Infections and Sepsis Flashcards
What are the 3 core or macro aspects of dealing with sepsis in a patient?
Recognise, resus, refer
What assessments should be considered for a potential sepsis case?
~Physical assessment - A-G
~Focussed assessment (e.g. respiratory if symptoms present)
~Blood cultures
~UA/MSU cultures
~any other relevant cultures (e.g. would swab)
~ Chest X-ray
What are the 6 main components of sepsis Resus?
- Oxygen = maintain ^95% SpO2
- Blood cultures
- Check Serum lactate
- IV fluids
- Antibiotics
- Monitoring and Assessment
What are some risk factors for Sepsis?
- Re-presentation within 48hrs
- Recent surgury or wound
- Indwelling medical device
- Immunocompromised
- Age > 65yrs
- Fall
What are some ‘subjective’ Signs and symptoms of Sepsis?
- Fever or Rigors
- Dysuria/frequency
- Cough/speutum/ breathlessness (SOB)
- Line accosiated infection
- Abdo pain
- altered LOC/ cognition
How many risk factors/s&s’ and yellow/ red crieteria are needed to place a patient on the sepsis pathway?
1x risk factor and EITHER
2 x yellow criteria OR
1x Red criteria
What are the red zone criteria?
Systolic BP (SBP) <90mmHg
Lactate > 4mmol
Base excess < -5.0 (related to PH? = indic. acidosis or the other one…)
What are the yellow zone criteria?
RR <10 or >25
SpO2 <95%
HR <50 or >120
Altered LOC / new onset of confusion
Temp <35.5 or >38.5
Lactate >2mmol/L is significant
What are the nursing considerations for A - airway, in a septic patient?
Assess and maintain airway
What are the nursing considerations for B - Breathing in a septic patient?
assess and administer O2 PRN (aim SpO2 >95%)
What are the nursing considerations for C - Circulation, in a septic patient?
Lactate, vascular access, Blood/culture collection, Fluid resus & antibiotics
Within what time would ABx’s have to be administered to be considered the gold standard?
Within 1 hr of presentation/ diagnosis
What is the minimum # of blood cultures needed to collect for a potential septic patient?
at least 2 sets
What are the nursing considerations for D- disability, in a septic patient?
Assess LOC using AVPU
What are the nursing considerations for E - exposure, in a septic patient?
Re-examine patient for other potential sources of infection to guide further investigations
What are the nursing considerations for F - Fluid, in a septic patient?
Monitor/ document strict fluid input/output, and consider IDC if not already in situ
What is the final step of the ‘Resus’ portion of the sepsis pathway?
Monitor and reassess
After completing the sepsis pathway, what are some signs that indicate a patient is deteriorating further?
RR is in yellow or red zone
SBP <100mmHg
deceased LOC
Urine output <0.5mL/kg/hr
Serum lactate of 2mmol/L (or increasing)
if no improvement after fluid resus ?septic shock
