Sepsis: Pathophysiology, Nursing Problems, SBAR, Treatment Analysis

This report provides a comprehensive overview of sepsis, a systemic response to infection, discussing its pathophysiology, which involves systemic inflammatory response syndrome (SIRS), and the progression to severe sepsis and septic shock. It explores the nursing problems associated with sepsis, such as interrupted nutrient and oxygen delivery, and the use of the SBAR tool for effective communication about a patient's condition. The report details the required treatments, including antibiotics and supportive measures, and emphasizes the importance of nursing care, such as maintaining dignity, monitoring vital signs, and ensuring accurate documentation. The analysis includes clinical findings, assessment, and recommendations for patient care, aligning with clinical guidelines and aiming to improve patient outcomes. The report also addresses the ABCDE assessment tool for identifying and prioritizing patient needs, highlighting the significance of early recognition and intervention in managing sepsis.

Sepsis exam

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Pathophysiology..........................................................................................................................1
Nursing problems........................................................................................................................2
SBAR..........................................................................................................................................2
Treatment....................................................................................................................................4
Nursing care................................................................................................................................5
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6

INTRODUCTION
Nursing is referred to as the collaborative care to the individual person who has been
going through any specific issue or problem. It is significant in the promotion of the health,
curing illness and live the best quality life. Sepsis is manifested two or more Systemic
Inflammatory Response Syndrome (Hackett and et.al., 2015). It tends to have high degree of
immune response associated with the bacterial infection. This study mainly focuses on the
carrying out the pathophysiology, nursing problem, SBAR, treatment and nursing care associated
with the sepsis.
MAIN BODY
Pathophysiology
Sepsis is referred to as the systematic response to the specific infection. It is however
manifested two or more Systemic Inflammatory Response Syndrome (SIRS). However, the SIRS
has been developed effectively with the key attempt in describing the clinical manifestation
which mainly results from systematic response related with the infection (Knight, and et.al J.,
2017). It eventually results in the injury or organ failure. However, the criteria of the SIRS is
considered to be met by examining the 4 clinical findings which mainly includes:
 The temperature of the body is higher than 38 degree Celsius and is lower than 36 degree
Celsius.
 The heart rate is considered to be higher than 90 beats per minute.
 The RR rate is more than 20 breaths per minute.
 The WBC count us more than 12000 per μL or lower than 4000 per μL.
However, the SIRS tends to occur when the infection is present or when the non- infective tends
to cause Burns or Trauma. The development of the severe sepsis in turn is mainly dependent
upon the severe sepsis which has been played by the coagulation and immune response related
with the infection. Both anti- inflammatory and pro-inflammatory response tends to play one of
the key significant role associated with the septic shock. It is considered to be as the life
threatening organ dysfunction which is dysregulated host response associated with the infection.
Septic shock is well-defined by continuing hypotension requiring vasopressors in order to uphold
a mean arterial pressure of 65 mmHg or higher. Moreover, a serum lactate level greater than 2
mmol/L despite adequate volume resuscitation (Tiwari, and Beriha, 2015). Activation of the
coagulation system is mainly linked with the consumption of the endogenous anticoagulants.
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Inflammatory mediators and anti- inflammatory mediators tends to play one of the crucial role
within sepsis. This eventually leads to the poor patient outcomes. Sepsis is considered to be as a
complex set of syndrome which eventually results in the activation of the variety of the systems.
In Sepsis the inflammation tends to start and the capillaries tends to leak fluid. The area tends to
become red and warm because of the dilated blood vessel. Moreover, the pathophysiology of the
sepsis also results in the activation associated with the host defence mechanism which leads to
influx of activated monocytes and neutrophils. This also results in the release of the
inflammatory mediators and also tends to activate inflammatory pathways. This also results in
the activation of the increased degree of endothelial permeability (Panigada and et.al., 2015).
The signs and symptoms associated with the sepsis are patches, discoloured skin, change within
the mental ability, decreased level of urination, problem in breathing, unconsciousness, abnormal
heart functions, low platelet count, fast heart rate, hyperventilation, disorientation, shortness of
breath or rapid breathing, hypothermia, chill because of the fall in the body temperature.
Bacterial infection is considered to be as the most common cause associated with the sepsis.
Nursing problems
The ability of the body to provide nutrients and oxygen to the cell is highly interrupted.
The heart tends to compensate by pumping at a faster rate. Hypotension tends to occur because
of the vasodilation. It also results in the increase in the cardiac output in order to maintain the
blood pressure. More carbon dioxide within the body (Park and et.al., 2016). There seems to be
decrease in the urine output. There seems to be deterioration in the mental health of the patient
and it also elevate the lactate level. One of the key significant problem which in turn has been
faced by the nursing at the time of treating Rochelle Benson is that, the pulse rate has been
increasing at a faster pace from 95 beats per minute at 8:30 am to 120 beats per minute at 9:30
am. Tachycardia states hypovolemia and also the necessity for intravascular fluid repletion.
However, an increased heart rate tends to persist in sepsis despite suitable fluid repletion.
Moreover, tachycardia and narrow pulse pressure are measured to as the earliest signs of sepsis
shock.
SBAR
Situation
I am a student nurse within the ward no. XXX. This study is associated with the patient
Rochelle Benson who is a 54 year and is in a surgical ward.
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Background
This study is based on the case of the Rochelle Benson who is a 54 year and is in a
surgical ward. She is 6 days post- operative who has been following a repair associated with the
ruptured duodenal ulcer (Itenov and et.al., 2018). Yesterday, Rochelle Benson has complained
that her wound were sore and upon inspection it has been found out that it was oozing and
inflamed. Further, a swab has been taken and has been presented in the micro- biology for the
sensitivity and culture. She has been feeling hot and unwell overnight. She has been received 1g
of Paracetamol at the 4 am in the morning. At the time of the clinical observation around 9:30
am she feels awful and has appeared to be flushed.
Assessment
The respiration breaths per minute on the 17th July 9:00 am was 22 and at 9:30 am was
24. The respiration breaths per minute on the 17th July at 8:30 am is around 20. However, as per
the septic shock news chart the SpO2 Scale 1 oxygen saturation percentage is 96 on 17th July at
8:30 am. At 9:00 am the SpO2 Scale 1 oxygen saturation percentage of Rochelle Benson was 94
and at 9:30 it was 93. The oxygen level of the Rochelle Benson is 2 at both 9:00 am and at 9:30
am. The device used was spec. The blood pressure of the Rochelle Benson was between 85- 120
mmHg at 8:30 on 17th July. Moreover, at 9:00 am the blood pressure was between 80-110 mmHg
and at 9:30 the blood pressure was between 70- 90 mmHg. The pulse rate of the Rochelle
Benson at 8:30 am was 95 beats per minute, at 9:00 am it was 105 beats per minute and at 9:30
am it was 120 beats per minute. The consciousness score for the Rochelle Benson was alert at all
the 3 intervals. The temperature of the Rochelle Benson at 8:30 am was 38 degree Celsius, at
9:00 am it was 38.5 degree Celsius and at 9: 30 am it was 39.0 degree Celsius. The news total in
turn has accounted for 1 at the 8:30 am. 8 for 9: am and 12 at 9:30 am for the 17th July. The
monitoring frequency for the Rochelle Benson was estimated to be 30 at both 8:30 am and 9:00
am. The escalation of care at 8:30 am was not provided. However, the escalation of care at 9:00
am and 9:30 am was provided to Rochelle Benson.
The total oral input by the Rochelle Benson are:
 The tea at 4: 00 am around 150 ml was given to the Rochelle Benson.
 The tea at 6: 00 am around 150 ml was given.
 The squash of 150 ml was given at 8: 00 am.
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However, the total oral input within Rochelle Benson amounts for 450 ml till 8:00 am in the
morning.
The hourly urine output at 4:00 am is 200 and at 6: am the hourly urine output is 100. The total
urine output till 6: 00 am is 300.
Recommendation
The Septic shock is considered to be as one of the key significant measure which is useful
in restoring the intravascular volume. It is important to increase the oxygen delivery to the
tissues. Developing weekly sepsis is significant in reviewing identification (Hwang and et.al.,
2018). It is crucial to provide the patient with the right kind of medication associated with the
Sepsis which tends to best suit the person.
Treatment
The health care practitioner must often focus on carrying out several set which is
significant in pinpointing the underlying infection. Antibiotics is considered to be as one of the
most effective measure which helps in significantly providing the best possible care to the patient
who has been suffering from Sepsis (McGill and et.al., 2016). The patient in turn is also required
to give the blood test samples which mainly includes evidence of infection, abnormal liver
function, impaired oxygen availability, electrolyte imbalances, clotting problems and abnormal
kidney function. The other laboratory tests like urine test, wound secretion test and respiratory
secretion test are considered to be of utmost importance. The health care practitioners will also
carry out magnetic resonance imaging, X ray, computerized tomography and ultrasound are
considered to be as one of the effective measure which helps in treating the patient with Sepsis.
The healthcare practitioner must focus on encouraging and reassuring deeper set of breathing.
There seems to be high degree of need for the intravascular access by significantly using ANTT
technique and also check the patency associated with the existing canula with the use of VIP
score. Taking wound swabs for the sensitivities and culture is of utmost importance. Another
effective treatment is associated with the ABG measure lactate and also focuses on effectively
measuring a urine output. It is considered to be highly crucial to take into account IV
Paracetamol or Opioid bolus which is significant for the breakthrough pain (Song and et.al.,
2018). Giving oxygen to the patient in order to keep the saturation above 94%. It is important to
take into consideration the blood cultures for the matter of sensitivities. It is crucial before giving
ABX to the patient.
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Nursing care
It is very crucial for the nursing practitioner to effectively ensure that dignity and privacy
has been maintained at all the times. The nursing care practitioner must in turn also focus on
continuing the level of oxygen which has been prescribed. It is very crucial to give mouth acre to
the patient on a timely and appropriate manner. It is significant for the nursing to effectively
focus on the catheter management in order to provide the best possible care and outcomes. It is
also significant to effectively maintain accurate fluid balance chart which is highly significant in
effectively examining the sepsis patient care. It is crucial for the nurses to make the patient
comfortable (Calvert and et.al., 2016). It is crucial to make an appropriate set of documentation
related with the care and medication. The IV drugs must be significantly checked by the 2
trained nurses. It is considered to be highly significant in continuously assessing the patient for
the improvement and also plan ahead and ensuring safe transfer. The care practitioner must also
focus on ensuring the fluid delivery services. Moreover, at the time of providing care to the
patient it is useful to effectively comply with the 5 rights associated with the drug administration.
This in turn mainly comprise of right drug, right patient, right dose, right time and right route.
CONCLUSION
From the conducted study it has been summarized that, Sepsis has high degree of immune
response associated with the bacterial infection. The signs and symptoms associated with the
sepsis are patches, discoloured skin, change within the mental ability, disorientation, shortness of
breath or rapid breathing, hypothermia, decreased level of urination, problem in breathing,
unconsciousness, abnormal heart functions, low platelet count, fast heart rate, hyperventilation,
chill because of the fall in the body temperature. The Septic shock is considered to be as one of
the key significant measure which is useful in restoring the intravascular volume. The health care
practitioners will also carry out magnetic resonance imaging, X ray, computerized tomography
and ultrasound with appropriate medication.
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REFERENCES
Books and Journals
Calvert, J.S and et.al., 2016. A computational approach to early sepsis detection. Computers in
biology and medicine, 74, pp.69-73.
Hackett, N.J and et.al., 2015. ASA class is a reliable independent predictor of medical
complications and mortality following surgery. International journal of surgery, 18, pp.184-190.
Hwang, S.Y and et.al., 2018. Low accuracy of positive qSOFA criteria for predicting 28-day
mortality in critically ill septic patients during the early period after emergency department
presentation. Annals of emergency medicine, 71(1), pp.1-9.
Itenov, T.S and et.al., 2018. Induced hypothermia in patients with septic shock and respiratory
failure (CASS): a randomised, controlled, open-label trial. The Lancet Respiratory
Medicine, 6(3), pp.183-192.
Knight, M and et.al J., 2017. Saving lives, improving mothers' care: lessons learned to inform
future maternity care from the UK and Ireland confidential enquiries into maternal deaths and
morbidity 2009-2012.
McGill, F and et.al., 2016. The UK joint specialist societies guideline on the diagnosis and
management of acute meningitis and meningococcal sepsis in immunocompetent adults. Journal
of Infection, 72(4), pp.405-438.
Panigada, M and et.al., 2015. Assessment of fibrinolysis in sepsis patients with urokinase
modified thromboelastography. PloS one, 10(8), p.e0136463.
Park, S.H and et.al., 2016. Immature platelet fraction in septic patients: clinical relevance of
immature platelet fraction is limited to the sensitive and accurate discrimination of septic patients
from non-septic patients, not to the discrimination of sepsis severity. Annals of laboratory
medicine, 36(1), pp.1-8.
Song and et.al., 2018. Performance of the quick Sequential (sepsis-related) Organ Failure
Assessment score as a prognostic tool in infected patients outside the intensive care unit: a
systematic review and meta-analysis. Critical Care, 22(1), p.28.
Tiwari, S. and Beriha, S.S., 2015. Pantoea species causing early onset neonatal sepsis: a case
report. Journal of medical case reports, 9(1), p.188.
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