Sepsis

Question 1

What is Sepsis?

Answer 1

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

Question 2

According to NICE and the surviving sepsis campaign, if sepsis is not recognised early and managed promptly, what can it commonly lead to?

Answer 2

Septic Shock, multiple organ failure and death

Question 3

According to Sepsis Trust (2018), when considering which children are more susceptible to developing sepsis, which of the following groups are known to have the highest risk?

Answer 3

24 weeks and 1 year old

Question 4

What is Sepsis six?

Answer 4

Administer oxygen, take blood cultures, Give IV antibiotics, Give IV fluids, Check serial lactates, Measure urine
output.

Question 5

When monitoring the intravenous fluid in a sepsis resuscitation you notice the infusion is 1 hour
behind in terms of remaining volume. What should you do first?

Answer 5

Make sure the infusion rate is infusing at the prescription ordered rate.

Question 6

You are about to change the patients intravenous infusion and notice the cannula insertion site
appears very red and is oozing yellow pus. What is your next action?

Answer 6

Inform the patient’s doctor, insert a new cannula before starting the next infusion, remove the old cannula and
send the cannula tip for lab analysis.

Question 7

The main goal of treating septic shock is:

Answer 7

Identification and elimination of the cause of infection.

Question 8

Pneumonia typically affects which of the following parts of the respiratory system?

Answer 8

Bronchioles

Question 9

You need to administer 15 litres of oxygen to a patient who has just been admitted with Sepsis, if
you follow the British Thoracic Society (2017) Emergency Oxygen Guidelines which mask will you
choose?

Answer 9

Non Rebreather mask

Question 10

What part of the brain triggers the emetic or vomiting reflex?

Answer 10

The higher brain centres and the chemoreceptor trigger zone.

Question 11

The surviving sepsis campaign promotes treatment within what time scale?

Answer 11

1 Hour of patient presentation

Question 12

An ultrasound result comes back stating your patient has a kidney stone lodged in the urinary
tract, how will this most likely have caused a urinary tract infection?

Answer 12

Stasis of urine inside the urinary bladder due to obstruction attracts bacteria colonisation.

Question 13

Your patient describes, red/brown discolouration of urine. What are they describing?

Answer 13

Haematuria

Question 14

What are the indicators for an ECG?

Answer 14

Chest pain 
Use of accessory muscles 
History of drug use 
Low or high HR/ respiratory rate /BP
Dizziness or fainting episodes

Question 15

You really need to encourage your patient to follow the antibiotic regime, only taking half the
prescribed course is causing antibiotic resistance issues. How might you encourage them?

Answer 15

Provide adequate health education in an easily accessible/understandable format.

Question 16

The pulmonary defence mechanisms help maintain low levels of microorganisms, these include
which mechanisms?

Answer 16

Cough reflex, Mucociliary clearance system and immune response.

Question 17

In suspected pneumonia cases why might you send a C-reactive protein (CRP) level?

Answer 17

It is an acute phase reactant, a protein made by the liver that is released into the blood within a few hours after
tissue injury, the start of an infection or other inflammation

Question 18

Your patient suffers regularly with xerostomia (a dry mouth.) you notice they have been struggling to swallow
food and have developed a cough. What do you suspect may have happened here?

Answer 18

Aspiration of food.

Question 19

Who is most at risk from meningitis?

Answer 19

New-born babies and infants

Question 20

The health care assistant shows you normal sinus rhythm on the patients 3-Lead trace, but says the patient
doesn’t respond when they call their name, according to the Resus Council (2015) what should you do next?

Answer 20

Check if you can rouse the patient by shouting a little louder in both ears.

Question 21

According to sepsis trust 2018, what percentage of hospitals in England use a red flag sepsis criterion?

Answer 21

90%

Question 22

How many patients a year in England acquire a healthcare associated infection as a consequence of care within the NHS

Answer 22

300,000 patients

Question 23

What did the LeDer report in 2018 a key contribute to premature mortality?

Answer 23

Sepsis

Question 24

What is the sepsis six for children?

Answer 24

Administer oxygen, take blood cultures, Give IV antibiotics, Give IV fluids restricted to a specific volume , Check serial lactates, Measure urine
output, early consideration of inotropes to control blood pressure.

Question 25

What does SIRS stand for?

Answer 25

Sepsis has been defined as Systemic inflammatory response syndrome (SIRS) caused by infection both for adults and children

Question 26

What is SIRS used for?

Answer 26

It is relevant in the identification of infection and uncomplicated sepsis

Question 27

What does SOFA stand for?

Answer 27

Sequential organ failure assessment

Question 28

What is a QSOFA?

Answer 28

Quick sequential organ failure assessment tool to aid in the identification of patients with infection who have a high risk of death

Question 29

What is the difference between SOFA and QSOFA

Answer 29

SOFA tool requires multiple lab tests and wasn’t always quickly enough and would take too long to start treatment, often resulting in the golden hour being missed qSOFA is a quick sepsis related organ dysfunction assessment score was designed. Despite the SOFA is still considered by some clinicians at point of admission to be useful in predicting outcomes and more useful then SIRS

Question 30

What score on a NEWS2 score should suspect sepsis?

Answer 30

Above 5

Question 31

What can alter the scores on early warning systems?

Answer 31

- cardiac medication may mask tachycardia - paracetamol may mask pyrexia - patient with altered body shape naturally have a higher respiratory rate - pregnant female will have a greater circulating volume

Question 32

What is a PEWS?

Answer 32

The PEWS score is calculated using an observation chart. Each assessment includes respiratory rate and effort, oxygen requirements, heart rate, level of consciousness and clinical family concern

Question 33

What does the assessment include within sepsis six?

Answer 33

``` Assess temperature Heart rate Respiratory rate Oxygen saturation Level of consciousness CRT in children under 12 years Blood pressure Examine for mottled or ashen appearance Ask the person, parent or cater about frequency of urination ```

Question 34

What does the treatment include for sepsis

Answer 34

``` Antibiotics Analgesic and anti- emetics Nutrition and hydration Body posture Vasopressors Supportive care Surgery ```

Question 35

What are the high risk side effects of sepsis?

Answer 35

``` Lethargy/ excessive tiredness Poor mobility Breathlessness Swollen limbs Joint and muscle pains Insomnia Hair loss Dry and flaking skin Taste changes Poor appetite Changes in vision Changes in sensation in limbs Repeated infections from the original site Reduced kidney function Feeling cold Excessive sweating ```

Question 36

What are the psychological and emotional symptoms of sepsis?

Answer 36

- anxiety - depression - flashbacks - nightmares - insomnia - PTSD - poor concentration - short term memory loss - mood swings

Question 37

What is the oxygen management for sepsis?

Answer 37

Aim for oxygen saturation of 94-98% and 88-92% in hypercapnia respiratory failure in adults In critical illness, initiate treatment with a reservoir mask at 15L/min and aim for patients target saturations Closely monitored and reassessed frequently Blood gas sample may be required

Question 38

What is neutropenic sepsis?

Answer 38

Neutropenic sepsis is potentially life threatening complication of neutropenia and is defined as a temperature greater then 38 degrees

Question 39

What is a urinary tract infection?

Answer 39

An infection in the urinary system cause by the presence and multiplications of micro organisms which can affect the upper urinary tract and lower urinary tract

Question 40

What is line sepsis?

Answer 40

Sepsis can be associated with the direct introduction of microbes into the blood stream through insertion or subsequent colonisation of bacteria. It is almost avoidable therefore every case of Sepsis associated with an invasive device should be investigated with both the insertion and care techniques being reviewed

Question 41

What is Pneumonia and when does it occur?

Answer 41

Pneumonia is defined as inflammation of the lung caused by bacteria. Pneumonia occurs when there is a defect in normal host defence or pathogens overwhelm the immune response.

Question 42

What is meningococcal sepsis?

Answer 42

This is a type of blood poisoning caused by the meningococcus bacteria which can also cause meningitis usually due to infection. This carries a far worse prognosis than meningitis alone

Question 43

What is the pneumonic for signs and symptoms of sepsis?

Answer 43

``` S- Shivering, fever or very cold E- extreme pain P- pale or discoloured skin S- sleepy, confused I- thoughts of impending doom S- short of breath ```