Section 3: Sepsis Physiology and Treatment Flashcards
Define sepsis.
Life-threatening condition that occurs when the body’s response to an infection injures its own tissues.
What are the causes of sepsis?
Any type of infection can lead to sepsis - Bacterial, viral, protozoal or fungal infections
Common causes of sepsis include infections of:
-Lungs – e.g. such as pneumonia
-Kidney, bladder and other parts of the urinary system
-Gastrointestinal system
-Bloodstream
-Catheter sites
-Wounds or burns
Clinical signs and symptoms of sepsis
- Fever or Hypothermia: High body temperature (fever) or abnormally low body temperature (hypothermia).
- Chills and Shivering: Feeling very cold and shivering uncontrollably.
- Extreme Pain or Discomfort: Generalized pain or discomfort throughout the body.
- Pale or Mottled Skin: Skin may appear pale, mottled, or discoloured.
- Fatigue and Weakness: Severe tiredness and weakness, often accompanied by a feeling of impending doom.
- Rapid Heart Rate: Heart rate increases as the body tries to compensate for low blood pressure.
- Shortness of Breath: Difficulty breathing due to fluid buildup in the lungs or other respiratory issues.
What is neutropenic sepsis/febrile neutropenia?
Neutropenic sepsis is a whole-body reaction to an infection. It’s a serious condition that can be life-threatening. It can happen when you have a low level of neutrophils and an infection at the same time. You may also hear it called febrile neutropenia.
When are you most at risk of neutropenic sepsis?
- you have a temperature of 38°C or above
- you have a temperature below 36°C
- you’ve had any type of anti-cancer treatment in the last four weeks (causing a low level of neutrophils).
Howdoesthe pathophysiology oflactic aciddisplaytheworsening of sepsis?
High lactate in sepsis results from tissue hypoxia and anaerobic metabolism due to impaired perfusion, vasodilation, and hypotension. Reduced oxygen delivery forces a shift from aerobic to anaerobic metabolism, producing lactate as a byproduct. Liver dysfunction, also caused by hypoxia, impairs lactate clearance. Elevated lactate levels indicate severe sepsis and higher mortality, while decreasing levels suggest better outcomes.
Policies including the Sepsis six and NICE guidance; how they direct care in specific patient profiles.
Sepsis 6 is a list of six actions that if applied within the first hour of presentation can double the chance of survival.
For Paediatrics
- High flow oxygen
- Obtain intravenous (into vein), intraosseous (into the bone), access and take bloods (gas, lactate and blood cultures)
- Give intravenous/intraosseous antibiotics
- Consider fluid resuscitation
- Involve senior clinical early
- Consider inotropic support early medicines that change the force of heart contractions
For adults
- Give high-flow oxygen
- Take blood cultures
- Give IV antibiotic
- Measure lactate
- Measure urine output
Common side effects following sepsis.
Lethargy
Poor mobility
Insomnia
Hair loss
Excessive sweating
Changes in vision
Poor appetite
Breathlessness
Reduced kidney function
Changes in sensation of limbs
Anxiety
Depression
Flashbacks
Nightmares
Post Traumatic Stress Disorder
Short term memory loss
Poor concentration
Mood swings
Sam, 37yo man came to the clinic with a productive cough indicative of chest infection. His initial observations were as listed:
Oxygen saturations (SpO2)= 90%,
Blood pressure= 100/60 mmhg
Pulse rate= 90bpm
Temperature = 38.5 degrees Celsius (accompanied by rigors)
Neutrophil count = 0.4 x 109/L.
Appearance of mottled skin
A feeling of general malaise
Clinical information of relevance: First cycle of chemotherapy given two weeks ago and discharged home.
Based on Sam’s clinical symptoms, what is his possible diagnosis? (1 mark)
Neutropenic Sepsis
Sam, 37yo man came to the clinic with a productive cough indicative of chest infection. His initial observations were as listed:
Oxygen saturations (SpO2)= 90%,
Blood pressure= 100/60 mmhg
Pulse rate= 90bpm
Temperature = 38.5 degrees Celsius (accompanied by rigors)
Neutrophil count = 0.4 x 109/L.
Appearance of mottled skin
A feeling of general malaise
Clinical information of relevance: First cycle of chemotherapy given two weeks ago and discharged home.
Examine three possible causes for Sam’s clinical condition. (3 marks)
- Cytotoxic chemotherapy
- Immunosuppressive drugs
- Stem cell transplantation
- Infections
- Bone marrow disorders
- Nutritional deficiencies
Sam, 37yo man came to the clinic with a productive cough indicative of chest infection. His initial observations were as listed:
Oxygen saturations (SpO2)= 90%,
Blood pressure= 100/60 mmhg
Pulse rate= 90bpm
Temperature = 38.5 degrees Celsius (accompanied by rigors)
Neutrophil count = 0.4 x 109/L.
Appearance of mottled skin
A feeling of general malaise
Clinical information of relevance: First cycle of chemotherapy given two weeks ago and discharged home.
Formulate two nursing assessments that you will undertake on Sam and state your rationale for these assessments. (4 marks)
- A clinical history - Ask the Sam or his carers about any known causes or risk factors for neutropenia, including the type of cancer treatment, possible risk factors for infection including food ingested or exposure to communicable infections and any recent travel. This helps to identify causes and inform treatment for his clinical condition.
- Undertake a physiological assessment to establish a baseline and monitor for improvement or deterioration of his condition. This includes BP, P, T and spo2
- ABCDE assessment of Sams clinical well being to establish a baseline of overall wellness or illness and plot this as an indicator of the success of proposed treatment.
Describe how a nurse would implement the Sepsis Six in the first hour of identifying sepsis. Include at least four components. (6 marks)
Once sepsis is suspected, the nurse must act urgently using the Sepsis Six protocol to improve patient outcomes:
- Administer high-flow oxygen: This improves oxygen delivery to tissues and prevents further hypoxia and organ damage.
- Obtain blood cultures: This helps identify the causative organism and allows antibiotics to be tailored later.
- Administer IV broad-spectrum antibiotics: These are given immediately after cultures to start fighting infection.
- Begin IV fluid resuscitation: A fluid bolus (e.g. 500 ml) is given to restore circulating volume and improve blood pressure.
- Measure serum lactate: Elevated lactate indicates tissue hypoperfusion.
- Monitor urine output: A urinary catheter may be used to track output, as low levels suggest renal dysfunction.
Explain how sepsis affects multiple body systems and describe the signs/symptoms associated with this impact. (8 marks)
Cardiovascular: Vasodilation causes hypotension and tachycardia. Capillary leak leads to hypoperfusion, risking organ failure.
Respiratory: Fluid accumulation in the lungs can cause shortness of breath and may progress to ARDS (acute respiratory distress syndrome).
Renal: Reduced perfusion causes acute kidney injury, evidenced by oliguria (low urine output) and rising creatinine.
Neurological: Reduced cerebral perfusion leads to confusion, agitation, or altered consciousness.
Haematological: Sepsis can trigger disseminated intravascular coagulation (DIC), causing both bleeding and clotting abnormalities.
Discuss the role of the nurse in recognising, managing, and monitoring a patient with sepsis, including escalation and communication. (10 marks)
The nurse plays a critical role in early recognition and management of sepsis. Prompt action can be life-saving.
Recognition: Nurses must assess for signs such as fever, confusion, tachypnoea, hypotension, and low urine output. The use of tools like the NEWS2 score helps identify clinical deterioration.
Initial Management: The nurse initiates the Sepsis Six within one hour, including oxygen therapy, obtaining blood cultures, administering antibiotics, IV fluids, measuring lactate, and monitoring urine output. Nurses also prepare equipment, draw up medications, and monitor for side effects.
Communication: Using SBAR (Situation, Background, Assessment, Recommendation), the nurse communicates efficiently with the multidisciplinary team. For example, if blood pressure drops despite fluids, they alert the doctor promptly.
Monitoring: Ongoing monitoring includes vital signs, fluid balance, mental status, and blood work. Nurses document trends and report abnormalities. They also monitor lactate levels and response to treatment.
Holistic Care: Nurses support the patient and family emotionally, explain interventions clearly, and ensure dignity is maintained. In cases where the patient has LD, they must make reasonable adjustments and avoid diagnostic overshadowing.
Escalation: If the patient continues to deteriorate, nurses escalate care to the critical care outreach team or senior clinician to consider inotropes or intensive care.
Explain the key physiological changes that occur during sepsis and discuss how these changes contribute to multi-organ dysfunction. (8 marks)
Sepsis triggers a dysregulated immune response, resulting in widespread inflammation
It releases inflammatory cytokines, which cause systemic vasodilation and increased capillary permeability. This leads to a significant drop in blood pressure and leakage of fluid into tissues, resulting in poor perfusion to vital organs.
As circulation becomes impaired, oxygen delivery to tissues is reduced, causing cells to shift to anaerobic metabolism. This produces lactic acid, contributing to lactic acidosis, a key marker of sepsis severity.
Mitochondrial dysfunction also occurs, meaning cells cannot generate enough energy to maintain basic functions, which accelerates cellular and organ failure.
These processes combine to affect multiple body systems. The kidneys may stop producing urine due to hypoperfusion, the lungs can develop acute respiratory distress syndrome (ARDS), and the brain may experience reduced perfusion, leading to confusion or altered consciousness. If left untreated, this cascade of events results in irreversible multi-organ failure and potentially death.
Explain the pathophysiology of sepsis and outline the nursing interventions based on this understanding. (10 marks)
Sepsis is a life-threatening condition caused by a dysregulated immune response to infection. When pathogens are detected by the immune system, cytokines are released, leading to systemic inflammation. This causes vasodilation and increased capillary permeability, which lowers blood pressure and reduces perfusion to vital organs. Oxygen delivery becomes insufficient, triggering anaerobic metabolism and lactic acid build-up — a key indicator of severity.
The coagulation system is also activated, leading to microthrombi and, in severe cases, disseminated intravascular coagulation (DIC), which increases the risk of both clotting and bleeding. Mitochondrial dysfunction worsens energy failure at the cellular level, accelerating organ damage. These changes can lead to acute kidney injury, respiratory failure, and neurological symptoms such as confusion.
Nursing interventions based on this pathophysiology include rapid implementation of the Sepsis Six: administering oxygen, collecting blood cultures, giving IV antibiotics and fluids, monitoring lactate levels, and measuring urine output. Nurses must closely monitor vitals, escalate care using tools like SBAR, and observe for signs of deterioration. Understanding these physiological changes helps nurses identify early warning signs, act quickly, and deliver targeted care to prevent multi-organ failure.
