Sepsis

Question 1

What are the possible risk factors which could lead to sepsis?

Answer 1

Catheter
Invasive lines
Wounds
Pressure ulcers
NG/NJ tubes
Ventilation (risk of pneumonia)
Risk of bowel perforation
Abdominal surgery
Multi-resistant organisms
Malnutrition

Question 2

What are the nursing actions to help reduce the risk factors for sepsis?

Answer 2

Mobilise pt as soon as possible
Remove any unnecessary lines
Hand hygiene
Monitor pt
Regularly check wound site
Nutrition - dietician r/v and encourage eating
Medication
Documentation
Challenge bad behaviours by others

Question 3

What does the NICE Guidelines (2007) for the handover of a pt require?

Answer 3

Summary of critical care stay
Monitoring and investigation plan
Plan of ongoing treatment
Physical state and rehabilitation
Psychological and emotional needs
Communication barriers/needs

Question 4

What are the criteria for sepsis?

Answer 4

Glucose: > 7.7
Temperature: > 38.3 degrees or 20
PaCO2: 90
WCC: >12 or

Question 5

What information is required during handover?

Answer 5

Current obs, baseline and monitoring plan - how often, criteria for informing docs if deteriorates
Blood results - CRP, U+E (K, Na, Ca, Mg) ESR, INR, PTT, platelets,LFTs, Creat, Hb, ABG
Medication - antibiotics, analgesia, any specific blood levels needed, time critical meds
Skin integrity
Pain score
Mobility
Check wound site
IVIs - date for replacement/insertion, skin intact
PMH - any allergies
Pt details - NOK
Key summary of critical care
Infection status
Nutritional status
ECG history
Bowel movement
Emotional/psychological state
Medical plan
Any communication barriers

Question 6

What is sepsis?

Answer 6

An uncontrolled systematic response to infection that doesn’t work normally
Can rapidly escalate

Question 7

What is SIRS?

Answer 7

Systemic inflammatory response syndrome

Question 8

What is the severe sepsis screening tool?

Answer 8

Screening tool
Very generic
Used for new onset

Question 9

What counts as infection?

Answer 9

Pneumonia, UTI, anything breaching the mechanical barrier of skin, C-diff, peritinitis, wound infection, meningitis, bacterial, viral, fungi, secondary infections, multi-resistant strains

Question 10

What is the first line of priority to avoid sepsis?

Answer 10

Avoiding infection

Question 11

What are the characteristics of sever sepsis?

Answer 11

Signs of SIRS which is interfering with O2 delivery to organs, leading to the organs shutting down
Drop in BP
MAP

Question 12

What is the pathogenesis of sepsis?

Answer 12

1. Pathogen enters the body
2. Normal inflammatory response which is repeatedly triggered
3. Overriding inflammatory response which becomes hard to control
4. Cytokine chemical mediators
5. Coagulation triggered
6. Inside cell dysfunction/mitochondrial dysfunction

Question 13

What are the symptoms of multi-organ dysfunction?

Answer 13

Stress response
Increased BM
Altered mental state
Liver dysfunction 
Lungs become "leaky" = pulmonary oedema
Oedema all over the body

Question 14

What causes the symptoms of sepsis?

Answer 14

Systematic vasodilation = less pressure in the blood vessels
Increased capillary permeability = hypovelimia
Hyperdynamic circulation
Increased coagulation

Question 15

What are the priorities for a pt with suspected sepsis?

Answer 15

Early identification
Sepsis care bundle
Sepsis 6

Question 16

What is involved in the sepsis care bundle?

Answer 16

First 3 hrs = measure lactate level, blood cultures before antibiotics, administer fluids

First 6 hrs = not responding to fluid resus:CV line, HDU/ICU, measure O2 saturation of venous blood, apply vasopressors (noradrenaline)

Question 17

What is involved in the sepsis 6

Answer 17

1. High flow O2 via non-rebreathe mask
2. Blood cultures (all devices, swabs and samples)
3. Give antibiotics (IV, 1 hr of diagnosis, broad spectrum)
4. Give fluids (30 mls per KG per hr, 500 ml bolus)
5. Check lactate and Hb (normal lactate =

Question 18

What are the nursing priorities for a septic pt?

Answer 18

Prevention of infection
Infection management
Initial resuscitation
Initiate early resuscitation measures
Psychological support
Change location of care