Nursing Interventions and Rationales for Sepsis in Surgical Patients

This report examines the pathophysiology of sepsis and outlines crucial nursing interventions for patients, using the case of Christopher Collins as an example. The report details the mechanisms of sepsis, including the inflammatory response and its impact on various bodily systems. It emphasizes the importance of early recognition and intervention, aligning with NSW policy guidelines. The interventions discussed include escalating to senior healthcare professionals, monitoring lactate levels, taking blood cultures, administering IV antibiotics and fluids, and monitoring urine output. Each intervention is thoroughly justified with rationales and supported by relevant research and guidelines, highlighting the significance of timely and appropriate care in managing sepsis and improving patient outcomes. The report stresses the importance of a holistic approach to sepsis management, encompassing assessment, intervention, and continuous monitoring.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Pathophysiology of sepsis:
Sepsis is a severe and debilitation clinical condition occurring due to contamination of
the surgical wound with microbes and initiation of inflammatory process at the site (Gotts and
Matthay 2016). It is mostly common in elderly patients. Local response includes phagocytosis of
the bacteria by macrophages and release off pro-inflammatory cytokines resulting in innate
immune response to the pathogen. It is also triggered by surgical procedures like trauma and if
this process is not balanced by homeostatic anti-inflammatory mechanisms, it has adverse effect
on integrity and repair of tissues nears the wound or surgical site (Mira et al. 2017). Hence, this
pathophysiological mechanism delays wound healing process.
Sepsis is associated with adverse effect on different parts of the body such as blood
pressure, heart rate and respiratory rate. During septic shock, adhrenergic hyporesponsiveness
increase leading to release of vasoactive agenets like nitric oxide. This has affect n the normal
redistribution of blood flow resulting in systemic hypotension and vasoplegia (Kato and Pinsky,
2015). Ventilatory abnormalities like increase in respiratory and heart rate are seen in patients
with sepsis because of increase in energy demand and metabolic demands. This occurs because
of inflammatory response (Prescott et al. 2016). This type of infection is seen in patients after
surgery because of immune-suppression and increase in non-specific inflammatory response
resulting in infection and tissue injury.
Intervention and rationale:
To provide appropriate intervention for sepsis patient Christopher Collins, review of
major problem for him is important. First problem for him is sepsis indicated by red, tight and
shiny skin near the wound site. The second problem for patient was intense pain at the incision

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site. The review of his A-G assessment data revealed low SpO2 values, high heart rate and poor
ABG value indicating risk of poor ventilation for Mr. Collins. Hence, intervention will focus on
addressing these problems for Mr. Christopher Collins. The following are the interventions that
will be implemented for treatment of sepsis:
1. Escalating the senior health professional: The first intervention that needs to be
implemented is to escalate and inform the senior professionals regarding the risk and
symptoms of sepsis. This intervention is relevant with NSW policy on preventing harm to
patient with sepsis as it mentions recognizing signs and symptoms of sepsis and
informing senior clinician as the first step towards sepsis prevention (NSW Government
2014). This intervention is important for Mr. Christopher Collins as the signs and
symptoms of sepsis (redness, swelling and pain), breathlessness, recent surgery and
nausea was found in patient. Hence, informing the senior health professional would help
to initiate treatment as per sepsis resuscitation guideline. Harley et al. (2019) gives
evidence regarding the responsibility of nurse to recognize patients with sepsis and
escalate it to a new medical officer as this ensures appreciation of clinical urgency.
2. Repeat lactate for patient: The sepsis management plan of NSW guideline mentions
monitoring lactate level 4 hours or 8 hours post recognition of sepsis (NSW Government
2014). This strategy is necessary for management of patients with sepsis because of
accumulation of lactic acid due to inadequate oxygenation and increase in by-products
like lactate. Serum lactate monitoring is beneficial in risk stratifying patients with sepsis
and facilitates aggressive early treatment. Regular monitoring of lactate at the bedside
decreases the time to administration of intravenous fluids in patients with sepsis (Rhee et
al. 2018).

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3. Take blood culture of patient: The next vital step for prevention and management of
sepsis as per NSW guidelines includes collecting blood culture of patient. This strategy
comes under the resuscitation stage of sepsis management (NSW Government 2014). The
main rationale behind taking blood culture of Mr. Christopher Collin is that it helps to
identify type of antibiotic therapy required for patients to control infection and
complication in patients. The advantage of blood culture test is that it helps to detect
types of infection in patient and ensures initiation of appropriate antibiotic therapy to
improve symptoms of surgical patient. The best practice is to take two sets of blood
culture from different site to increase the effectiveness of blood culture results (Levy,
Evans and Rhodes 2018).
4. Administer IV antibiotics: Administrating antibiotics comes under the ‘resuscitate’
strategy of NSW guidelines for sepsis management (NSW Government 2014). Antibiotic
therapy is most vital part of sepsis treatment as this has the potential to treat broad range
of pathogens like Streptococcus pneumonia and Staphylococcus aureus. The main
purpose of initiating antibiotic therapy is to prevent harmful effects and increase in
severity of sepsis. It is recommended that antibiotics should be administered within first
hour of recognition of severe sepsis as this therapy acts against all like pathogens and
enhance rate of survival for patients (Bernhard et al. 2014). There are many evidence that
shows that delay in every 1 hour of antibiotic administration is associated with reduction
in survival rate of patient (Vattanavanit, Buppodom and Khwannimit 2018; Bernhard et
al. 2014). Hence, providing antibiotic on time should be a clinical priority to promote
recovery and improvement in symptom of patient.

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5. Administer IV fluid to patient: The next intervention that needs to be provided to patients
like Christopher Collins with sepsis includes administration of IV fluids. The NSW
guideline for management of patent with sepsis encourages prompt administration of
antibiotics and resuscitation fluid (NSW Government 2014). The main rationale for
administration of fluids to patients with sepsis is that fluid can help maintain tissue
perfusion. The main issue found in patient with septic shock is that it leads to salt and
water overload. Hence, administration of fluid is effective in restoring intravascular
volume, increasing cardiac output, improving oxygen delivery and promoting tissue
oxygenation. By implementing this intervention for Mr. Collins, it can be associated with
corrections in hypovolemic states by augmenting cardiac output and improving oxygen
transport to cells (Malbrain et al., 2018).
6. Monitor urine output: According to the NSW guideline, it is necessary to reassess and
monitor patient regarding signs of deterioration. Monitoring urine output is a part of this
process and the goal is to assess whether urine output is less than 0.5 mL/kg/hour or not.
The benefit of urine output assessment is that it is an indicator of proper renal perfusion
and cardiac output and this is important for patient with severe sepsis or septic shock
because urine output significantly impairs renal function in patient (Schmidt et al. 2017).

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