Sepsis Spring2025 - Student

Course Outcomes

  • Infer the multidimensional impact of sepsis and infectious disorders on clients and their families (course outcome #1)

  • Correlate the pathophysiology, medical treatment, complications, and nursing interventions for sepsis and infectious disorders (course outcome #2)

  • Differentiate primary, secondary, and tertiary prevention measures for sepsis and infectious disorders (course outcome #2)

  • Prioritize nursing care for sepsis and infectious disorders to reduce risk potential (course outcome #2)

  • Design nursing care plans that incorporate pharmacological, dietary, lifestyle, and lifespan considerations (course outcome #2)

  • Differentiate signs and symptoms of sepsis and infectious disorders (course outcome #3)

  • Correlate abnormal assessment and diagnostic findings to priority nursing actions (course outcome #3)

  • Apply transmission-based precautions to care of clients with communicable infections (course outcome #4)

Sepsis Statistics

  • Leading cause of death in hospitalized patients

  • Annual deaths: 11 million

  • Annual cases: 47-50 million

  • Children affected: 40% of cases

  • Mortality rate: 25-50%

    • Sources: Sepsis Fact Sheet, 2020; Sepsis Awareness Campaign, 2010

Healthcare-Associated Sepsis

  • Sepsis acquired in healthcare settings is among the most frequent adverse events during care delivery worldwide.

Patient Assessment - qSOFA Criteria

  • Altered mental status, low blood pressure, fast respiratory rate

Definitions of Sepsis

  • CDC Definition: "The body’s overwhelming and life-threatening response to infection which can lead to tissue damage, organ failure, and death."

  • NIH Definition: "An illness in which the body has a severe response to bacteria or other germs."

Understanding Sepsis

  • Definition: Sepsis occurs when the body’s response to an infection injures its tissues and organs. Can lead to shock, organ failure, and death if not treated early.

  • Inflammatory mediators, interleukins, interferon, and histamine: Three weapons of mass destruction cause: vasodilation, capillary leakage “edema”, clotting blood

Stages of Sepsis

  1. SIRS (Systemic Inflammatory Response Syndrome)

  2. Sepsis

  3. Severe Sepsis

  4. Septic Shock

Detailed Stages of Sepsis

Stage 1: SIRS

  • Characterized by a severe inflammatory reaction.

  • Present if 2 or more of the following are observed:

    • Elevated Heart Rate >90

    • Abnormal Temperature <96.8 OR >101

    • Altered Respirations >20

    • Abnormal WBC Count < 4,000 OR >12,000

Stage 2: Sepsis

  • Positive for SIRS (2 of 4 criteria)

  • Known or suspected infection present.

Stage 3: Severe Sepsis

  • 2 SIRS Criteria + known/suspected infection

  • Signs/symptoms indicating organ failure present. LABS

Stage 4: Septic Shock

  • 2 SIRS Criteria + known/suspected infection + signs of organ failure

  • Persistent hypotension: SBP < 90 after fluid bolus indicates Severe Sepsis present. Urine output in an hr < 30cc/hr

Acute Organ Failure Indicators

  • Body Systems Affected:

    • Neurological

      • Confusion, Lethargy, Agitation

    • Cardiovascular

      • Increased HR, Decreased BP

    • Respiratory

      • Hypoxemia

      • Tachypnea

    • Hematologic

      • Clotting Issues

      • Leukocytosis or Leukopenia

      • Bleeding/Bruising

    • GI/Hepatic

      • Nausea/ Vomiting/ Diarrhea

      • Elevated Liver Function Tests

      • Ileus is a common complication in patients with sepsis, often leading to bowel obstruction and requiring careful management.

    • Renal

      • Decrease in Urine output <30/cc/hr

      • Elevated Creatinine

    • Integumentary

      • Decreased skin turgor

      • Cool and clammy/ Hot and flushed

      • Dry mucous membranes

Priority Assessments for Body Systems

  • Neurological System: Specific indicators needed.

  • Cardiovascular System: Specific indicators needed.

  • Respiratory System: Potential source of infection: Pneumonia.

  • Hematologic System: Specific indicators needed.

  • GI/Hepatic System: Potential sources of infection: Gastroenteritis, ischemic bowel.

  • Renal System: Potential sources: UTI, pyelonephritis.

  • Integumentary System: Potential sources: wounds, burns.

Significant Lab Findings

  • Identify relevant lab tests and ranges indicative of sepsis:

    1. Lab test 1

      1. Procalcitonin (Bacteria) >2= Sepsis / >10= Septic Shock

      2. Lactate Level: >2 mmol/L indicates sepsis; >4 mmol/L suggests septic shock.

    2. Lab test 2

Initial Treatment Bundles

  • Treatment within 3 hours:

    1. Intervention 1

      1. Start IV Fluid Resuscitation 30ml/kg crystalloid (NS, LR, Normosol)

      2. 1 liter in 60 men in gen care, 30 mins in ICU

    2. Intervention 2

      1. Labs- Lactate Acid Level (Check every 6 hours), Procalcitonin

    3. Intervention 3

      1. Blood cultures should be obtained prior to starting antibiotics to identify any underlying infections. 2 sets

    4. Intervention 4

      1. Broad Spectrum Antibiotics within 1 hour

Risk Factors for Sepsis

  1. Specific risk factor

    1. Hospital-acquired infections

      1. Increase in invasive procedures and medical devices

      2. CAUTI, Pneuomia

  2. Specific risk factor

    1. Increased number of antibiotic-resistant microorganisms

  3. Specific risk factor

    1. Emergency Surgeries

  4. Malnutrition or immunosuppression

  5. Specific risk factor

    1. Chronic Illnesses (diabetes, hepatitis, CKD, and immunodefificency)

  6. Increase in the older population.

    1. Decreased physiologic reserves

    2. aging immune system

    3. Comorbidities

Nursing Interventions

  • Identify source of infection.

  • Collect specimens for culture and sensitivity.

  • Administer prescribed IV fluids and medications

  • Monitor Serum Levels (lactate,procalcitonin,WBC, coagulation Studies)

  • Additional interventions needed.

  • Monitor vital signs and intake and output.

  • Additional intervention needed.

  • Obtain provider of patient assess to evaluate the patient's condition and determine the necessity for further treatment options. ment

Case Study #1

  • Patient: 86-year-old female with new onset of weakness and fatigue. Vital signs:

    • HR: 92

    • Temp: 101.1°F

    • RR: 18

    • BP: 118/78

    • SPO2: 94% on Room Air

  • Assessment: Determine if SIRS, sepsis, severe sepsis, or septic shock is present.

Case Study #1 Continued

  • Diagnostics:

    • Chest x-ray: negative for acute disease

    • UA: Positive for UTI

    • WBC: 14.6

    • Lactic Acid: 2.6

  • Assessment: Determine presence of SIRS, sepsis, severe sepsis, or septic shock.

Infection Control and Prevention * KNOW MATRIX

  • Standard Precautions:

    • Used for all patients

    • Primary strategy for preventing Hospital Acquired Infections (HAIs)

  • Transmission-Based Precautions: For highly contagious microbes.

    • Categories: airborne, droplet, contact

Multi-Drug Resistant Organisms (MDRO)

  • Definitions:

    • Resistant to several drugs/medications, including:

      • Bacteria resistant to antibiotics

      • Viruses resistant to antivirals

      • Fungi resistant to antifungals

    • Over 2.8 million antibiotic-resistant infections occur in the U.S. annually, with over 35,000 deaths (CDC, 2019).

Common MDROs

  • Methicillin Resistant Staphylococcus aureus (MRSA)

  • Vancomycin Resistant Enterococcus (VRE)

  • Gram-negative bacteria producing extended spectrum beta-lactamase (ESBL)

  • Vancomycin Resistant Staphylococcus aureus (VRSA)

  • Carbapenem-resistant Enterobacteriaceae (CRE)

  • Carbapenemase-producing CRE (CP-CRE)

C. difficile Infection

  • Causes immense suffering and death, with 15,000 annual deaths attributed to the infection.

  • Approximately 500,000 illnesses occur in one year related to C. difficile.

  • Risk factors include:

    • Patients on antibiotics (7-10 times more likely)

    • Individuals in healthcare settings, especially hospitals or nursing homes

    • Over 80% of deaths occurred in individuals 65 and older.

Precautions for C. difficile

Enteric (Contact) Precautions

  • Strict contact measures are essential.

Airborne Precautions

  • Protocols for family and visitors for airborne precautions mentioned.