03.02 Sepsis

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Overview

  1. Sepsis
    1. Complicated infection
    2. Dysregulated immune response

Nursing Points

General

  1. Infection leaks into bloodstream
    1. Inflammatory response -> dysregulated (SIRS)
    2. Vasodilation -> vascular leakage
      1. Septic shock
        1. Low blood pressures
        2. Do NOT improve with fluid bolus
      2. Ischemia and hypoperfusion
        1. Tissue damage
        2. Organ dysfunction
          1. MODS
          2. Death
  2. Sepsis/SIRS Alert (2-3 of criteria met)
    1. ELEVATED LACTIC ACID (>2)
    2. Low systolic pressure (<100)
    3. High respiratory rate (>20)
    4. Abnormal WBC (>12000 or <4000)
    5. High heart rate (>90)
    6. Fever (>100.5)

Assessment

  1. Blood cultures
  2. Assess for source of infection
  3. Vital signs
  4. Lactic acid level

Therapeutic Management

  1. IV antibiotics- broad spectrum
  2. IV fluids
    1. Bolus
    2. Maintenance fluids
  3. Vasopressors
    1. Increase blood pressure

Nursing Concepts

  1. Immunity
    1. System responds to spread of infection
  2. Infection control
    1. Sepsis begins with infection
  3. Perfusion
    1. Sepsis results in decreased organ perfusion
    2. Result = MODS

Patient Education

  1. Infection prevention
    1. Wound care
  2. See doctor when sick
    1. Complete prescribed antibiotics

Reference Links

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Video Transcript

Hey guys! In this lesson we will explore sepsis. 

So, sepsis begins as an infection of any kind in the body and becomes complicated because it leaks into the bloodstream causing a dysregulated inflammatory response by the body. Let’s dig deeper into the patho of sepsis. 

So there is some sort of infection in the body that leaks into the bloodstream causing cytokines to be released. These cytokines alert the white blood cells that help is needed to fight off the infection, but in sepsis, homeostasis isn’t maintained. This means that the body’s processes aren’t able to function normally. This leads to vasodilation causing vascular leakage. The patient will then go into septic shock and their blood pressures will drop.

With the drop in pressures, the organs cannot be perfused with blood to provide the oxygen and nutrients they need. The body will begin producing energy without oxygen. This is called anaerobic metabolism and a product of this is lactate or lactic acid.  Without enough perfusion, eventually the patient will go into multiple organ dysfunction syndrome or MODS. The shutting down of organ systems eventually results in death of the patient. Check out the lesson on SIRS and MODS to get further details on them. Next I will explain the sepsis criteria.

So there are a variety of signs that will alert you and the physician that the patient is septic or in a systemic inflammatory response syndrome. The doctor will order a lab draw for lactate or lactic acid, and if it is greater than 2 they are likely septic because remember the body resorts to anaerobic metabolism to provide energy to the cells when they’re lacking oxygen perfusion, and lactate is the byproduct.  So the higher the lactic acid level, the less oxygen perfusion the patient’s organs have. So the doctor will order IV fluids to bring the lactate down. This works by increasing volume which better perfuses the tissues and organs.

The patient’s respirations may be higher than 20 because their body is super acidic from the buildup of lactic acid and more breathing helps blow off the CO2 which then decreases acid in the blood.

The white blood cell count will be abnormal either greater than 12,000, or lower than 4,000. They might be elevated because they are working hard trying to fight the infection, and they could be low if the immune system tires out and the bacteria is basically winning. Their heart rate may be greater than 90, and their temperature will probably be elevated greater than 100.5. When the patient goes into septic shock, their systolic blood pressure will drop below 100 and be difficult to bring up. Guys, these patients are VERY sick. I take care of septic patients often in the hospital, and sometimes you can push and push fluids and their blood pressures continue to drop and they become lethargic and confused from the lack of blood flow to the brain. Next let’s discuss the patient assessment. 

When assessing the patient with sepsis, vital signs are a great way to monitor the patient’s status. You will assess the patient’s body to find the source of infection. Sometimes the source is found by tests ordered by the doctor, and other times it is unknown. Doctor orders for the patient with sepsis include blood cultures and a lactic acid level. Blood cultures like in this picture should be drawn before the antibiotic treatment begins so that you have an accurate growth of bacteria without any antibiotic interference in the culture. Remember, lactic acid levels greater than two show that the tissues are not being perfused enough. Now let’s discuss sepsis management. 

So the patient with sepsis has an infection somewhere, so broad spectrum IV antibiotics will be ordered by the doctor to cover the bacteria causing the issue. IV fluids are key to treating sepsis. Boluses will be given first, and then maintenance fluids in attempt to keep the organs perfused. In cases where the patient goes into septic shock, their blood pressures remains low even after receiving IV fluids so they need vasopressors to help bring up their blood pressure. Let’s move on to patient education. 

We should suggest infection prevention techniques such as handwashing and wound care. Let your patient’s know that they should seek help by the doctor when they are very ill, especially with ongoing fevers. Educate the importance of finishing the antibiotic treatment so that they kill off all of the bacteria. 

So our priority nursing concepts for sepsis are immunity, infection control, and perfusion. 

Okay, now let’s review the key points about sepsis. Sepsis begins with an infection somewhere in the body that leaks into the bloodstream, causing a dysregulated immune response. So when the bacteria move into the blood, cytokines are released that alert the white blood cells to help. In sepsis, the body is unable to properly fight this infection and instead results in a systemic inflammatory response, and eventually the organs lose perfusion from the fluid shifting so they shut down. Eventually after multiple organ dysfunction takes over, the patient will die. The doctor and nurse will be alerted that the patient is septic by elevated lactic acid levels greater than two, low systolic blood pressure, high respirations, high heart rate, abnormal white blood cells, and fevers. We will assess the septic patient by checking vital signs and looking for a source of infection. The doctor will order blood cultures and a lactic acid level. We will manage the sepsis by providing IV antibiotics to treat the infection and pushing the IV fluids to perfuse the body by bringing up the blood pressures. If the IV boluses and maintenance fluids are unsuccessful at bringing the blood pressures up, the doctor may order vasopressors. 

Thanks so much for listening guys! Now go out and be your best self today, and as always, happy nursing!

Read more

  • Question 1 of 10

The nurse is caring for a client who is septic. The ABCs are intact. What is the first action to take?

  • Question 2 of 10

A nurse received report on 4 clients and reviews each diagnosis, labs, and vitals. The nurse knows that of the 4 clients the one with the diagnosis of which of the following is most at risk for sepsis?

  • Question 3 of 10

A 78-year-old client has been admitted to the hospital with sepsis. The nurse understands that older adults are at a higher risk of developing septic shock when compared to young adults. Which best describes the reason for this risk?

  • Question 4 of 10

A client comes into the emergency room with sepsis. Which of the following orders should the nurse implement first?

  • Question 5 of 10

A nurse is caring for a septic client with hypotension who is tachycardic and tachypneic. The nurse knows that the client is tachypneic for which of the following reasons?

  • Question 6 of 10

A nurse receives lab results on a client and knows that which of the following will alert the nurse that the client has sepsis?

  • Question 7 of 10

The nurse is caring for a client whom the provider believes is suffering from sepsis. Which of the following orders would the nurse anticipate receiving for treatment for sepsis? Select all that apply.

  • Question 8 of 10

The nurse is caring for a client who is demonstrating signs of sepsis. What is the priority for septic clients? Select all that apply.

  • Question 9 of 10

A client is being discharged from the hospital after recovering from septic shock. The nurse is providing discharge instructions about what to look for if post-sepsis syndrome develops. Which of the following is a symptom of post-sepsis syndrome?

  • Question 10 of 10

A nurse is caring for a client who is admitted for pneumonia and sepsis. The nurse is reviewing orders and knows to implement which of the following prior to hanging antibiotics?