SEPSIS: Case Study

SEPSIS: Case Study
Student Name
University Name
Student Note

Table of Contents
Introduction......................................................................................................................................3
Systematic assessment.....................................................................................................................3
CNS..............................................................................................................................................3
CVS..............................................................................................................................................3
RENAL........................................................................................................................................4
ABDOMINAL.............................................................................................................................4
RESPIRATORY..........................................................................................................................5
OTHER........................................................................................................................................5
Priorities of treatment......................................................................................................................6
Titrate oxygen to a saturation target of 94%...............................................................................6
Take blood cultures and consider source control........................................................................7
Administer empiric intravenous antibiotics.................................................................................7
Measure serial serum lactate........................................................................................................7
Start intravenous fluid resuscitation............................................................................................7
Commence accurate urine output measurement..........................................................................8
Discharge Planning..........................................................................................................................8
References......................................................................................................................................10

Introduction
Mr Paul Peters is a 45 year old man who was admitted in the emergency ward after
feeling unwell for four days. It was found that he acquired a wound in his left leg, two weeks
ago, while fishing. Upon wound examination, it was observed that the wound had swelled up to
release green exudate, indicating infection.
Systematic assessment
Considering the case of sepsis and sepsis shock, these two assessments are very necessary
in order to understand the effect and the degree of the infection that are of – Central nervous
system and Cardiovascular system. This will also help in the identification if the causative agent
and its source, which can help in removing the pathogen from the source and improve the overall
medical condition of the patient (McClelland and Moxon 2014).
CNS
Sepsis is often defined by acute brain disorder due to elevated disease and death rate. The
diagnosis of brain dysfunction in sepsis is primarily based on neurological testing and
neurological testing, such as electroencephalography (EEG) and neuroimaging. Sepsis-associated
encephalopathy (SAE) is the most common form of encephalopathy in ICU and is probably
sometimes misdiagnosed due to its variety of diseases (Sonneville et al. 2013). The brain plays a
key part in sepsis as it governs the immune response and functions as the process's sensitive goal
(Fang et al. 2011). EEG is one of the most delicate experimental methods used to identify SAE
and a precious instrument for clinical evaluation in the ICU. In general, CT and MRI pictures are
physiological, particularly in the earlier phases of encephalopathy (Gofton and Young 2012).
Currently, the therapy of sepsis-associated encephalopathy comprises primarily of overall sepsis
treatment and infuriating conditions prevention, along with metabolic disorders, substance
overdoses, anticholinergic drugs, withdrawal syndromes, and encephalopathy for Wernicke
(Molnar et al. 2018).
CVS
Sepsis is defined by organ dysfunction signs and manifestations that can result in deadly
results. Myocardial dysfunction in sepsis is caused by a complicated interplay that continues
incompletely known among several variables (Kakihana et al. 2016). Coagulatory pathway

endothelial activation and induction also lead to sepsis pathophysiology (Merx and Weber 2007).
Sepsis-induced cardiac dysfunction evaluated by echocardiography proved that MAPSE
assessment was a good indicator of mortality in combination with APACHE II. The
cardiovascular system and its dysfunction during sepsis have been researched in clinical and
basic research for more than 5 centuries as a significant organ system commonly impacted by
sepsis and always impacted by septic shock (Clemente et al. 2015). Calvin et al are the first to
show myocardial disease in properly volume-resuscitated septic individuals with reduced
ejection fraction and enhanced end-diastolic volume index using mobile radionuclide cine
angiography (Merx and Weber 2007).
RENAL
Renal assessment of the patient is very crucial, as it has been observed that acute renal
failure is a very common medical complication associated with sepsis and sepsis shock
(Rch.org.au, 2019). This renal assessment is done in order to identify whether the arterial
vasodilation along with the reduced systemic vascular resistance causes hypo-perfusion of the
kidneys leading to sepsis induced acute renal injury (Zarbock, Gomez and Kellum 2014).
Patients suspected to have acquired sepsis or suffering from a sepsis shock, have been observed
to have difficulty in maintaining their frequency of urination. Adults are required to undergo a
renal assessment where they are monitored to see whether they are able to pass urine within 18
hours. If, upon assessment, excessive Oliguria is detected, then it suggests that most amount of
the urine is detained in the bladder, which indicates post renal failure (De Vriese 2003). This
condition in adult males can result in the enlargement of prostate, which might raise the need for
a catheter to help monitor the fluid balance. However, it needs to be ensured that the insertion of
the catheter doesn’t result in any further induced infections. The most reliable biomarker for
acute renal failure in sepsis patients is the reduced production of creatinine, without any weight
changes, or modifications in extracellular fluid or haematocrit (Doi et al. 2009). Thus, the urine
assessment is done to check signs of dysuria, frequency of urination as well as the appearance of
the urine (Pollard, Edwin and Alaniz 2015).
ABDOMINAL
Sepsis patients are often checked for tenderness in the abdomen, as well as a pain
assessment is often included in the abdominal assessment process to determine the incidence of