Evaluating and Managing Sepsis: Pathophysiology, Assessment, and Care

This report examines sepsis, a severe bloodstream infection often resulting from surgical procedures, focusing on its pathophysiology, nursing assessment, and treatment. It details the physiological processes involved, including inflammation, altered blood flow, and coagulopathy, which can lead to multiple organ failure. The report emphasizes the importance of early assessment, including both primary (ABCDE) and secondary examinations, to identify changes in vital signs and neurological status. It outlines comprehensive nursing care strategies, such as monitoring vital signs, managing fluid balance, and providing supportive care, with a focus on preventing complications and promoting patient recovery. The report also provides information on patient discharge instructions, ensuring continuity of care and patient education.

Running head: ASSESSING AND TREATING SEPSIS
Assessing and treating sepsis
Name of the Student
Name of the University
Author Note

1ASSESSING AND TREATING SEPSIS
Executive Summary:
Sepsis is a major blood stream infection occurs when the body fails to prevent a localized
infection within its source. The infective organisms then disperse in the blood stream thereby
causing sepsis. This condition involves inflammation, maldistributed blood flow and
coagulopathy followed by failure of multiple organs in the body. The patient after invasive
surgeries is more prone to this kind of infection. Thus, in providing proper treatment and
care, the nurse should assess the patient as early as possible whenever any changes in vital
signs are observed. In this report we will discuss the pathophysiology of sepsis in a patient
followed by nursing assessment and proper diagnosis.

2ASSESSING AND TREATING SEPSIS
Table of Contents
Introduction:...............................................................................................................................3
Pathophysiology of sepsis:.........................................................................................................3
Assessment of the patient:..........................................................................................................4
The primary examination:......................................................................................................5
The secondary examination:..................................................................................................7
Nursing care:..............................................................................................................................9
Patient discharge:.....................................................................................................................11
Conclusion:..............................................................................................................................11
References:...............................................................................................................................13

3ASSESSING AND TREATING SEPSIS
Introduction:
A patient named Mrs. Bery Hayes who underwent laparoscopic cholecystectomy was
deteriorating after three days of the surgery. She was diagnosed with sepsis, which could be
due to the invasive surgery she underwent during the laparoscopy. Thus in this following
report, the pathophysiology of her clinical condition, sepsis will be discussed along with
patient assessment and required nursing care followed by proper guidance to the patient
during her discharge.
Pathophysiology of sepsis:
Sepsis is a bloodstream infection with an estimated 750,000 cases every year and the
incidental rate increasing to date rates reaching to 85% in which more than four organ
functions fail (Bratzler et al. 2013). In understanding the body response to sepsis, the
pathophysiology of the condition should be reviewed. Whenever the body fails to restrict a
localized infection within its source, the infective organisms disperse in the blood stream
thereby causing sepsis condition (Mehta et al. 2014). This condition involves inflammation,
maldistributed blood flow and coagulopathy. Therefore the dispersed organism or antigen in
the blood releases toxic endotoxin which is linked with gram-negative bacteria. The immune
system in response releases mediators for proinflammation such as cytokines in the blood
circulation (Kamel and Iadecola 2012). The cytokines released by the white blood cells
responding to endotoxins, causes the vasodilation, increased permeability of capillaries along
with increase in coagulation (Boisrame-Helms et al. 2013). The patient condition with sepsis
in involves uncontrolled healing caused by increased release of immunemodulators
stimulated by endotoxins resulting in exaggeration (Neviere Parsons and Finlay 2016).
Vasodilatation is a body response to increase the blood flow towards the affected area by
transporting more amounts of white blood cells to control the infection (Rajendran et al.

4ASSESSING AND TREATING SEPSIS
2013). But due to disproportionate blood volume during vasodilatation causes hypotension
(Prowle and Bellomo 2015). Increase in the permeability of the capillaries causes the leaking
of fluid into the surrounding tissue from the blood stream leading to edema which further
decreases the blood pressure (Oakley and Tharakan 2014). Consecutively, fibrinolysis is
disrupted causing in decreased clot breakdown which occurs due to body response in antigen
confining. Thus the fibrin clots formed causes microthrombi leading to tissue hypoperfusion
and necrosis resulting in organ failure (Levi et al. 2012).
In this case, the patient during admission showed temperature 36.5, pulse 82,
respiratory rate 18, blood pressure 165/95 with oxygen saturation 98% with 130kg weight. 3
days of her surgery she was not recovering fully and the nurse after assessment found
changes in her vital signs showing increase in temperature to 37.7, pulse to 125, respiratory
rate also increased to 26 causing hyperventilation, and decrease in blood pressure to 110/60
with reduced saturation to 92%. The patient undergoing invasive surgeries can develop
microorganism within their body causing sepsis as in this case. Extreme age causes weak
immune system leading to immunosupression (Dellinger et al. 2013). The clinical
manifestations in sepsis are recorded with decrease in blood pressure causing hypotension
and decreased oxygen saturation. The decrease in oxygen saturation causes the heart to beat
faster thereby increasing the pulse rate. The temperature can either rise or decrease. All these
signs and symptoms were noted in the patient who correlated with the diagnosis of sepsis as
she had recently undergone laparoscopic cholecystectomy.
Assessment of the patient:
Assessment of the patient is one of the major and primary responsibilities of the
nurses which should be carried out with preciseness and diligence. The patient who
underwent a recent laparoscopic surgery showed altered vital signs after 3 days. Thus in order

5ASSESSING AND TREATING SEPSIS
to properly diagnose the condition; the nurses should perform immediate assessment in order
to start the treatment. The assessment will be done by health assessment framework
comprising two components such as the primary examination and the secondary examination.
The primary examination:
This examination involves assessing the general physical condition of the patient
through ABCDE (ie that is airway, breathing, circulation, disability and exposure assessment)
along with examining the mental status. The patient with serious infection is observed with
flushed, toxic and acutely ill appearance (Adam Odell and Welch 2013).
Table 1: Primary survey of the patient diagnosed with sepsis
Assessment parameters Procedure Relevant data
Airway (A) The airway passage should be
examined to confirm whether it
is secure and patent. This will
be done by listening the flow of
air, observing the rise and fall
of the chest (Baker 2016)
Breathing (B) The breathing pattern should be
examined by observing the rise
and fall of the chest and the
patient’s skin should be
observed carefully for any signs
of pale or gray colour with
mottled skin which are caused
by the poor perfusion of the
tissues that occurs usually in
septic shock (THOMAS MAIN
The saturation rate of the
oxygen should be recorded
which gets lowered in sepsis.
The tidal volume along with the
rate of respiration that increases
in order to compensate the
oxygen deficiency should also
be checked and recorded
(Esmond 2013).

6ASSESSING AND TREATING SEPSIS
MAXWELL and KEILTY
2016)
Circulation (C) The blood circulation should be
examined in order to report that
the patient is having adequate
circulation. This will be done by
checking the pulse rate and
assessing the pulse strength.
The skin colour of the patient
will also be observed minutely
to check any pale or grayish
colouration caused due to
reduced flow of blood
(Antonelli et al. 2013).
Heart rate should be recorded
that increases in sepsis causing
tachycardia, noted as a common
feature during sepsis and
indicates a response to stress
indicating a response to stress.
This is usually common
indicating pulmonary
dysfunction reported in
pneumonia and acute
respiratory disorders which
increases the mortality rates in
sepsis (Morelli et al. 2013). The
toxic endotoxins stimulate the
centre of medullar ventilation
causing increased respiratory
rate to compensate the
metabolic acidosis followed by
shortened breath and mild
anxious (Ellis Calne and
Watson 2016)
Disability (D) The patient’s level of
consciousness should be
checked in order to check any
disorientation in the patient
which is a common symptom in

7ASSESSING AND TREATING SEPSIS
old people (Oxman Schnurr and
Silberfarb 2014)
Exposure (E) The surrounding of the patient
should be checked in order to
identify any exposures along
with maintain and preserving
the dignity of the patient
(Grindrod 2012)
The secondary examination:
The Secondary examination is done assessing the function of every system of the body
individually from head to toe. Early identification of any issues can be enabled by assessing
all the system of the body in order to provide appropriate intervention to prevent further
complications.
a. Neurological assessment: The neurological assessment is done performing the Glasgow
Coma Score (GCS), a tool used for assessing conscious level related to responses such as
arousal and verbal/physical in the patient (Maldonado 2017). Sedatives or muscle relaxants
administration should be checked as this influences the GCS accuracy (Couchman et al.
2007). If she was ventilated, then a more advanced tool should be used along with GCS in
communicating with her nonverbally such as by using letter boards, mouthing words, note
writings. The pupil size along with the reaction should also be accessed as a part for this
assessment (Morgan and Wood 2012.). This done as the mental status of the patients
deteriorates in this condition.
b. Assessing the cardiovascular system: This assessment should be done to determine the
adequacy of the cardiac output and the complications associated with it (Dellinger et al.

8ASSESSING AND TREATING SEPSIS
2013). This is done by recording the heart rate, pressure of central venous system, blood
pressure, urine output, peripheral perfusion and chest X-ray along with analysing the serum
electrolytes. Blood test should be performed to monitor the haemoglobin count as anaemia
can impact the oxygen carrying capacity of the patient (Holst et al. 2013). Conservation of
blood should be warranted in order to prevent anaemia. The cardiac studies will be carried out
by Electrocardiography (ECG) to report any acute myocardial infarction (Kolder Tanck and
Bezzina 2012). The nurses conduct this as the blood pressure is reduced causing hypotension
due to vasodilation and the heart rate increases to compensate the oxygen need (Rosendorff et
al. 2015).
c. Gastrointestinal assessment: The status of the nutrition is a major part of the assessment
and proper care (Volkert 2013). During this condition the intake capacity of the patient is
reduced due to presence of any sedation (Couchman et al. 2007). The symptoms are followed
by abdominal distension, rebound and localized tenderness along with rectal tenderness and
swelling (Budhram and Bengiamin 2014). To combat this situation the nurse should follow a
build up feeding protocol in which the feeding pattern and absorption is monitored closely.
The feeding rate should be increased by incorporating prokinetics for better results.
Ultrasonography of the abdomen can be done if obstruction in bile tract is suspected (Sarkaria
et al. 2013).
d. Assessment of metabolic system: The body temperature should be monitored as an
increased temperature points out the response of patient to the infection (Young et al. 2012).
Along with this, the count of the white blood cells, procalcitonin (PCT) levels and C-reactive
protein (CRP), IL-6 should be measured to detect the response to infection (Lee 2013.).
e. Urine output assessment: Reduced cardiac output lowers the urine output caused by the
neural and hormone mechanism such as by the secretion of the antidiuretic hormone and

9ASSESSING AND TREATING SEPSIS
rennin-angiotensin-aldosterone system activation (Cheuvront and Kenefick 2014). This is
done because the water is conserved by the body in response to inflammation thereby
reducing the urine content (Langley et al. 2013).
All these primary and secondary examination should be done in order to diagnose the
condition and provide further treatment for recovering the condition the patient is going
through.
Nursing care:
Sepsis can result either from cholysistitis, a condition of inflammation of gall bladder
or from cholecystectomy, surgical removal of the gall bladder.
The factors that are responsible for sepsis are the exposure of the patient to the
bacteria and unsterile operation room. These unsterile surrounding lead to the nosocomial
infection followed by sepsis (Mossie 2013). Once the operated part is exposed to the unclean
surrounding of the operation room or the hospital premises, the microorganisms get the
opportunity to invade the bloodstream and multiply. The increased number of the pathogens
triggers the pro-inflammatory mediators which in turn activates the immune system of the
body. The sepsis condition of the patient is influenced by the triggered cytokines. The
activation of the interleukin 4-10, cytokines, bradykinin and others results in the feedback
mechanism.
This affects both the cardiac system by dilating the arteries and the arterioles causing
the lungs to be filled with fluids (Bhan et al. 2016). The alveoli get collapsed and lose the
capability of gas exchange. Lung failure occurs followed by heart failure due to hypoxia of
blood resulting to death.

10ASSESSING AND TREATING SEPSIS
Sepsis also results in the loss of function of nephrons leading to acute renal failure.
This decrease the supply of blood to the brain and dysfunction of the brain occurs due to
hypoxia. This makes the patient to be in coma.
The diagnosis of the septic condition can be done by complete blood (CBC) count
which may show abnormal blood cell count, bacterial cultures in the blood sample, studying
urine samples. Biomarkers such as procalcitonin and presepsin may be used to detect early
septic condition (Endo et al. 2014). Chest radiograph, electrocardiography and abdominal
ultrasonography to diagnose any obstruction in the biliary tract may be done. Thoracentesis
and paracentesis may also be adopted to diagnose sepsis.
The patient with sepsis is recommended to undergo fluid resuscitation which is the
most effective way of treatment. Fluid boluses of crystalloid (a volume of 500 mL) is
administered repeatedly proves to be an effective measure in correcting hypotension. Normal
saline and albumin should also be given in order to control the septic condition.
Effective IV antimicrobials are immediately administered to the patient diagnosed
with the symptoms of sepsis. Intravenous broad spectrum antibiotics are given to the patient.
Procalcitonin is used to monitor the antimicrobial drugs (Wacker et al. 2013). Procalcitonin
monitoring helps to reduce the length the treatment duration. The reduction or the termination
of the treatment can be suggested by the procalcitonin monitoring of the antimicrobial drug.
Patient discharge:
Sepsis is one of the most vital problems faced by the patient. The discharge of the
patients suffering from sepsis needs special care (Ortego et al. 2015). The strategies for the
prevention of septic shock should be explained by the nurse to the patient. The patient’s
family should also be taught to identify the symptoms of the sepsis that may relapse after

11ASSESSING AND TREATING SEPSIS
discharge. The treatment modalities like the administration of drugs during emergency, skin
care, ambulation and IV therapy should be explained to the patient’s family.
It is the duty of the nurse to maintain hygiene of the patient. The nurse should
regularly monitor the blood glucose level and administer insulin (Drahnak et al. 2016). The
vital signs of the patient is monitored by the in every hour, administer medicines and control
the dips. It is the duty of the nurse to make the patient comfortable by giving him fentanyl
and midazolam. Oral care, endotracheal tube care and suction also become the part of the
care a nurse needs to carry out. The nurse should also make the patient aware of the care that
he should take after his discharge.
It is the duty of the nurse to arrange a referral for the patient after her discharge. The
nurse should provide the personal information of the patient and request to the healthcare
organization to provide on behalf of the patient.
Conclusion:
From the above report it can be concluded that sepsis is the infection of the caused by
the presence of harmful bacteria and their toxins in the wound of an individual. The above
discussion states the pathway, diagnosis and treatment of the patient which requires special
care. Thus to conclude, by the extensive care of the nurse the septic condition can be treated.
References:
Adam, S., Odell, M. and Welch, J., 2013. Rapid assessment of the acutely ill patient. John
Wiley & Sons.