale of interventions
The reason behind carrying these interventions include the main aim of improving the
patient condition and reducing the effect of infection. It can help them in knowing how effective
the treatment is. Also, these practices will support health-care professionals in improving the
quality of diagnosis provided by them (Roberts & Mullighan, (2015). At this stage, the health-
care professionals determine the progress towards patients well-being and the effectiveness of
the nursing care plan. It is the most important step in order to make sure that nurses intervention
which are implemented should be continued or terminated.
The has been analysed that the best intervention that has improved patient condition after
suffering from septic shock is interdisciplinary collaboration as it includes multi-disciplinary
team which provides acute care in treating infection.
CONCLUSION
From the entire report it has been summarised that Jedda was suffering from septic shock
which is one of the main reason for infection in her body. Also, the two vital symptoms of
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clinical deterioration were high respiratory rate and low count of white blood cells. Report also
includes nursing care plan about clinical priority which has been set up by nurses. It shows that
health-care professionals are firstly required to understand the patient pathophysiology that
includes all the psychological and physical condition of service user. Further, report also
includes nursing interventions which are provided to improve patients well-being.
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REFERENCES
Books and journals
Angus, D. C., Barnato, A. E., Bell, D., Bellomo, R., Chong, C. R., Coats, T. J., ... & Howe, B.
(2015). A systematic review and meta-analysis of early goal-directed therapy for septic
shock: the ARISE, ProCESS and ProMISe Investigators. Intensive care medicine.41(9).
1549-1560.
Asfar, P., Meziani, F., Hamel, J. F., Grelon, F., Megarbane, B., Anguel, N., ... & Legay, F.
(2014). High versus low blood-pressure target in patients with septic shock. New
England Journal of Medicine.370(17). 1583-1593..
Bassetti, M., Righi, E., Ansaldi, F., Merelli, M., Cecilia, T., De Pascale, G., ... & Trecarichi, E.
M. (2014). A multicenter study of septic shock due to candidemia: outcomes and
predictors of mortality. Intensive care medicine.40(6). 839-845.
De Backer, D., Orbegozo Cortes, D., Donadello, K., & Vincent, J. L. (2014). Pathophysiology of
microcirculatory dysfunction and the pathogenesis of septic shock. Virulence.5(1). 73-
79.
King, E. G., Bauzá, G. J., Mella, J. R., & Remick, D. G. (2014). Pathophysiologic mechanisms in
septic shock. Laboratory investigation.94(1).4.
Marik, P. E., Khangoora, V., Rivera, R., Hooper, M. H., & Catravas, J. (2017). Hydrocortisone,
vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a
retrospective before-after study. Chest.151(6).1229-1238.
Opal, S. M., & Van Der Poll, T. (2015). Endothelial barrier dysfunction in septic shock. Journal
of internal medicine.277(3). 277-293.
Payen, D. M., Guilhot, J., Launey, Y., Lukaszewicz, A. C., Kaaki, M., Veber, B., ... & Mimoz,
O. (2015). Early use of polymyxin B hemoperfusion in patients with septic shock due to
peritonitis: a multicenter randomized control trial. Intensive care medicine, 41(6), 975-
984.
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Prism Investigators. (2017). Early, goal-directed therapy for septic shock—a patient-level meta-
analysis. New England Journal of Medicine.376(23). 2223-2234.
Sadaka, F., Juarez, M., Naydenov, S., & O’brien, J. (2014). Fluid resuscitation in septic shock:
the effect of increasing fluid balance on mortality. Journal of intensive care
medicine. 29(4). 213-217.
Schlapbach, L. J., Straney, L., Alexander, J., MacLaren, G., Festa, M., Schibler, A., ... &
ANZICS Paediatric Study Group. (2015). Mortality related to invasive infections,
sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002–13:
a multicentre retrospective cohort study. The Lancet Infectious Diseases.15(1). 46-54.
Shankar-Hari, M., Phillips, G. S., Levy, M. L., Seymour, C. W., Liu, V. X., Deutschman, C.
S., ... & Singer, M. (2016). Developing a new definition and assessing new clinical
criteria for septic shock: for the Third International Consensus Definitions for Sepsis
and Septic Shock (Sepsis-3). Jama.315(8). 775-787.
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., ... &
Hotchkiss, R. S. (2016). The third international consensus definitions for sepsis and
septic shock (Sepsis-3). Jama.315(8).801-810.
Wong, H. R., Cvijanovich, N. Z., Anas, N., Allen, G. L., Thomas, N. J., Bigham, M. T., ... &
Shanley, T. P. (2015). Developing a clinically feasible personalized medicine approach
to pediatric septic shock. American journal of respiratory and critical care
medicine.191(3). 309-315.
Zhou, J., Qian, C., Zhao, M., Yu, X., Kang, Y., Ma, X., ... & Wu, D. (2014). Epidemiology and
outcome of severe sepsis and septic shock in intensive care units in mainland
China. PloS one. 9(9). e107181.
Online
PHARMACOLOGICAL INTERVENTIONS. (2018). [ONLINE] Available through:
<https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0042175/>
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