Integrated Nursing Care of Sepsis Patient: Pathophysiology, Symptoms, and Evidence-Based Interventions

Case Study
Onyeka is a 27 year old
female of Nigerian heritage
suffering from Sepsis.
Evidence-based nursing intervention
The nursing staff for taking care of a sepsis patient should keep continuously assessing the patient's
symptoms like temperature changes, level of oxygen, respiratory and heart rate. The nurse should also assess
the patient's understanding of the disease and the treatment that has been prescribed to him for the condition.
Continuous assessment of the characteristics of the urine is also necessary in this case because here sepsis is
caused due to untreated UTI. The nursing intervention for the management of sepsis include:
Explaining sepsis : The nursing staff taking care of the patient should initiate with providing information
about sepsis and details about the complications linked with sepsis to the patient. The patient should also be
informed with the details about the mechanism of action of the antimicrobials and antibacterial prescribed by
the doctor and the side effects and interaction linked with the drugs. The nursing staff should also tell the
possibilities of mental dysfunctional effects like delusion and confusion. Nurse should acknowledge if she is
being anxious or frightened
Managing pain and irritation: The nurses should then take care of the pain and burning sensation in the
urinary tract that the patient is experiencing. Antispasmodics can be prescribed to the patient along with the
antibiotics to relieve him off the pain and the issue of bladder irritation. Analgesics can also be added to the
treatment regime the pain is unbearable. Also the patient should be provided with written information about
the medications.
Fluid intake: The nurses should explain the importance of fluid intake to the patient and should make sure
that the patient intakes liberal amounts of liquids and fluids so that the blood flow in the kidneys and the
urinary tract can be maintained. Proper maintenance of blood flow would ease out the flushing of the bacteria
out of the body through urine. For this the urine output should be monitored.
The patient should also be told about the sign of reoccurrence of sepsis and also about the psychological
impacts related to sepsis. The patient should also be provided with support for recovery from the condition by
providing her with leaflets and suggesting her to enrol in a support group.
For assessing the control of spread of sepsis in the body nurses should keep testing the blood and urine
samples, assess patient for haemodynamic stability, administer IV fluids with doses of corticosteroids and
vasopressors. Some other points that need to be taken care of are continuous monitoring of the CRP,WCC,
lactate and blood sugar levels as well. The oxygen and carbon dioxide levels in the blood should also be
monitored through arterial blood gas analysis.
As sepsis can result in organ damage, Bloods including FBC< U and E, LFT and clotting should be
monitored every half an hour to keep a check on organ function.
Pathophysiology and its relation to observed symptoms
Key symptoms
The patient's symptoms included dehydration, severe abdominal pain on a scale of 8 out of
10 and very dark and smelly urine and extremely low output of urine. On physical
examination her hands were found to be cold but her chest was warm to touch that is her body
temperature was elevated. She was also found to be hypoxic and tachypnoea was also noticed.
These all are symptoms of sepsis which are a result of her untreated UTI.
Pathophysiology
Sepsis is defined as a systemic inflammatory response which in this case was due to untreated
condition of UTI. The main access point for the bacteria to enter the urinary system is through
the urethra and then begins to replicate in the bladder. The bacteria then gets adhered to the
inner epithelium layer of the urinary tract and begin colonizing there resulting in activation of
immune response. This activation of the innate immunity of the host results in infiltration of
neutrophils and macrophages at the sites of infection. After infiltration of the neutrophils, they
begin to fight with the bacteria colonizing the tract which results in initiation of overwhelming
response of pro- inflammatory reaction and anti inflammatory reaction. The inflammation
results in vasodilation at the infection site and increased migration of phagocytes at the site.
Sepsis is resulted from the unregulated response of the body to the infection which then can
take form of systemic inflammatory response that is fatal for the patient. This is a result of
increased number WBCs in the body to fight the infection. Due to infection, the inflammatory
mediators cytokines are released in the body in large amounts leading to their massive
response. This massive response causes febrile responses in the body like increase in body
temperature, increases metabolic rate of the whole body resulting in hypoxia and tachypnoea
and use of accessory muscles. Cytokines can also cause haemodynamic collapse resulting in
low BP, tachycardia, low UO, peripheral low temperature and can even cause shock. The
hypoxia caused by increased release of cytokines can even lead to cerebral dysfunction which
is the reason for delusions and confusion. The above normal lactate level observed in her is
also due to anaerobic metabolism resulted from hypoxic condition in the body.
Research Evidence
AIM: To identify the nursing interventions in the determination, anticipation as well as mechanism of sepsis in
acute patients.
METHODOLOGY: This is a type of study that do not involve human beings but is a integrative review
which aims at providing more organized and wide-ranging analysis of the investigate the topic. This review is done
following six steps: identification and selection of the research question, deciding the inclusion and exclusion
criteria, classification of studies, evaluation of quality of trainings included in the review, results understanding and
presentation of the review of acquired knowledge.
FINDINGS: Potential relevant paper were found out of which nine were found to be eligible for inclusion
which were published in various years since 2013. out of the nine articles one of them was directed by a team
belonging to central medication while the rest eight were written or published under the name of nurses who aimed
at representing the relevancy of the theme with the society.
LIMITATION: There was not any major limitation to be identified. But there was a limitation that only one
database which is EBSCO database and one exploration engine that is google scholar was accessed and article in
English and Portuguese languages were selected.
How does this contribute to the existing body of knowledge?
The articles selected suggested that the management of sepsis is based on early detection of the condition. If the
nurses are able to detect the presence of sepsis in the patient, they can use their skills and training for the
management of sepsis. Professionals need to have clear knowledge of the medication and involvement of the
antibacterial and antimicrobials as a part of treatment regime so that they can pass on the knowledge to the patient.
Integrated care needs
A sepsis patient is prone to suffer from other issues as well because sepsis can even result in
multi organ failure therefore the patients requires integrated care. The patient should be kept
in close observation for detecting any further spread of sepsis as it can result in dead of the
patient as well. The nurses should carefully observe the symptoms of the patient .
As in the given case study the patient was catheterised therefore the nurses should ensure the
catheter being infection free to a possible extent. Also the nurse should keep assessing the
site of catheterisation for any further signs of infection. Before discharging, the patient
should be suggested to avoid practices that might be enjoyable for her but can have
damaging effect on her health. She should also be told not to over work and exhaust herself
and that she should maintain a healthy circadian rhythm and to avoid crying as well.
i
i
Academic Poster
Sepsis Patient
i