GMED3009- Sepsis

Question 1

Define Sepsis

Answer 1

life-threatening organ dysfunction caused by a dysregulated host response to infection

Question 2

What assessment is used to identify pt with potential sepsis?

Answer 2

• The quick Sequential Organ Failure Assessment (qSOFA) score is a bedside prompt that may identify patients with suspected infection who are at greater risk for a poor outcome outside the intensive care unit (ICU). It uses three criteria, assigning one point for low blood pressure (SBP≤100 mmHg), high respiratory rate (≥22 breaths per min), or altered mentation (Glasgow coma scale<15). A score ≥2 is associated with poor outcomes due to sepsis

Question 3

What are the clinical criteria for septic shock?

Answer 3

• Hypotension
• Serum lactate greater than 2 mmol/L
• MAP >65mmHg

Question 4

What is Multiple Organ Dysfuntion Syndrome (MODS)?

Answer 4

in an acutely ill patient, such that homeostasis cannot be maintained without intervention

Question 5

Aetiology of Sepsis

Answer 5

• caused by a dysregulated host repsonse to infection
• RISK FACTORS- ICU admission, bactermia patients, advanced age, immunosuppresion pts (AIDS, renal failure, diabetes) cancer, previous hospitalisation, genetic factors

Question 6

Signs and symptoms of Sepsis

Answer 6

• Hypotension
• Tempature - fever
• Tachycardia
• Tachponea
• Confusion
• Fatige

Question 7

Diagnostic findings with spesis

Answer 7

Leukocytes- WBC >12,000 or leukopenia WBC <4000
Hyperglycemia - plasma glucose >140mg/dL or 7.7 mmol- in the absense of diabetes
Arterial hypoxemia - AOT (PAo2<300)
Urine output <05ml/kg/hr for 2 hrs
Creatine increases >0.5mmg or 44,3 micromol/L
- Thrombocytopenia (platelet count <100,000 microL–1).
- Hyperbilirubinemia (plasma total bilirubin >4 mg/dL or 70 micromol/L).
- Hyperlactatemia

Question 8

Sources of infection

Answer 8

20% blood
19% intra abdominal
13% UT
7% SKin
36% Respiratory

Question 9

Pathophysiology of sepsis

Answer 9

1) When a bacterial pathogen enters a sterile site, resident cells detect a invader to initiate a response.
2) The immune system sends out cytokine and proinflammaotry mediators as a reponse to the foreign invader.
3) In sepsis release of proinflammatory mediators in response to an infection exceeds the boundaries of the local environment, leading to a more generalized response.
4) proinflammatory mediators, which include cytokines interact with endothelial causing injury to the endothelium and activation of the coagulation factors
5) blood vessels the coagulation response, in combination with endothelial damage, may impede blood flow leading to blood vessels becoming leaky and clot formation
6) As fluid and microorganisms escape into the surrounding tissues, the tissues begin to swell in the lungs can lead to pulmonary oedema, manifesting as shortness of breath
-> cytokines- cause vasodilation, decreasing BP
-> inadequate tissure perfusion- cellular hypoxia and lactic acidosis
-> cellular injury accompanied by the release of proinflammatory and antiinflammatory mediators, often progresses to organ dysfunction. No organ system is protected from the consequences of sepsis

Question 10

Define Septic shock

Answer 10

a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality

Question 11

Diagnostic studies to be performed with sepsis

Answer 11

● Blood Test: FBC including WBC, INR, aPTT, Prothrombin Time (PT), urea and electrolytes, Liver function Test (MODS).
● BGL
● Blood Cultures, Urine specimen and Sputum Specimen
● Xrays, Ultrasound, CT
● Lumbar Puncture
● Wound swabs and cultures
● Aspirates
● Cultures of indwelling lines

Question 12

Specific routine nursing care of a patient with sepsis

Answer 12

● Immediate management
● Assess for airway patency and administer oxygen
● Obtain IV access, blood cultures and baseline blood tests (including lactate)
● Other diagnostic samples if they will not delay antibiotic treatment (e.g. sputum, urine, pus)
● Prescribe and administer antibiotics (should be administered in first hour)
● IV fluid bolus if patient showing signs of shock/hypoperfusion – 250-500 mL crystalloid (e.g. N/Saline, Hartmanns or Plasmalyte) repeated as required.
● Seek senior help and transfer to ICU if transient or no response to treatment
● Examination for source of sepsis if not already clear
● Monitor fluid balance and urine output
● ABG’s- Aiming for PaO2 > 70mmHg and normal pH
● ICD and Urine output- 0.5ml/kg/Hr
● Vital Signs: Temp, BP, RR, HR and SaO2
● Temperature control- active cooling and antipyretic agents
● Monitor BGLs- tight control
● Central Venous Pressure Monitoring aiming for >10mmHg for adequate hydration status
● Arterial Line Monitoring- for BP monitoring. Aiming for MAP >65-70mmHg
● Administration of Inotropes
● Full patient ADL’s
● Maintain Aspetic techniques
● 5 moments of Hand Hygiene
● Nutritional support- increase due to increase in metabolic demand

Question 13

What are the complications associated with sepsis?

Answer 13

-MODS
- Disseminated intravascular coagulation - xcessive exposure to tissue factor causes clot formation and there is a diminishment of natural anticoagulants- causing ischemia, necrosis, infarction
- Septic shock

Question 14

Pharmological therapies for sepsis

Answer 14

Crystalloids- 0.9% Normal saline
Colloids- Gelofusion and albumin
-> Noradrenaline -asympathomimetic - vasoconstriction
-> Piperacillin Tazobactim- antibiotic