Comprehensive Sepsis Case Study: Assessment, Treatment, and Management

This case study examines the case of Mr. Paul Peters, a 45-year-old patient admitted to the emergency department with symptoms suggestive of sepsis. The study provides a detailed assessment of the patient's condition, including CNS, CVS, respiratory, abdominal, and renal evaluations, as well as wound assessment. It outlines the priorities of treatment, emphasizing respiratory stabilization, fluid resuscitation, and vasopressor therapy. The assignment delves into the importance of laboratory and radiographic studies, including blood counts, metabolic panels, and blood cultures. It also discusses antibiotic therapy, vasopressor therapy, and the use of the qSOFA score for early detection of sepsis. The study concludes with a focus on the reassessment of hemodynamics and discharge planning, providing a comprehensive overview of the management of sepsis. The assignment also uses Harvard referencing style.

Running head: SEPSIS CASE STUDY
SEPSIS CASE STUDY
Name of the Student
Name of the University
Author’s Note:

1SEPSIS CASE STUDY
Introduction:
In this case study, the medical condition of Mr. Paul Peters will be discussed who is a 45-
year-old. He was admitted in the emergency department of the hospital after feeling not well four
days at home. He has a wound in his left leg which secretes green exudate and has been
inflamed.
Systemic Patient Assessment:
CNS:
The CNS assessment would be conducted so as to evaluate the neurological functions of
the patient. The neurological evaluation is broadly classified under seven aspects that include,
mental state evaluation, cranial nerve assessment, evaluating reflexes and the sensory system as
well as assessing coordination, station and gait. The level of consciousness would be assessed
with the help of the Glasgow Coma Scale. The provided patient information suggests that the
GCS reading of the patient was reported to be 15. As per Urden et al. (2017), the GCS reading is
measured in between the range of 3 to 15, where 3 indicates the worse level of consciousness and
15 indicates the normal level of consciousness marked by the parameters of best eye, verbal and
motor response.
The MSE evaluation would help to assess the memory and orientation of the patient.
Next, gait would be assessed by evaluating the body posture, symmetry of the limb, length,
rhythm and speed of the steps as well as steadiness and turns. This would be followed by
assessing the pupil shape, size and sensitivity towards light. Next, the finger tapping and toe
tapping assessments would help to detect the proper functioning and coordination of the

2SEPSIS CASE STUDY
corticospinal as well as extrapyramidal tract (Urden et al. 2017). Finally, the level of sensation
would be assessed using the superficial sensation test and the deep sensation test.
CVS:
The cardiovascular assessment takes into consideration the evaluation of heart sound,
pulse, extremity and capillary refill time, presence of oedema or cyanosis (Lewis et al. 2016).
The documental vital signs mention the heart rate to be equivalent to 120. As per Lewis et al.
(2016), the normal heart range for an adult patient is expected to be in between the range of 60 to
100 beats per minute, the heart rate of 124 suggests that the patient is tachycardiac.
Respiratory Assessment:
The respiratory assessment takes into consideration the assessment of breath sounds,
breathing pattern, cough, type of sputum, agonal breathing, gasps, shallow or laboured
respirations, existing retractions, dyspnea on exertion and asymmetrical chest rise. On the basis
of the documented vital signs, the respiratory rate of the patient has been recorded to be
equivalent to 24. Research studies mention the normal range of respiratory rate to be in between
12 to 20 breaths per minute (Lewis et al. 2016). The patient’s recorded RR is equivalent to 24
which states that the normal respiratory process of the patient is disrupted.
Abdominal Assessment:
The abdominal assessment of the patient includes assessing the abdomen of the patient
for detecting any signs of abnormality. The abdominal assessment critically includes the four
stages of inspection, auscultation, percussion and palpation. Inspection includes the general
examination of the abdomen and auscultation includes the use of stethoscope to examine the

3SEPSIS CASE STUDY
abdomen. The next stage includes percussion of the abdomen for the detection of any
abnormality in the form of dull sound and the last step includes palpating the abdomen for the
detection of any sort of pain (Urden et al. 2017). On the basis of the assessment results, the
patient might be referred to specific tests for the confirmation of any disorder. The provided
patient information does not offer any detail on the abdominal assessment and therefore no
details can be provided in this context.
Renal:
Research studies suggest that the gold standard for the assessment of renal function is the
evaluation of the Glomerular Filtration Rate. The measurement of the GFR rate helps to estimate
the normal renal functioning of the patient who have high level of serum creatinine concentration
in the blood. In addition to this, the estimation of the GFR rate also help to assess patients who
might be suffering from a renal impairment or an adverse drug reaction caused by lithium, an
anti-inflammatory drug or angiotensin converting enzyme inhibitors. The normal range of the
Glomerular Filtration Rate is expected to be in between the range of 80 to 120 ml/min (Artioli et
al. 2017). The provided patient information does not mention any particulars about the
glomerular filtration rate of the patient, therefore, no information can be mentioned about the
normal renal function of the patient.
Other:
It is integral to note in this context that the provided case scenario mentions that the
patient has sustained a wound on his left leg for two weeks. Therefore, conducting a wound
assessment would be important so as to obtain a clear overview about the wound recovery status
and accordingly implement appropriate medical interventions that can facilitate an accelerated

4SEPSIS CASE STUDY
recovery. While conducting the wound assessment a total of 11 factors would be taken into
consideration. The factors would comprise of assessing the type of wound, determining the
aetiology, assessing the location and surrounding skin around the wound, evaluation of tissue
loss, estimating the clinical appearance of the wound bed and the stage of healing (Benbow
2016). In addition to this, other parameters such as the measurement and dimensions of the
wound along with wound edge, exudate and presence of infection, pain and previous wound
management would also be evaluate to plan an appropriate intervention for the recovery of
wound (Benbow 2016).
Priorities of Treatment:
Early sepsis management needs respiratory stabilization. All patients should be provided
with additional oxygen. Mechanical ventilation is suggested if additional oxygen does not
enhance oxygenation, is immediate cardiac failure, or is not capable of protecting the airway.
After respiratory stability perfusion is evaluated. Hypotension means insufficient infusion of
tissue. Hypoperfusion clinical signs include altered mental state, cold or clammy skin, anuria or
oliguria, and acidosis of the lactic acid (Gauer 2013). After early respiratory stability of the
patient, fluid resuscitation, vasopressor therapy, identification and management of infections,
timely administration of antibiotics, and elimination and drainage of infection are included in the
priorities of the treatment (Gauer 2013). These priorities of the treatments are discussed in the
section below.
Initial Fluid Resuscitation:
In early sepsis, the vascular access and fluid resuscitation are the most important
elements. Hypovolemia, hypoperfusion and myocardial depression lead to hypotension, the most

5SEPSIS CASE STUDY
significant event in patients with sepsis that causes greater morbidity and mortality. When sepsis
is acknowledged, intravenous fluid should instantly be launched (Kelm et al. 2015). Delay in
fluid recovery may make the tissue hypoxia worse, leading to dysfunction of several organs.
Isotonic crystalloid is the most widely used resuscitative liquid but there were no variations in
pulmonary edema, death, or hospitalization relative to isotonic crystalloid when colloid fluids
were employed. Within the first three hours patient with confirmed or suspected sepsis or septic
associated hypo-perfusion, nurses should administer 30 mL / kg crystalloids (Kelm et al. 2015).
In contrast to colloids, such as albumin or hetastarch, crystalloid is an IV fluid that has a
balanced electrolyte structure such as saline or lactated ringer solution (Hershey and Kahn 2017).
The nurse has a crucial role to play in monitoring appropriate fluid administration when patients
have been diagnosed with sepsis (ED on floor, floor to ICU) as the patient transitions between
the levels of care (Hershey and Kahn 2017).
Laboratory and Radiographic Studies:
Suggested blood counts with differential, fundamental metabolic panel, lactate and liver
enzyme level measurement, coagulation and urinalysis are recommended. The assessment should
be done with chest x-ray and blood gas arterial tests for hypoxemia and acid-base abnormalities
to evaluate suspected respiratory influences (Khwannimit and Bhurayanontachai 2015). If
intravascular coagulation is predicted, fibrin degradation products, dimer concentrations and
concentrations of fibrinogen should be measured. Blood cultures should be collected (two
peripheral catheters, each with an inhabited catheter), from urine culture, stool culture (for
diarrhea or latest antibiotic use), sputum, skin culture and culture of soft tissue (Khwannimit and
Bhurayanontachai 2015). Nurses should get two or more sets of blood cultures before antibiotic
administration; at least one set should be peripheral and, where current, a vascular access device.

6SEPSIS CASE STUDY
Bacteremia is prevalent in patients with sepsis; before antibiotics are given, culture collection
provides us with the greatest opportunity to detect the right organism before antibiotics can
influence pathogen development (Mayr et al. 2017). In two distinct bottles, one anaerobic bottle
and one aerobic culture bottle, a' set' of blood cultures should be gathered.
Antibiotic therapy:
The enhanced clinical results are linked to early suitable antibiotic therapy. In septic
shock, the beginning of antibiotic treatment is increased in 1 hour; with each hour of antibiotics
treatment, survival reduces by about 8 percent (Ferrer et al. 2014). Consensus guidelines suggest
antibiotics treatment within one hour of the suspected sepsis. The most probable source, clinical
context (population versus hospital-acquired sepsis latest use of antibiotics and local resistance
patterns should be based on empiric antibiotics treatment. Administration of broad -
spectrum (covers gram-positive and gram negative organisms) antibiotics should be conducted
for a single hour after the diagnosis or in case with suspected clinical suspicion for sepsis (Ferrer
et al. 2014). The control of the source of the disease with or without the use of antibiotics or
intervention to treat these diseases is the basis for treating patients with septic or septic shock
(Singer et al. 2016). If the source of infection does not control, sepsis or septic shock will persist
or worsen, and your patient can not be stabilized.
Vasopressor Therapy:
Support for vasopressor when the administration of intravenous fluid does not restore
appropriate mean blood pressure and organ infusion is suggested. The median blood pressure
should be kept above 65 mm Hg. The primary vasopressor agents suggested to treat septic shock
are dopamine and norepinephrine (Marik et al. 2017). Give vasoactive drugs if the patient stays
hypotensive or if after the original fluid challenge lactate stays high. A medium arterial pressure

7SEPSIS CASE STUDY
(MAP) of > 65 mmHg should be maintained while administrating vasoactive medicines. The
first vasopressor that is usually introduced is Norepinephrine (Levophed) (Gordon et al. 2016).
The starting point is typically 2-5 mcg / min and a MAP greater than 65mmHg. Typically,
vasopressin is the second vasoactive drug added at 0.03 rpm. This drug was not titrated and can
be added to reduce norepinephrine dose (Gordon et al. 2016).
Quick sequential organ failure assessment (qSOFA):
The nurses should use the quick sequential organ failure assessment (qSOFA) to detect
patients at risk for medically decayed patients and organ dysfunction related to sepsis in this
situation. Further assessment should be carried out quickly if two qSOFA criteria are present
(April et al. 2017). In this situation the breath frequency of the patients > 22 breaths / min and
the blood pressure systolic of 100 mmHg or lower (Williams et al. 2017). The nurses should
therefore be worried about sepsis. Whenever necessary, it is essential to understand the basis of
your patient. Other variables that might influence the qSOFA score are dementia, low SBP
or systolic blood pressure (Williams et al. 2017). Nurses should be conscious of these factors.
Reassessment of hemodynamics:
It is essential to revalue hemodynamics, volume status and tissue perfusion frequently in
the treatment of a patient with sepsis. Blood pressure, heart rate, breathing rate, temperature,
urine production, and oxygen saturation should commonly be reviewed by nurses (Ranjit et al.
2014). In order to evaluate fluid reactivity, dynamic measures such as passive leg increase (PLR)
are suggested. The PLR simulates an expansion in the endogenous quantity (equivalent to about
300 mL of the bolus liquid) and can be seen as a challenge before loading (Saugel et al. 2015). It
is used to predict if an extra liquid bolus is responded by a patient.

8SEPSIS CASE STUDY
Discharge Planning:
Discharge plan for the patient in this case will include the following parameters:
Prevention of infection: the patient should have to take special care in order prevent of further
infection by washing hands with soap and water. Hygiene should be maintained around the area
of infection.
Management: The patient has to take medicine and have to know about his medicine as he lives
alone. Therefore, health literacy will be provided to him before discharging him from the
hospitals (Donnelly et al. 2015).
Diet, Exercise, and Other Lifestyle Changes: Patient has to change his diet and have to take
nutritious food like fresh fruit to heal the sepsis quickly. He has to limit his beer consumption
and number cigarettes per day. In addition to this, he also has to control his body weight. The
patient should also rest a lot while you recover in addition to a healthy diet. Every night, he
should attempt to sleep for at least 7 to 9 hours (Jones et al. 2015).
Appointments: As the patient is admittedly having trouble reading (only Grade 7 of primary
school pass), a periodic check up will be set up so that patient current conditions can be
evaluated.
Contact the health care provider if: Chills or sweats, Fever higher than 38.6° C, Nausea or
vomiting, Body aches, Dizziness, Fast heartbeat, Confusion, or fainting (Prescott and Angus
2018).

9SEPSIS CASE STUDY
References:
April M D, Aguirre J, Tannenbaum L I, Moore T, Pingree A, Thaxton R E, Sessions D J and
Lantry J H 2017 Sepsis clinical criteria in emergency department patients admitted to an
intensive care unit: an external validation study of quick sequential organ failure assessment The
Journal of emergency medicine 52 622–631
Artioli, G., Foà, C., Cosentino, C. and Taffurelli, C., 2017. Integrated narrative nursing: a new
perspective for an advanced assessment. Acta Bio Medica Atenei Parmensis, 88(1-S), pp.7-17.
Benbow, M., 2016. Best practice in wound assessment. Nursing standard, 30(27).
Donnelly J P, Hohmann S F and Wang H E 2015 Unplanned readmissions after hospitalization
for severe sepsis at academic medical center-affiliated hospitals Critical care medicine 43 1916
Ferrer R, Martin-Loeches I, Phillips G, Osborn T M, Townsend S, Dellinger R P, Artigas A,
Schorr C and Levy M M 2014 Empiric antibiotic treatment reduces mortality in severe sepsis
and septic shock from the first hour: results from a guideline-based performance improvement
program Critical care medicine 42 1749–1755
Gauer R L 2013 Early recognition and management of sepsis in adults: the first six hours.
American family physician 88
Gordon A C, Mason A J, Thirunavukkarasu N, Perkins G D, Cecconi M, Cepkova M, Pogson D
G, Aya H D, Anjum A and Frazier G J 2016 Effect of early vasopressin vs norepinephrine on
kidney failure in patients with septic shock: the VANISH randomized clinical trial Jama 316
509–518

10SEPSIS CASE STUDY
Hershey T B and Kahn J M 2017 State Sepsis Mandates — A New Era for Regulation of
Hospital Quality N Engl J Med 376 2311–3
Jones T K, Fuchs B D, Small D S, Halpern S D, Hanish A, Umscheid C A, Baillie C A, Kerlin M
P, Gaieski D F and Mikkelsen M E 2015 Post–acute care use and hospital readmission after
sepsis Annals of the American Thoracic Society 12 904–913
Kelm D J, Perrin J T, Cartin-Ceba R, Gajic O, Schenck L and Kennedy C C 2015 Fluid overload
in patients with severe sepsis and septic shock treated with early-goal directed therapy is
associated with increased acute need for fluid-related medical interventions and hospital death
Shock (Augusta, Ga.) 43 68
Khwannimit B and Bhurayanontachai R 2015 The direct costs of intensive care management and
risk factors for financial burden of patients with severe sepsis and septic shock Journal of
critical care 30 929–934
Lewis, S.L., Bucher, L., Heitkemper, M.M., Harding, M.M., Kwong, J. and Roberts, D.,
2016. Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems,
Single Volume. Elsevier Health Sciences.
Marik P E, Khangoora V, Rivera R, Hooper M H and Catravas J 2017 Hydrocortisone, vitamin
C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after
study Chest 151 1229–1238
Mayr F B, Talisa V B, Balakumar V, Chang C-C H, Fine M and Yende S 2017 Proportion and
Cost of Unplanned 30-Day Readmissions After Sepsis Compared With Other Medical
Conditions JAMA 317 530

11SEPSIS CASE STUDY
Prescott H C and Angus D C 2018 Enhancing recovery from sepsis: a review Jama 319 62–75
Ranjit S, Aram G, Kissoon N, Ali M K, Natraj R, Shresti S, Jayakumar I and Gandhi D 2014
Multimodal monitoring for hemodynamic categorization and management of pediatric septic
shock: a pilot observational study Pediatric Critical Care Medicine 15 e17–e26
Saugel B, Trepte C J, Heckel K, Wagner J Y and Reuter D A 2015 Hemodynamic management
of septic shock: is it time for “individualized goal-directed hemodynamic therapy” and for
specifically targeting the microcirculation? Shock 43 522–529
Singer M, Deutschman C S, Seymour C W, Shankar-Hari M, Annane D, Bauer M, Bellomo R,
Bernard G R, Chiche J-D, Coopersmith C M, Hotchkiss R S, Levy M M, Marshall J C, Martin G
S, Opal S M, Rubenfeld G D, Poll T van der, Vincent J-L and Angus D C 2016 The Third
International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA 315 801–10
Urden, L.D., Stacy, K.M. and Lough, M.E., 2017. Critical Care Nursing-E-Book: Diagnosis and
Management. Elsevier Health Sciences.
Williams J M, Greenslade J H, McKenzie J V, Chu K, Brown A F and Lipman J 2017 Systemic
inflammatory response syndrome, quick sequential organ function assessment, and organ
dysfunction: insights from a prospective database of ED patients with infection Chest 151 586–
596