Severe Sepsis and Septic Shock: Management and Performance Management

SEVERE SEPSIS AND SEPTIC SHOCK: MANAGEMENT AND PERFORMANCE IMPROVEMENT

Referring to the Medical Surgical Textbook by Brunner and Suddarth’s 14th Edition, “Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection” (Pg. 313). Sepsis may also be referred to as “blood poisoning.” It often leads to organ failure or injury. Sepsis progresses to septic shock when the blood pressure drops instantly leading to inadequate tissue perfusion and this could lead to death. This article explains etiology, signs and symptoms, diagnostics, treatment, prevention, management and use of various approaches to improve sepsis outcome in the healthcare system.

Schorr, Zanotti and Dellinger’s article explains how large variability in clinical practice including creation of awareness that certain processes of care associated with improved critical care outcomes, has led to the development of clinical practice guidelines in a variety of areas related to infection and sepsis. This leads to early detection of sepsis and septic shock signs reducing the mortality and morbidity rate. Nurses are a critical part in the healthcare system given that they interact more with the patient. By close monitoring with collaboration of other team members such as the physicians, nurse technicians, lab technicians there can be prevention, identification and early treatment of sepsis especially for the hospitalized patients because of their compromised immune system.

Very young/old patients, diabetes/cirrhosis patients, patients with wounds/burns and those with invasive devices like catheters are more prone to sepsis. Bacterial microbes are the most common causative organisms though manifestation can also be seen with fungal, viral and parasitic infections. Genito-urinary, respiratory and the gastrointestinal systems are the most common sites of infection. Sepsis is the leading cause of death in non-coronary ICU patients with infections including those of the skin, lungs, urinary tract infections and abdomen directly affecting the bloodstream. Patients with this type of infection need immediate aggressive care that is often treated in the Intensive Care Unit because progression may result to multiple organ failure and finally death. Critical Care and Reviews states that “Multiple organ failure is a sepsis complication that results when there is a prolonged systemic hypotension, disturbed perfusion of the circulation that cannot be effectively restored and direct tissue toxicity hence contributing to the failure of multiple vital organ systems. 

Fever is the first manifestation of sepsis while pneumonia is the common presentation leading to sepsis. Other manifestations include; tachycardia, tachypnea and diaphoresis. Late signs include; Dizziness, loss of consciousness, confusion slurred speech, shortness of breath, clammy and cool skin and paleness especially on extremities.

ATI Medical Surgical Nursing Textbook states various ways that can be used to diagnose sepsis includes; ECG, Electrocardiogram, CT Scan, Cardiac catheterization and chest x-ray. Some of the lab tests that can be used includes; ABGs, serum lactic acid, serum glucose and electrolytes which increases during shock.

There are various ways used to manage sepsis/septic shock. In cases of severe sepsis, immediate clinical treatment is needed or call 911. Before any medical management is initiated, the underlying cause is first identified so that it can be corrected to avoid progress to shock. Initial resuscitation which includes goals within the first 6 hours are initiated. Fluids replacements such as IV fluids and medications are administered to maintain an adequate blood pressure to have an adequate tissue perfusion. Broad-Spectrum antibiotics are initiated, and blood cultures are collected before administration. Vasopressin therapy is also initiated in severe cases in case the patient remains hypotensive.

Nurses are required to continuously monitor the tissue perfusion and administer oxygen supplements if needed. Transfusion of packed red blood cells in cases of severity and monitoring hemodynamic status is also crucial. Nurses should also give brief explanations about diagnostics, treatment procedures and outcomes. This helps to ease stress and reduce anxiety to the patient and the family. Promote safety by preventing falls, close monitoring and frequent reorientation.

Nurses should educate the patient on proper handwashing techniques to avoid other episodes of infections that may cause sepsis. Educate patients on getting recommended vaccines example; influenza, pneumococcal. Clean skin wound properly; a wound care nurse may step in to make sure the wound has totally healed with no complications. Practice oral hygiene to prevent teeth infection that may cause sepsis, follow up with the doctor’s appointments and total compliance with the medications.

It is only with early diagnostics and expedited treatment can sepsis morbidity and mortality decrease. According to research proper utilization of the sepsis guidelines has helped improve septic shock severity. However, as sepsis remains the leading cause of mortality worldwide, additional studies are needed to determine the most effective way to achieve sepsis bundle targets, including the incorporation of nurse-led screening and treatment protocols.

Reference

• Assessment Technologies Institute (ATI) Nursing Education. (2016). ATI content mastery series: Medical Surgical, Review module edition 7.0.  Assessment Technologies Institute, LLC.
• Hinkle, J. L & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th Ed.). Philadelphia: Wolters Kluwer
• Rossaint, J., & Zarbock, A. (2015). Pathogenesis of Multiple Organ Failure in Sepsis. Critical Reviews in Immunology,35(4), 277-291. doi:10.1615/critrevimmunol.2015015461
• Schorr, C. A., Zanotti, S., & Dellinger, R. P. (2014). Severe sepsis and septic shock Management and performance improvement. Virulence, 5(1), 226. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=edb&AN=93549802&site=eds-live&scope=site