Early Recognition and Management of Sepsis in General Ward

This essay will explore early recognition, management and treatment of sepsis in general ward. It will highlight the nursing interventions, communication, monitoring of septic patients and applying clinical practices to reduce infections using the current evidenced-based practices. Nurses perform a crucial role in identifying deteriorating patients with sepsis, escalating and initiating early treatment. This essay will look at how sepsis can be recognised and successfully treated to improve outcomes.

Sepsis is referred to potentially life-threatening condition which is caused due to the response of the body towards an infection. In normal condition, the body releases chemical into the bloodstream for fighting an infection but in sepsis, the response of the body toward the infection is out of balance that creates changes which can damage multiple internal organ systems of the body (Rhodes et al. 2017). The NICE informs that there are nearly 123,000 cases of sepsis reported in England every year out of which 36,900 patients are seen to face fatal consequences (NICE, 2016).The NICE informs that more incidences of sepsis are seen among people who are living longer and has experienced intricate medical and surgical intervention (NICE, 2016). This informs that older people with intricate medical conditions are more prone to experience sepsis compared to children and young people.

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The study by Mira et al. (2017) informs that Lipid Aand other bacterial products secrete cytokines and other nature of immunomodulators which mediates the manifestations related to sepsis. The interferon-gamma (INF-gamma), tumour necrosis factors (TNF-α) and other nature of colony-stimulating factors are secreted rapidly after interaction with lipid A along with macrophages and monocytes. A self-stimulating process is instigated by the inflammatory mediator releases along with the release of interleukin(IL)-1, nitric oxide, IL-2, IL4, IL-6 and others which further increases the level of cytokines in the blood (Miranda et al. 2016). This informs the way sepsis affects the body and the reason behind blood cultures to be done and source control to be determine in caring for the patients as per guidelines mntioned in Sepsis Six. It is evident as the data awares that raise of cytokines in the blood occurs during sepsis which can be determined through blood culture and determination of the source of control would help to determine the nature of medications to be provided to the patient (rcem.ac.uk, 2014).

The study of Morgan et al. (2017) mentioned that circulatory lesion in sepsis disrupts the oxygenations of tissues which alters the metabolic regulation of oxygen delivery to the tissues contributing to the organ dysfunction. In addition, the lytic enzymes, vasoactive substances and oxygen reactive species often leads to injury of the microcirculation which leads the erythrocytes experience inability to navigate the septic microcirculation. This indicates that nurses are to perform blood tests and blood oxygen staturation are to be measured to determine the extent to which sepsis has affected the body of the patient. In contrast, the study by Hattori et al. (2017) mentions the organ dysfunction in sepsis may occur as a result of direct cytotoxicity in which the TNF-α, endotoxin and nitric oxide causes damage to the mitochondrial energy metabolism leading the organs unable to use oxygen for their normal functioning. In other studies, the theory of apoptosis and immunosuppression are referred as the reason behind the failure of organs in sepsis (Lv and Wang, 2016).The information is required in nursing care to lead the nurses understand the way sepsis affects the organs of the patients making them remain alert to take effective action during care to avoid occurance of organ damage in patients.

The presence of any nature of viral, fungal or bacterial agents can lead to sepsis but the presence of pneumonia, urinary infection, bowel perforation, skin infection, bloodstream infection, infection of the kidney and other parts of the body leads to development of sepsis (Umbro et al. 2016). This is because the bacteria and other viral agents present during infection of different parts of the body are circulated through the blood to damage the proper functioning of other organs and develop sepsis in patients. The use of unsterilized surgical equipment, poor hand hygiene, caring of patients in infectious environment and others lead to cross-infect individuals with microorganisms leading them to face sepsis (Jonsson et al. 2011). The symptoms of sepsis include decreased urination, problem breathing, abnormal heartbeat, low blood platelet and others (Haslam and Macgregor, 2018).The diagnostic features of the sepsis include patients having fever with temperature above 38ºC, heart rate of 90 beats per minute, breathing rate of more than 20 per minutes, altered mental state, PaCO2 < 4.3 kpa and white blood cell count more than 1200 per mm3(McClelland and Moxon, 2014). The presence of more than two of the factors among individuals makes them fulfil the criteria to have sepsis.During screening, the specimen of the patient are examined in the laboratory and later they are disposed in a proper way so that cross-infection does not occurs.

The diagnostic test to be performed for detecting sepsis include complete blood count assessment to determine the number of white and red blood cells along with platelets present in the body. The is becauselower platelet count is seen among patients with sepsis as a result of disseminated intravascular coagulation. In addition, the white blood cells are also reduced as sepsis results in NETosis (Robson and Daniels, 2013). The lactate test to diagnose sepsis is also performed as increased lactate present in the blood would indicate organ dysfunction. The blood gas test is also to be performed in sepsis to detect the oxygen level in the blood and the acid-base balance in the body. This is because lower oxygen level would lead the person to face troubled breathing (Boland et al. 2016; Singh et al. 2016). In addition, the CT scan, X-ray or ultrasound test is top be performed in sepsis to determine the source of the infection (Miguel Lourenço Varela et al. 2019). This is because it would help the health professional to determine the nature of intervention requiredbased on the source to resolve sepsis in the patient. The blood culture is to be performed in sepsis for the patients to determine the type of microorganism which has affected the patient helping the health practitioners to determine the antibiotics to be used for treatment of the patient (Rannikko et al. 2017).

The NEWS2 (National Early Warning Score) is implemented for identifying the degree of illness a patient is suffering by considering six key physiological findings and one observation (Williams, 2019). As mentioned by Burns (2018), nurses require to focus on NEWS2 score of patient to determine which of them requires early care compared to others. This is because increased NEWS2 score of the patient indicates the person is suffering from illness in intricate manner and need effective intervention at the earliest to ensure better health. As argued by Malik (2019), lack of the proper care and early intervention for the patients with higher NEWS2 score leads to deteriorated health condition of the patient. The UK Sepsis Screening Tool is to be used for detecting sepsis in patients. This is because it is the simplest tool which allows the nurses to perform proper diagnostic test to successfully identify the presence of sepsis among patients in timely manner ensuring proper care is provided to the individuals in an immediate manner for improving their health condition (sepsistrust.org, 2020).

The SBAR (Situation, Background, Assessment and Recommendation) tool is used for facilitating immediate and appropriate communication of health condition of the patients to ensure them timely care with involvement of proper healthcare professionals and multi-disciplinary team (Drahnak et al. 2016). The SBAR tool is to be used to inform the condition of patients with sepsis in general ward by the nurses so that proper intervention by health professionals in the right way can be made for the management of the health of the patient. The management of sepsis includes administration of antibiotics to the patients. At the initial stage, a broad-spectrum of antibiotics is provided to determine which of them are effective in controlling the infection and later through blood analysis the specific antibiotic is selected that is administered intravenously in case of moderate to severe sepsis or orally in case of mild sepsis (Liu et al. 2017). The antibiotics used for treatment of sepsis include ceftriaxone, ciprofloxacin, azithromycin and others (Klompas, Calandra and Singer, 2018). However, the side-effects of the antibiotics may cause patients with sepsis to experience skin allergy, nausea, vomiting and others making them avoid to take the medication (Kalich et al. 2016).

The patient with sepsis is provided intravenous fluid for treatment of their condition. This is because intravenous fluid increases oxygen supply to the organs of the body and lower chances of long-term disability that are related to poor tissue perfusion as seen in case of sepsis (Puskarich et al. 2016). This is related with the guidance provided in Sepsis Six where intravenous fluid resuiscitation is mentioned to be initiated among sepsis patients for improviong their health and avoiding occurrence if septic shock (rcem.ac.uk, 2014). The vasopressors are used in patients with sepsis to improve their blood pressure. This is because sepsis lowers the flow of blood in the body making the immune system to be less effective in acting against the pathogen to ensure improvement (Daniel, 2011). The Sepsis Six guidelines mentions empiric intravenous antibiotics is to be administered to the patients with sepsis (rcem.ac.uk, 2014). Thus, the action of administering vasopressors to sepsis patients is relevant as per the guidance mentioned in Sepsis Six. The management of proper urine output is necessary for sepsis patients as it indicates proper fluid balance and effective renal function in the body (Kleinpell et al. 2019). The Sepsis Six also mentions that proper urine output is to be ensured for sepsis patients for determining their health is effectively managed and fluid content in the body is stabilised (rcem.ac.uk, 2014). Thus, the nurses by making sepsis patients to take increased fluid are to ensure proprer urine output is established.

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To conclude this essay, sepsis is the body’s systemic inflammatory response to infection which can cause organ damage, shock, and consequential death (Fleischmann et al 2016; NHS England, 2015). It is one of the leading causes of mortality in all countries causing around 37,000 deaths in the United Kingdom every year (Daniel, 2011). Nurses play a leading role in identifying and recognising septic and deteriorating patients. Education and training in clinical areas have facilitated awareness to reduce infection rates and skills to identify signs and symptoms of sepsis which nurses can easily identify and immediately escalate the problem to the appropriate medical and outreach team.

References:

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