Sepsis Early Detection and Treatment free essay sample

Associated mortality rates with sepsis in the United States have remained largely unchanged for several decades. Through an international collaboration known as the Surviving Sepsis Campaign formed in 2002 under the sponsorship of the International Sepsis Forum, it was recommended that evidence-based guidelines be used for the treatment of patients with severe sepsis and septic shock. From these guidelines, recommendations of the development of an initial resuscitation bundle and then followed by a management bundle came from the Institute for Healthcare Improvement (Durthaler, Ernst Johnston, 2009). Early Detection Sepsis can be defined as a systemic inflammatory response syndrome in response to infection. Severe sepsis is associated with acute organ dysfunction (Durthaler et al. , 2009). Sepsis can be identified in a patient with two indicators of systemic inflammatory response syndrome along with a known or suspected infection. For successful treatment of sepsis, early recognition and rapid response are vital as the progression to severe sepsis and then septic shock can be quick. We will write a custom essay sample on Sepsis Early Detection and Treatment or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page While severe sepsis requires treatment in a critical care area, its recognition is often made outside of the Intensive Care Unit (ICU). With nurses being at the side of a patient from admission to discharge, this places them in an ideal position to be first to recognize sepsis. Assessments by nurses need to take into account the signs and symptoms of sepsis. The progression of sepsis can be subtle, rapid and often deadly. Sepsis is broken down into four stages. The first stage is the systemic inflammatory response syndrome (SIRS). SIRS can be a systemic inflammation resulting from any major insult to the body. In SIRS you will have two or more of the following present: A temperature higher than 38 C or lower than 36? C. Heart rate greater than 90 beats per minute. Respiratory rate greater than 20 breaths per minute or a partial pressure of carbon dioxide (PCO2) less than 32 mmHg. White blood cell count higher than 12 x 103/mm3, lower than 4 x 103/mm3or with more than 10% band cells. The patients in stage one can usually be cared for out of the ICU but should be continuously monitored for signs and symptoms of sepsis. The second stage is sepsis which is identified by the presence of two of the SIRS criteria along with a known or suspected infection. In many cases however the actual cause of infection is never identified. Treatment can be delayed in waiting for confirmation of infection source. Once suspected the most effective course of action is to initiate treatment and monitor the patient for signs and symptoms of organ failure. The third stage is severe sepsis which occurs when a patient shows signs and symptoms of organ failure. The patient will require aggressive treatment in the critical care area once severe sepsis is suspected. The fourth stage is septic shock which is defined as severe sepsis plus hypotension that does not respond to fluid resuscitation. The chances of recovery are significantly reduced if by this stage the patient has not already been transferred to the ICU (Nelson, LeMaster, Plost and Zahner, 2009). Treatment of Sepsis As stated in Rivers, Nguyed, Havstad, Ressler, Muzzin, Knolich et al. (2001): Early hemodynamic assessment on the basis of physical findings, vital signs, central venous pressure, and urinary output fails to detect persistent global tissue hypoxia. A more definitive resuscitation strategy involves goal-oriented manipulation of cardiac preload, afterload, and contractility to achieve a balance between systemic oxygen delivery and oxygen demand. End points used to confirm the achievement of such a balance (hereafter called resuscitation end points) include normalized values for mixed venous oxygen saturation, arterial lactate concentration, base deficit, and pH. Mixed venous oxygen saturation has been shown to be a surrogate for the cardiac index as a target for hemodynamic therapy. In cases in which the insertion of a pulmonary-artery catheter is impractical, venous oxygen saturation can be measured in the central circulation (p. 1368). The focus for the general care nurse outside of the ICU is to be able to recognize sepsis and to initiate appropriate interventions in an appropriate amount of time. Nurses need to facilitate the transfer of the patient to an ICU as urgently as possible. Once sepsis is suspected, it is important to closely monitor patients for signs and symptoms of progression with increasing frequency of assessments. While awaiting transfer of a patient to the ICU certain interventions can be initiated by nursing. The physician can be alerted and request for orders to draw lab work to help monitor the patient. Administer oxygen as needed and place a urinary catheter to track output closely. Suggest placing a central line and the beginning of fluids for support(Nelson, 2009). In the Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock (Dellinger, Carlet, Masur, Gerlach, Calandrea, Cohen, et al. 004, March) discussed evidence based therapies in the management of sepsis. Resuscitation of patients should begin as soon as sepsis is recognized and not delayed prior to ICU admission. Appropriate cultures should be obtained prior to antibiotics being started. Empirical anti-infective therapy should be guided by the susceptibility patters of microorganisms in the community and in the hospital. One or more should have activity against likely pathogens and be able to penetra te into the likely source of the sepsis. Therapy should be typically 7 to 10 days and guided by clinical response. Each patient presenting with sepsis should be evaluated for the source of infection and source control. Fluid resuscitation may consist of natural or artificial colloids or crystalloids. After an appropriate fluid challenge has failed to restore adequate blood pressure then vasopressors should be started with norepinephrine or dopamine as the first choice. Dobutamine should be considered in patient with low cardiac output after adequate fluid resuscitation. Corticosteroids are recommended for patients who require vasopressors therapy despite adequate fluid replacement. Recombinant human activated protein C in recommended in patients at high risk of death, sepsis induced multiple organ failure and acute respiratory distress syndrome with no contraindication related to a risk for bleeding. Without any extenuating circumstances red blood cell transfusion should occur only when hemoglobin decreases to less than 7. 0 g/dL to target hemoglobinof 7 to 9 g/dL. In patient with sepsis platelets should be given when levels