Nursing Interventions for Sepsis

Instructor: Leasha Roy

Leasha is licensed as a registered nurse and clinical nurse specialist. She has over 17 years of nursing experience in a variety of settings and roles including long-term care, acute care, critical care, education, and leadership.

Sepsis is a life-threatening condition caused by an infection in the body. This lesson will discuss sepsis and nursing interventions that can be beneficial in its treatment.

A Serious Illness

Amanda is a new graduate nurse who has reported for duty on her first day at her new job in the intensive care unit. She is assigned to train with Donna, a registered nurse with over fifteen years of experience. They get reports in the morning and sit down to plan their day. One of the patients in their assignment is Dan, a 43-year-old gentleman who was admitted for sepsis after a cut he sustained at work became infected. Amanda wonders how a simple cut could lead to Dan's being admitted to the intensive care unit. Let's discuss what happened to land Dan in this condition.

What Is Sepsis?

Sepsis is the body's devastating response to an infection, and it can be life-threatening as the chemicals the body uses to fight the infection provoke severe reactions in the body itself. Sepsis can happen quickly and if left untreated or not treated in a timely manner, it may lead to tissue damage, organ failure, and even death. There are over a million diagnoses of sepsis each year in the United States, and it kills just over 250,000 people annually. Although anyone can develop sepsis, the very young, very old, and immune-compromised are at the highest risk.

Signs and symptoms of sepsis include:

  • Fever
  • Chills
  • Elevated heart rate (over 100 beats per minute)
  • Fast breathing (over 20 breaths per minute)
  • Nausea, vomiting, or diarrhea
  • Muscle aches
  • Poor appetite
  • Fatigue
  • Recent or current infection

The most important sign is the presence of a current or recent infection. These signs and symptoms can also be related to other healthcare conditions; thus, it is important to determine if infection is present or was recently present.

Diagnosis and Treatment of Sepsis

Sepsis can be broken down into three stages: sepsis, severe sepsis, and septic shock. When left untreated or undertreated, sepsis can develop into septic shock, the most severe and deadly stage of sepsis. A fourth stage that is sometimes included in the sepsis cascade is systemic inflammatory response syndrome (SIRS). SIRS, like sepsis, is the body's response to an insult; however, SIRS may develop secondary to trauma, ischemia or inflammation, as well as infection. Determination of the stage of sepsis depends on the symptoms that are present.

Stages of sepsis
sepsis

Donna tells Amanda how important their nursing assessment is in identifying sepsis as early as possible. Donna teaches her about each stage of sepsis and stresses the importance of notifying the physician as soon as sepsis is suspected so that treatment can begin. Amanda is starting to put the pieces together to better understand Dan's illness. She asks Donna what treatment for sepsis may include.

Donna begins to explain the treatment process. Treatment for sepsis must begin as early as possible and should be aggressive to avoid progression of the condition or organ damage. Treatment is multi-factorial and several elements must often occur concurrently to ensure that every component is timely. Current sepsis treatment guidelines recommend:

  • Drawing blood cultures and lactate level within three hours of sepsis identification.
  • Administering broad spectrum antibiotics within three hours of sepsis identification.
  • If the blood pressure is low or lactate level elevated, administering intravenous fluids (at least 30 mL/kg).
  • If blood pressure remains low after fluids, beginning intravenous vasopressor (blood pressure support) therapy.
  • Ongoing monitoring and treatment of symptoms to maintain blood pressure and tissue perfusion.

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