The majority of medical practitioners and organizations specializing in the delivery of healthcare are concerned about the increased rate of mortality and morbidity among infants and mothers. For this reason, measures have been taken to ensure the reduction of child and maternal mortality rates. For instance, a study carried out by Bishai et al. (2016), showed that such rates have reduced from 43% in 1990 to 40% in 2010, which was attributable to the improvement in education, governance, income, technology, societal changes, and better healthcare. In spite of this, empirical evidence shows that neonatal sepsis adversely affects the efforts taken to ensure reduced cases of child and maternal mortality especially in developing countries. This paper provides an in-depth analysis of the subject of neonatal sepsis.
Background
Neonatal sepsis can be either early-onset or late-onset. In the majority of the cases, early-onset sepsis occurs following the possibility of the baby having acquired various microorganisms from the mother (Shah & Padbury, 2013). Some of the common microorganisms responsible for this category of sepsis include Escherichia coli, coagulase-negative Staphylococcus, Group B Streptococcus (GBS), Listeria monocytogenes, and Haemophilus influenzae. In spite of this, the prevalence of sepsis due to GBS has reduced over time because of the use of prenatal screening as well as other treatment protocol for Group B Streptococcus.
On the other hand, the late-onset sepsis develops later after a child is born, between 4 to 90 days. Often, this category of sepsis results from the caregiving environmental conditions. While a newborn is exposed to numerous microorganisms that can trigger sepsis, the Coagulase-negative Staphylococcus is known to be the major cause of neonatal sepsis.
Literature Review
Neonatal sepsis has been identified as a leading cause of term and preterm infants morbidity and mortality (Gebremedhin, Berhe, & Gebrekirstos, 2016; Bishai et al., 2016). In spite of the various measures taken to ensure advanced neonatal care, sepsis still accounts for a significant percentage of morbidity and mortality in infants having very low weight at birth. Neonatal sepsiss signs and symptoms are not specific (Shah & Padbury, 2013). However, the most common ones experienced in children with sepsis include guaiac-positive stool, hepatomegaly, abdominal distention, bleeding problems, poor perfusion, bulging fontanel, seizures, hypotonia, irritability, feeding difficulties, apnea, and cyanosis among others.
The prevention and treatment of neonatal sepsis is challenging especially in developing countries. A study by Gebremedhin et al. (2016) indicated that the majority of the deaths of newborns in Ethiopia occur due to sepsis. In most of the cases, Gebremedhin et al. (2016) found out that such deaths are associated with factors such as the place of delivery, low birth weight, prematurity, prolonged rupture of membrane (PROM) and intrapartum fever, and the history of UTI/STI during the index pregnancy.
According to PATH (2015), it is recommedable to use either intravenous or intramuscular antibiotics for the treatment of neonatal sepsis. Nevertheless, such guidelines have not been useful since most of the healthcare settings lack hospital-based care. On the other hand, the World Health Organization (WHO) recommends the adoption of an outpatient treatment scheme to reduce child and maternal mortality rate due to neonatal sepsis. According to a study carried out by PATH (2015), it is possible to reduce infant deaths through the use of gentamicin. In spite of this, the only challenge in this case, would be the calculation of dosage.
Recent studies on neonatal sepsis have indicated that the examination of each category of sepsis can be effective in its prevention and treatment (Shah & Padbury, 2013; Schlapbach et al., 2011). As such, following the adoption and implementation of treatment protocol and prenatal screening, the prevalence rate of early-onset sepsis has decreased. The early detection as well as prompt treatment of neonatal sepsis remains to be a challenge due to the fact that the associated symptoms and signs of this illness are nonspecific. Numerous studies have been conducted to identify a number of diagnostic markers such as the cell surface markers, cytokines, procalcitonin, hematological indices, C-reactive protein, and acute phase reactants among others, which can be used in the detection of the signs and symptoms of neonatal sepsis (Shah & Padbury, 2013). In spite of this, there is a need for further researcher to establish a biomarker that is highly accurate.
Conclusion
Based on the analysis above, it is evident that child and maternal mortality is a common problem in healthcare nowadays. While interventions have been adopted to reduce the rate of morbidity and mortality rates of infants, neonatal sepsis has adversely affected such efforts. This is attributable to the fact that sepsiss symptoms are nonspecific making their early detection and treatment a challenge. The adoption of technology in the healthcare sector has significantly increased the success rate regarding the prevention and treatment of neonatal sepsis. In spite of this, there is still much to be done to efficiently deal with this problem since more accurate and valid markers for the detection of signs and symptoms of neonatal sepsis are yet to be developed.
References
Bishai, D. M., Cohen, R., Alfonso, Y. N., Adam, T., Kuruvilla, S., & Schweitzer, J. (2016). Factors contributing to maternal and child mortality reductions in 146 low- and middle-income countries between 1990 and 2010. PLoS ONE, 11(1), e0144908. Web.
Gebremedhin, D., Berhe, H., & Gebrekirstos, K. (2016). Risk factors for neonatal sepsis in public hospitals of Mekelle City, North Ethiopia, 2015: Unmatched case control study. PLoS ONE, 11(5), e0154798. Web.
PATH. (2015). Gentamicin for treatment of neonatal sepsis A landscape of formulation, packaging, and delivery alternatives. Seattle: PATH.
Schlapbach, L., Aebischer, M., Adams, M., Natalucci, G., Bonhoeffer, J., Latzin, P., & Latalet., B. (2011). Impact of Sepsis on Neurodevelopmental Outcome in a Swiss National Cohort of Extremely Premature Infants. PEDIATRICS, 128(2), e348-e357.
Sepsis is the most severe manifestation of various acute infections poses a significant challenge to the healthcare systems around the world. It is one of the leading causes of death in hospital settings and intensive care units (ICU) that is not associated with coronary heart diseases. The frequency of sepsis ranges from 250 to 350 cases per 100,000 patients in countries with advanced healthcare systems (Fleischmann 2016), such as Germany or the USA (Novosad et al. 2016). The purpose of this paper is to analyze the presented case study, give definitions and criteria for sepsis, identify signs and symptoms of septic shock, and give criteria for organ dysfunction using recent academic literature and the provided patient data.
Sepsis Definitions and Criteria
The Third International Consensus on sepsis and septic shock identifies sepsis as a life-threatening dysfunction caused by the bodys overwhelming and disproportionate response to an infection (Singer, Deutschman & Seymour 2016). For ease of clinical analysis and identification, it is recommended to use the Sequential Organ Failure Assessment table (SOFA). Should the patient receive an assessment score of two or higher, they are considered susceptible to sepsis.
Having a score or greater is associated with mortality rates greater than 10%, and ending with a score of 9 or more, which is associated with mortality rates of 95%. Typically, the criteria for the standard SOFA table include the analysis of the following parameters: respiration, coagulation, liver activity, cardiovascular activity, central nervous system responsiveness, renal activity, and urine output. However, the recently implemented screen called the qSOFA offers a different set of criteria for patient evaluation:
According to the case study, the patient fits the criteria for qSOFA on day 5, with low blood pressure (SBP below 100 mm Hg), high respiratory rate (over 22 breaths per minute), and altered mental state (Glasgow Coma Scale score below 15). However, a retroactive analysis shows that the patient likely developed sepsis during day 2, which is three days prior to the completion of qSOFA (Raith, Udy & Bailey 2017).
Signs and Symptoms of Septic Shock
The Third International Consensus on sepsis and septic shock identifies septic shock as a subset of sepsis, characterized by severe circulatory, cellular, and metabolic abnormalities associated with greater risks of death when compared to regular sepsis (Singer, Deutschman & Seymour 2016). During septic shock, the blood pressure in a patient falls dangerously low, meaning that the cardiovascular system is not providing enough oxygen-enriched blood to body tissues, which often results in organ failure and ischemia (Sagy, Al-Qaqaa & Kim 2013).
Symptoms of septic shock include (Mayr, Yende & Angus 2014):
Reduced temperature and paleness in arms and legs explained by the lowered blood supply to the limbs.
Increased or decreased body temperature, caused by inflammation.
Altered mental status, which may present itself in the form of lightheadedness, dizziness, and confusion, caused by low blood pressure and decreased amounts of oxygen in the blood.
Little to no urine due to renal and urinal systems malfunction or failure.
Shortness of breath, if septic shock affected the lungs.
The patient was earlier diagnosed with influenza type A H5N1 and yet had exhibited certain symptoms that are uncharacteristic to influenza in adults, such as low blood pressure and vomiting. Other symptoms that indicated sepsis was fever and lower tongue temperature caused by peripheral perfusion. Zach entered septic shock on day 5, with following symptoms and characteristics:
Motley skin
Respiratory ratio (PaO2/FiO2) deterioration from 210 to 84 as the patient entered severe ARDS
Refractory hypotension, cannot maintain MAP.
The patient showed signs of kidney injury and failure.
Hepatocyte injury and ischemia caused by hypoxia, hypoperfusion, and inflammatory cytokines.
Presence of gastrointestinal and metabolic issues.
Patients Organ Dysfunction at Day 2
It is hard to assess the extent of the patients organ dysfunction on Day 2, as he scored 3 points on the qSOFA test only during day 5. On day 2, the patient has prescribed Azithromycin against suspected bronchitis, which indicates that breathing and lungs were already suffering from dysfunction. Other dysfunctions include the levels of ScVO2 at 70% at the beginning of the treatment and then dropped due to inadequate cell utilization caused by mitochondrial dysfunction.
Urine output was poor from the beginning, below 50 milliliters per hour, while the target urine output is supposed to be over 1 ml per hour per kilogram of mass. This indicated that urinal and renal systems were likely suffering a dysfunction by day 2, which ended in renal failure by day 5. To summarize, the systems suffering dysfunction at day 2 were urinal systems, renal systems, and lungs.
Appropriateness of Resuscitation
The patient was administered 3 liters of resuscitation fluid Albumin, over the course of 24 hours. Albumin is one of the standard solutions used for resuscitation for patients with sepsis and septic shock. It plays a critical role in regulating the volemic status, neutralizes free radicals in oxygen, and helps minimize any variations in PH level, which are often present during metabolic acidosis (Myburgh, & Mythen 2014).
So, in the patients case, the choice of the liquid is considered appropriate especially considering that SAFE trials showed no statistical difference between 4% albumin solution and 0.9% NaCl solution (Caironi et al. 2014). Three liters is a decent quantity, as the majority of the patients rarely require more. However, there was an issue in how quick said fluid was provided the patient received roughly 3 liters of fluids and measured lactate over 12 hours, which should have been done in three if followed the SS guidelines (Dellinger et al. 2012).
Some research, however, indicates that the use of fluid resuscitation in sepsis patients is used based on historical beliefs and incorrect and incomplete understanding of the pathophysiology of sepsis, which is one of the reasons for high mortality rates (Byrne & Van Haren 2017).
Conclusion
Sepsis is a very dangerous health complication with a high mortality rate, which can be triggered by inflammatory diseases. As demonstrated in this case study, the disease can avoid detection in earlier stages, as the current SOFA and qSOFA assessment systems require the disease to translate into later stages to be identified, which increases the risk of mortality and chances of a septic shock. In this case study, the patient developed sepsis by day 2 of hospital observation, yet the qSOFA identified it as sepsis only on day 5, and by that time the patient had already entered a state of septic shock with multiple organ dysfunction or failure, which ultimately lead to his death. Early detection of sepsis is paramount to the effectiveness of medical interventions aimed at stabilizing and treating the patient.
Reference List
Byrne, L & Van Haren, F 2017, Fluid resuscitation in human sepsis: time to rewrite history?, Annals of Intensive Care, vol. 7, no. 4, pp. 1-8.
Caironi, P et al 2014, Albumin replacement in patients with severe sepsis or septic shock, New England Journal of Medicine, vol. 370, pp. 1412-1421.
Dellinger, RP et al 2012, Surviving sepsis campaign: international guidelines for the management of severe sepsis and septic shock, Intensive Care Medicine, vol. 39, no. 2, pp. 65-228.
Fleischmann, C et al 2016, Hospital incidence and mortality rates of sepsis, Deutsches Arzteblatt International, vol. 113, no. 10, pp. 159-166.
Mayr, FB, Yende S, & Angus, DC 2014, Epidemiology of severe sepsis, Virulence, vol. 5, no. 1, pp. 4-11.
Myburgh, JA & Mythen, MG 2014, Resuscitation fluids, Survey of Anesthesiology, vol. 58, no. 4, pp. 164-165.
Novosad, SA et al 2016, Vital signs: Epidemiology of sepsis: prevalence of health care factors and opportunities for prevention, Weekly, vol. 65, no. 33, pp. 864-869.
Raith, EP, Udy, AA, & Bailey, M 2017, Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the Intensive Care Unit, Caring for the Critically Ill Patient, vol. 317, no. 3, pp. 290-300.
Sagy, M, Al-Qaqaa, Y, & Kim, P 2013, Definitions and pathophysiology of sepsis, Current Problems in Pediatric and Adolescent Health Care, vol. 43, no. 10, pp. 260-263.
Singer, M, Deutschman, CS, & Seymour, WS 2016, The Third International Consensus definitions for sepsis and septic shock (Sepsis-3), JAMA, vol. 315, no. 8, pp. 801-810.
This paper focuses on the discussion of the recent Bill regarding the introduction of sepsis protocols in New Jersey hospitals. No. 4678 state of New Jersey, 216th legislature sponsored by six assembly members presents a relevant review of the current health care problem associated with sepsis mortality and morbidity in adults and infants. The Bill declares that there is an urgent need to improve early recognition of the mentioned disease based on appropriate evidence-based diagnostics and treatment options. Considering that sepsis is one of the leading death-causing diseases in New Jersey as well as failure to address it, the selection of the identified Bill seems to be evident. Consistent with other interested stakeholders such as nurses, it is essential to note that the implementation of this Bill would enhance the existing clinical practice guidelines, enrich nursing profession, and clarify the role of nurses in addressing sepsis.
New Jersey Legislative Process and Difference Between the State and Assembly Versions of the Bill
The Bill under consideration, no. 4678 state of New Jersey, 216th legislature, requires hospitals to establish appropriate early sepsis recognition protocols. The review of this Bill shows that the legislative process adopted in New Jersey targets only the given state, while Congress covers all US states. The legislative branch of New Jersey creates laws in accordance with the emerging political, economic, social, and health care needs of citizens as well as adjusts old ones (“Bills, code, laws,” n.d.). The process of creating new bills consists of identifying assemblymen and assemblywomen sponsored the given bill, clarification of the bodies enacting it, the provision of the key points and aims, and the statement summarizing the Bill. The current Bill is sponsored by six assembly members from different districts of the state and enacted both by the General Assembly of the State of New Jersey and the Senate (“Assembly, no. 4678 state of New Jersey, 216th legislature,” 2015). There is only one version of the text of the Bill that is as introduced by the assembly members.
Rationale and Impact on Health and Welfare of the Public
Sepsis, severe sepsis, and septic shock are inflammatory conditions that result from a systemic response of a body to a bacterial infection. In such conditions, there is a critical decrease in tissue perfusion, while acute failure of many organs including lungs, kidneys, and liver can occur (New Jersey Hospital Association, n.d.). Pediatric sepsis is regarded as an invasive infection, usually bacterial, that develops in the neonatal period. Symptoms of sepsis are manifold and include a decrease in spontaneous activity, poor sucking during feeding, apnea, bradycardia, fluctuations in body temperature, respiratory distress, vomiting, diarrhea, bloating, and increased nervous excitability. Early diagnosis is important and requires knowledge of risk factors, especially in newborns with low birth weight. In response to the identified health care concerns, the mentioned Bill was introduced, thus promoting early sepsis detection and adequate treatment.
In order to justify the selection of no. 4678 state of New Jersey, 216th legislature, it is also essential to point out the impact of sepsis rates in New Jersey with regards to welfare of the public. Of the leading causes of death in the above state, sepsis takes the eighth place in adults, while it is the most common death cause in newborns. More to the point, as statistics shows, “New Jersey’s statewide inpatient severe sepsis mortality rate is close to 30 percent, with a national rate ranging from 20 to 50 percent” (New Jersey Hospital Association, n.d., para. 1). Currently, sepsis affects negatively patients’ health outcomes and also sets additional burden on costs of the treatment. Since the existing protocols cannot ensure adequate recognition of this disease both in adults and infants, it is essential to consider the Bill as a feasible and relevant solution to the problem. By mandating sepsis protocols, it is possible to achieve greater sepsis recognition and increase patients’ chances to survive. The implementation of the evidence-based interventions in combating sepsis is likely to significantly improve the above indicators and welfare of the public.
The strongest points of the Bill include a precise focus on the target populations and distinguishing between adults and infants, who need specific interventions. Another advantage is associated with providing the convincing rationale based on statistics from official sources for the adoption of sepsis protocols (“Assembly, no. 4678 state of New Jersey, 216th legislature,” 2015). The fact that it strives to support evidence-based interventions as well as consider ever-changing environment also demonstrates its benefits. Among the limitations, one may note that the Bill targets only the state of New Jersey and cannot be generalized to the whole US context. Another limitation refers to such an issue as control of sepsis protocols; namely, it is not stated how their quality would be verified. It would be better if the mentioned point was clearly identified in the text of the Bill to ensure long-term cooperation between the state’s hospitals and the department of health care. No financial statement is provided.
Personal Position and Healthcare Stakeholders’ Potential Views
In my point of view, sepsis is a life-threatening disease, attention to which should be increased in public health. In particular, it seems that the described no. 4678 state of New Jersey, 216th legislature would contribute to public health regarding sepsis identification and treatment. The review of the contemporary situation provided in the mentioned legislation shows that early administration of antibiotics may help patients to overcome it easier with fewer complications. As for severe sepsis and sepsis shock, I believe that the Bill would also improve the existing treatment methods by adjusting them in accordance with the most effective evidence-based clinical practical guidelines.
Other health care stakeholders may view this legislation as an attempt to make sepsis practice closer to its theory. For example, if I were to contact the American Nurses Association or New Jersey Hospital Association, I would more likely receive supportive responses from the representatives of these organizations. Since both of them pursue high-quality patient care, better patient outcomes and satisfaction, as well as evidence-based solutions, the Bill under consideration would be a great stimulus and foundation for achieving the above goals. If I were to contact specific interested stakeholders, I would ask for conversations with nurses as the direct care providers, who may critically assess the potential results of implementing the Bill through communicating with patients and evaluating their medical records. In other words, they may collect both objective and subjective data regarding patients with sepsis and analyze it accordingly, thus providing valuable evaluation and recommendations for further work on this health care issue. It should also be emphasized that these stakeholders would anticipate the decreased sepsis mortality rates, especially among infants.
Impact on Nursing and Nurses
Nursing profession aims at continuous improvement, and the given Bill would contribute to such an initiative. In particular, timely screening of severe patients who are at risk of infection, especially patients hospitalized in the intensive care units (ICUs), would be provided for early detection of clinical signs of sepsis and the earliest possible initiation of adequate antimicrobial and pathogenetic therapy. As for pediatric care, the Bill would impact positively by increasing survival rates in infants based on sepsis protocols. Since the latter would be based on recommendations based on evidence, patients with sepsis, severe sepsis, and septic shock would receive more appropriate nursing care. The profession of nursing would become more patient-centered and comprehensive, thus resulting in better patient health outcomes.
Specifically to nurses, the Bill would promote combined treatment of a physician and a nurse, leading to coherence of disease identification, treatment, and follow-up. The standardization of sepsis protocols would also direct nurses during the selection of proper strategies and techniques of working with a particular patient, be it an adult or an infant. In other words, nurses would receive clear guidelines on how to act in one or another situation while encountering patients with sepsis or the associated symptoms while the diagnosis is not yet specified. The Bill would be helpful to assist nurses in being more attentive and sensitive to patients’ needs, values, and expectations regarding health care services. In a broader sense, sepsis protocols introduced in New Jersey hospitals are likely to increase the level of awareness in care providers, patients, and health department. One may suggest that the implementation of no. 4678 state of New Jersey, 216th legislature would evolve new opportunities in detecting and treating sepsis in adult and pediatric care due to relevant guidelines.
Congressman, State Senator, and Two Assembly People in My District
Leonard Lance is a Congressman in my district 23 (Warren), and Michael J. Doherty is a State Senator. John DiMaio and Erik Peterson are Assembly People.
References
Assembly, no. 4678 state of New Jersey, 216th legislature. (2015). Web.
Bills, code, laws, regulation, & letter writing. (n.d.). Web.
New Jersey Hospital Association. (n.d.). Sepsis. Web.
The majority of medical practitioners and organizations specializing in the delivery of healthcare are concerned about the increased rate of mortality and morbidity among infants and mothers. For this reason, measures have been taken to ensure the reduction of child and maternal mortality rates. For instance, a study carried out by Bishai et al. (2016), showed that such rates have reduced from 43% in 1990 to 40% in 2010, which was attributable to the improvement in education, governance, income, technology, societal changes, and better healthcare. In spite of this, empirical evidence shows that neonatal sepsis adversely affects the efforts taken to ensure reduced cases of child and maternal mortality especially in developing countries. This paper provides an in-depth analysis of the subject of neonatal sepsis.
Background
Neonatal sepsis can be either early-onset or late-onset. In the majority of the cases, early-onset sepsis occurs following the possibility of the baby having acquired various microorganisms from the mother (Shah & Padbury, 2013). Some of the common microorganisms responsible for this category of sepsis include Escherichia coli, coagulase-negative Staphylococcus, Group B Streptococcus (GBS), Listeria monocytogenes, and Haemophilus influenzae. In spite of this, the prevalence of sepsis due to GBS has reduced over time because of the use of prenatal screening as well as other treatment protocol for Group B Streptococcus.
On the other hand, the late-onset sepsis develops later after a child is born, between 4 to 90 days. Often, this category of sepsis results from the caregiving environmental conditions. While a newborn is exposed to numerous microorganisms that can trigger sepsis, the Coagulase-negative Staphylococcus is known to be the major cause of neonatal sepsis.
Literature Review
Neonatal sepsis has been identified as a leading cause of term and preterm infants’ morbidity and mortality (Gebremedhin, Berhe, & Gebrekirstos, 2016; Bishai et al., 2016). In spite of the various measures taken to ensure advanced neonatal care, sepsis still accounts for a significant percentage of morbidity and mortality in infants having very low weight at birth. Neonatal sepsis’s signs and symptoms are not specific (Shah & Padbury, 2013). However, the most common ones experienced in children with sepsis include guaiac-positive stool, hepatomegaly, abdominal distention, bleeding problems, poor perfusion, bulging fontanel, seizures, hypotonia, irritability, feeding difficulties, apnea, and cyanosis among others.
The prevention and treatment of neonatal sepsis is challenging especially in developing countries. A study by Gebremedhin et al. (2016) indicated that the majority of the deaths of newborns in Ethiopia occur due to sepsis. In most of the cases, Gebremedhin et al. (2016) found out that such deaths are associated with factors such as the place of delivery, low birth weight, prematurity, prolonged rupture of membrane (PROM) and intrapartum fever, and the history of UTI/STI during the index pregnancy.
According to PATH (2015), it is recommedable to use either intravenous or intramuscular antibiotics for the treatment of neonatal sepsis. Nevertheless, such guidelines have not been useful since most of the healthcare settings lack hospital-based care. On the other hand, the World Health Organization (WHO) recommends the adoption of an outpatient treatment scheme to reduce child and maternal mortality rate due to neonatal sepsis. According to a study carried out by PATH (2015), it is possible to reduce infant deaths through the use of gentamicin. In spite of this, the only challenge in this case, would be the calculation of dosage.
Recent studies on neonatal sepsis have indicated that the examination of each category of sepsis can be effective in its prevention and treatment (Shah & Padbury, 2013; Schlapbach et al., 2011). As such, following the adoption and implementation of treatment protocol and prenatal screening, the prevalence rate of early-onset sepsis has decreased. The early detection as well as prompt treatment of neonatal sepsis remains to be a challenge due to the fact that the associated symptoms and signs of this illness are nonspecific. Numerous studies have been conducted to identify a number of diagnostic markers such as the cell surface markers, cytokines, procalcitonin, hematological indices, C-reactive protein, and acute phase reactants among others, which can be used in the detection of the signs and symptoms of neonatal sepsis (Shah & Padbury, 2013). In spite of this, there is a need for further researcher to establish a biomarker that is highly accurate.
Conclusion
Based on the analysis above, it is evident that child and maternal mortality is a common problem in healthcare nowadays. While interventions have been adopted to reduce the rate of morbidity and mortality rates of infants, neonatal sepsis has adversely affected such efforts. This is attributable to the fact that sepsis’s symptoms are nonspecific making their early detection and treatment a challenge. The adoption of technology in the healthcare sector has significantly increased the success rate regarding the prevention and treatment of neonatal sepsis. In spite of this, there is still much to be done to efficiently deal with this problem since more accurate and valid markers for the detection of signs and symptoms of neonatal sepsis are yet to be developed.
References
Bishai, D. M., Cohen, R., Alfonso, Y. N., Adam, T., Kuruvilla, S., & Schweitzer, J. (2016). Factors contributing to maternal and child mortality reductions in 146 low- and middle-income countries between 1990 and 2010. PLoS ONE, 11(1), e0144908. Web.
Gebremedhin, D., Berhe, H., & Gebrekirstos, K. (2016). Risk factors for neonatal sepsis in public hospitals of Mekelle City, North Ethiopia, 2015: Unmatched case control study. PLoS ONE, 11(5), e0154798. Web.
PATH. (2015). Gentamicin for treatment of neonatal sepsis — A landscape of formulation, packaging, and delivery alternatives. Seattle: PATH.
Schlapbach, L., Aebischer, M., Adams, M., Natalucci, G., Bonhoeffer, J., Latzin, P., … Latalet., B. (2011). Impact of Sepsis on Neurodevelopmental Outcome in a Swiss National Cohort of Extremely Premature Infants. PEDIATRICS, 128(2), e348-e357.
Sepsis is the most severe manifestation of various acute infections poses a significant challenge to the healthcare systems around the world. It is one of the leading causes of death in hospital settings and intensive care units (ICU) that is not associated with coronary heart diseases. The frequency of sepsis ranges from 250 to 350 cases per 100,000 patients in countries with advanced healthcare systems (Fleischmann 2016), such as Germany or the USA (Novosad et al. 2016). The purpose of this paper is to analyze the presented case study, give definitions and criteria for sepsis, identify signs and symptoms of septic shock, and give criteria for organ dysfunction using recent academic literature and the provided patient data.
Sepsis Definitions and Criteria
The Third International Consensus on sepsis and septic shock identifies sepsis as a life-threatening dysfunction caused by the body’s overwhelming and disproportionate response to an infection (Singer, Deutschman & Seymour 2016). For ease of clinical analysis and identification, it is recommended to use the Sequential Organ Failure Assessment table (SOFA). Should the patient receive an assessment score of two or higher, they are considered susceptible to sepsis.
Having a score or greater is associated with mortality rates greater than 10%, and ending with a score of 9 or more, which is associated with mortality rates of 95%. Typically, the criteria for the standard SOFA table include the analysis of the following parameters: respiration, coagulation, liver activity, cardiovascular activity, central nervous system responsiveness, renal activity, and urine output. However, the recently implemented screen called the qSOFA offers a different set of criteria for patient evaluation:
According to the case study, the patient fits the criteria for qSOFA on day 5, with low blood pressure (SBP below 100 mm Hg), high respiratory rate (over 22 breaths per minute), and altered mental state (Glasgow Coma Scale score below 15). However, a retroactive analysis shows that the patient likely developed sepsis during day 2, which is three days prior to the completion of qSOFA (Raith, Udy & Bailey 2017).
Signs and Symptoms of Septic Shock
The Third International Consensus on sepsis and septic shock identifies septic shock as a subset of sepsis, characterized by severe circulatory, cellular, and metabolic abnormalities associated with greater risks of death when compared to regular sepsis (Singer, Deutschman & Seymour 2016). During septic shock, the blood pressure in a patient falls dangerously low, meaning that the cardiovascular system is not providing enough oxygen-enriched blood to body tissues, which often results in organ failure and ischemia (Sagy, Al-Qaqaa & Kim 2013).
Symptoms of septic shock include (Mayr, Yende & Angus 2014):
Reduced temperature and paleness in arms and legs – explained by the lowered blood supply to the limbs.
Increased or decreased body temperature, caused by inflammation.
Altered mental status, which may present itself in the form of lightheadedness, dizziness, and confusion, caused by low blood pressure and decreased amounts of oxygen in the blood.
Little to no urine – due to renal and urinal systems malfunction or failure.
Shortness of breath, if septic shock affected the lungs.
The patient was earlier diagnosed with influenza type A H5N1 and yet had exhibited certain symptoms that are uncharacteristic to influenza in adults, such as low blood pressure and vomiting. Other symptoms that indicated sepsis was fever and lower tongue temperature caused by peripheral perfusion. Zach entered septic shock on day 5, with following symptoms and characteristics:
Motley skin
Respiratory ratio (PaO2/FiO2) deterioration from 210 to 84 as the patient entered severe ARDS
Refractory hypotension, cannot maintain MAP.
The patient showed signs of kidney injury and failure.
Hepatocyte injury and ischemia caused by hypoxia, hypoperfusion, and inflammatory cytokines.
Presence of gastrointestinal and metabolic issues.
Patient’s Organ Dysfunction at Day 2
It is hard to assess the extent of the patient’s organ dysfunction on Day 2, as he scored 3 points on the qSOFA test only during day 5. On day 2, the patient has prescribed Azithromycin against suspected bronchitis, which indicates that breathing and lungs were already suffering from dysfunction. Other dysfunctions include the levels of ScVO2 at 70% at the beginning of the treatment and then dropped due to inadequate cell utilization caused by mitochondrial dysfunction.
Urine output was poor from the beginning, below 50 milliliters per hour, while the target urine output is supposed to be over 1 ml per hour per kilogram of mass. This indicated that urinal and renal systems were likely suffering a dysfunction by day 2, which ended in renal failure by day 5. To summarize, the systems suffering dysfunction at day 2 were urinal systems, renal systems, and lungs.
Appropriateness of Resuscitation
The patient was administered 3 liters of resuscitation fluid – Albumin, over the course of 24 hours. Albumin is one of the standard solutions used for resuscitation for patients with sepsis and septic shock. It plays a critical role in regulating the volemic status, neutralizes free radicals in oxygen, and helps minimize any variations in PH level, which are often present during metabolic acidosis (Myburgh, & Mythen 2014).
So, in the patient’s case, the choice of the liquid is considered appropriate – especially considering that SAFE trials showed no statistical difference between 4% albumin solution and 0.9% NaCl solution (Caironi et al. 2014). Three liters is a decent quantity, as the majority of the patients rarely require more. However, there was an issue in how quick said fluid was provided – the patient received roughly 3 liters of fluids and measured lactate over 12 hours, which should have been done in three if followed the SS guidelines (Dellinger et al. 2012).
Some research, however, indicates that the use of fluid resuscitation in sepsis patients is used based on historical beliefs and incorrect and incomplete understanding of the pathophysiology of sepsis, which is one of the reasons for high mortality rates (Byrne & Van Haren 2017).
Conclusion
Sepsis is a very dangerous health complication with a high mortality rate, which can be triggered by inflammatory diseases. As demonstrated in this case study, the disease can avoid detection in earlier stages, as the current SOFA and qSOFA assessment systems require the disease to translate into later stages to be identified, which increases the risk of mortality and chances of a septic shock. In this case study, the patient developed sepsis by day 2 of hospital observation, yet the qSOFA identified it as sepsis only on day 5, and by that time the patient had already entered a state of septic shock with multiple organ dysfunction or failure, which ultimately lead to his death. Early detection of sepsis is paramount to the effectiveness of medical interventions aimed at stabilizing and treating the patient.
Reference List
Byrne, L & Van Haren, F 2017, ‘Fluid resuscitation in human sepsis: time to rewrite history?’, Annals of Intensive Care, vol. 7, no. 4, pp. 1-8.
Caironi, P et al 2014, ‘Albumin replacement in patients with severe sepsis or septic shock’, New England Journal of Medicine, vol. 370, pp. 1412-1421.
Dellinger, RP et al 2012, ‘Surviving sepsis campaign: international guidelines for the management of severe sepsis and septic shock’, Intensive Care Medicine, vol. 39, no. 2, pp. 65-228.
Fleischmann, C et al 2016, ‘Hospital incidence and mortality rates of sepsis’, Deutsches Arzteblatt International, vol. 113, no. 10, pp. 159-166.
Mayr, FB, Yende S, & Angus, DC 2014, ‘Epidemiology of severe sepsis’, Virulence, vol. 5, no. 1, pp. 4-11.
Myburgh, JA & Mythen, MG 2014, ‘Resuscitation fluids’, Survey of Anesthesiology, vol. 58, no. 4, pp. 164-165.
Novosad, SA et al 2016, ‘Vital signs: Epidemiology of sepsis: prevalence of health care factors and opportunities for prevention’, Weekly, vol. 65, no. 33, pp. 864-869.
Raith, EP, Udy, AA, & Bailey, M 2017, ‘Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the Intensive Care Unit’, Caring for the Critically Ill Patient, vol. 317, no. 3, pp. 290-300.
Sagy, M, Al-Qaqaa, Y, & Kim, P 2013, ‘Definitions and pathophysiology of sepsis’, Current Problems in Pediatric and Adolescent Health Care, vol. 43, no. 10, pp. 260-263.
Singer, M, Deutschman, CS, & Seymour, WS 2016, ‘The Third International Consensus definitions for sepsis and septic shock (Sepsis-3)’, JAMA, vol. 315, no. 8, pp. 801-810.
Sepsis is a health issue that affects people of all ages and leads not only to adverse outcomes and complications but also to death. Fortunately, innovative interventions can improve this situation. For instance, it is possible to use Meditech/SIRs tool (system inflammation response) for patients of a rehab unit. Identifying whether the elderly are likely to obtain the most benefit from this intervention, it is significant to find out the possible ways of preventing sepsis, types of infection that may lead to it, the most common symptoms, risk populations, and duration of life after diagnosing the illness.
Antibiotic Treatment
According to Shebabi et al. (2014), sepsis can be caused by various infections that are usually treated with antibiotics. Unfortunately, they do not always work effectively and improve the patient’s condition. What is more, in some situations, their intake turns out to provide an adverse influence on people’s health. The authors believe that a low procalcitonin cut-off on antibiotic prescription can have positive effects on the situation and currently, its value is underdetermined.
Conducting a quantitative research study with random sampling (which reduces possible biases and is advantageous for the research quality), they managed to find out that even though some improvement is observed, it fails to reach the expected 25% reduction in the duration of antibiotic treatment. Such findings prove that there is a necessity to continue the investigation and find out those tools that can reduce mortality in patients. Existing inconsistencies are faced because healthcare professionals and scientists are not yet aware of those interventions that will undoubtfully provide positive results. Lack of evidence is the main issue currently, but further research can provide an opportunity to identify the best intervention.
Early Intervention
Mohajer and Darouiche (2013) support the necessity to utilize those diagnostic methods that can provide an opportunity to diagnose sepsis at the initial stages so that the treatment can be started as early as possible. Just as Shebabi et al. (2014) they are focused on the opportunity to reduce the duration of antibiotic treatment. Mohajer and Darouiche (2013) emphasize that time management is imperative, so there is a reason to try using Meditech/SIRs tool for prediction and diagnosis because other assessment methods are not accurate enough to ensure positive health outcomes for all clients.
They are mainly interested in hospital-acquired device-related infections, which is critical for healthcare systems topic because they are meant to improve people’s health instead of worsening them. This limitation is not a disadvantage, but an opportunity to discuss the issue of sepsis in a narrowed environment with more detail.
Unlike their colleagues, Bate et al. (2013) discuss infections and sepsis in patients with cancer. This population is at high risk of mortality that is why those professionals who focus on their well-being do not usually pay much attention to sepsis, which is a great drawback. However, people’s condition after anticancer treatment is rather vulnerable. As routines prevention of sepsis can hurt their health, it is better to utilize those tools that can make diagnosing more accurate. In this framework, it is advantageous to investigate the influence of the Meditech/SIRs tool.
Mortality
After investigating the incidence, prevalence, and mortality connected with sepsis, Jawad, Lukšić, and Rafnsson (2012) concluded that it is vital for healthcare professionals to do their best to address this issue and reduce its magnitude. They emphasize that this condition is hard to define that is why medical staff often fails to provide timely interventions. What is more critical, it is connected with numerous other disorders, which makes diagnosing and treatment even more complex.
Regardless of the fact that healthcare is a sphere in the framework of which constant research studies are maintained, the issue of sepsis remains a global public health problem. On the basis of a literature review that includes the most authoritative and relevant articles, the authors concluded that new innovative interventions and approaches are required to achieve improvement. Thus, it is beneficial to discuss the value of the Meditech/SIRs tool.
The views of these researchers are supported by Cuthbertson et al. (2013). Professionals emphasize that sepsis often leads to adverse health outcomes. In order to find out what happens to people in 5 years after sepsis, they conducted a cohort study. Unfortunately, even though more than 400 participants were gathered for their research, less than half of them responded to the follow-up. Of course, this sample size is not enough to speak about broad generalizations, but it is enough to prove that particular findings are relevant for the selected population and trigger further research. It was revealed that patients face high ongoing mortality regardless of the currently used interventions. Thus, it is vital to improving diagnosing and treatment.
System Inflammation Response
Finally, Balk (2014) discusses SIRs, trying to identify whether they are still relevant and their treatment tools can be beneficial for patients. SIRs provides an opportunity to focus on responses to infections that is why they can be used when dealing with patients who have sepsis. SIRs tools are believed to be the most functional that is why they are advantageous for the understanding of mechanisms and pathophysiology. Previous research studies prove that they provide an opportunity to identify septic patients early so that timely treatment is provided. Unfortunately, this source is mainly based on a literature review and includes a lot of outdated sources. Thus, it would be advantageous to conduct a new study that will also discuss changes in patients’ conditions after sepsis treatment.
References
Balk, R. (2014). Systemic inflammatory response syndrome (SIRS): Where did it come from and is it still relevant today? Virulence, 5(1), 20-26.
Bate, J., Gibson, F., Johnson, E., Selwood, K., Skinner, R., & Chisholm, J. (2013). Neutropenic sepsis: Prevention and management of neutropenic sepsis in cancer patients (NICE guideline CG151). Archives of Disease in Childhood: Education and Practice Edition, 98(2), 73-75.
Cuthbertson, B. H., Elders, A., Hall, S., Taylor, J., MacLennan, G., Mackirdy, F., & Mackenzie, S. J. (2013). Mortality and quality of life in the five years after severe sepsis. Critical Care, 17(2), 1-8.
Jawad, I., Lukšić, I., & Rafnsson, S. B. (2012). Assessing available information on the burden of sepsis: Global estimates of incidence, estimates, and mortality. Journal of Global Health, 2(1), 1-9.
Mohajer, M. A., & Darouiche, R. O. (2013). Sepsis syndrome, bloodstream infections, and device-related infections. Medical Clinics of North America, 96(6), 1203-1223.
Shebabi, Y., Sterba, M., Garrett, P. M., Rachakonda, K. S., Stephens, D., Harrigan, P., … the ANZICS Clinical Trials Group. (2014). Procalcitonin algorithm in critically ill adults with undifferentiated infection of suspected sepsis: A randomized control trial. American Journal of Respiratory and Critical Care Medicine, 190(10), 1102-1110.
Evidence-based practice is a crucial approach to finding the best solutions for patient outcomes. In evidence-based decision making, the core role is given to patients’ choices and actions (Ellis, 2016). By using this methodology, medical practitioners are able to find the most efficient ways of treatment their patients. Ellis (2016) emphasizes the role of evidence-based practice by mentioning that not only does it promote patients’ health, but also broadens the nurses’ professional outlook and prepares them for the challenges that are inevitable in their work.
A Summary of the Area of Interest
Sepsis presents a crucial area of investigation as it is one of the most serious health conditions that may lead to fatal outcomes. Identifying the most efficient ways of diagnosis and treatment of sepsis in elderly patients is crucial because the immune system of this age group is rather weak, and the consequences of untimely diagnosis may be dramatic (Mohajer & Darouiche, 2013). Not only does sepsis cause high levels of morbidity and mortality but it also uses a lot of healthcare resources (Cuthbertson et al., 2013). Therefore, sepsis presents a rather significant area of interest.
Research Questions
Based on the area of interest, the following research questions may be suggested:
What are the possible ways of preventing sepsis?
What types of infection may lead to sepsis, and which of them is the most dangerous?
What are the most common symptoms of sepsis?
What are the risk populations for sepsis?
How long can a person live after having been diagnosed with sepsis?
To analyze the research questions for feasibility, I considered the possibility of finding an answer to each of them without spending too much time and resources. With the help of Google Scholar search engine, I was able to identify a number of scholarly articles and books containing the data that could be used to answer my research questions. For instance, Bate et al. (2013) investigate some of the ways of sepsis prevention.
Shebabi et al. (2014) research the kind of infection causing sepsis. The symptoms of sepsis and other blood infections are discussed in the article by Mohajer and Darouiche (2013). Risk populations, prevalence, and mortality of sepsis are analyzed in the article by Jawad, Lukšić, and Rafnsson (2012). Cuthbertson et al. (2013) discuss the peculiarities of patients’ lives after surviving sepsis.
The questions’ feasibility would not be so easily proved if I were to conduct research in a real-life situation to give an answer to them. However, research of scholarly articles is an accessible way of finding answers to the questions.
PICOT Question
The preliminary PICOT question is, what is the effect of sepsis recovery time in elderly population compared to the young adults?
P – Population: elderly patients of a rehab unit diagnosed with sepsis
I – Intervention: screening the patients by utilizing Meditech/SIRs tool (system inflammation response)
C – Comparison: young adult patients of a rehab unit diagnosed with sepsis
O – Outcome: decreased mortality
T – Timeframe: during patients’ stay at hospital
The population chosen for research is elderly people as they are one of the most fragile population groups. The suggested intervention is aimed at identifying sepsis in patients as soon as possible so that productive methods of treatment may be employed timely. The outcomes in elderly patients will be compared to those of young adults so that a conclusion could be made about the efficiency of the intervention for various age groups. The ultimate outcome of the project is decreased mortality. When sepsis is not diagnosed on time, there may be a threat to the patient’s life. Thus, by timely identification of the problem, it will become possible to save more patients. The timeframe for the project is hospital stay: there is no possibility to perform this intervention before or after the person is admitted to a hospital.
Keywords and a Rationale for Their Choice
To conduct a literature search for my PICOT question, the following keywords may be used: sepsis prevention, sepsis causes, sepsis symptoms, sepsis in elderly, sepsis risk populations, surviving sepsis, sepsis intervention, sepsis recovery time, sepsis intensive care, and sepsis treatment.
The rationale for choosing these keywords is associated with the possibility of the articles containing them to answer the PICOT question. The sources containing data on sepsis risk populations and sepsis in elderly will help to outline the major risks for elderly patients. Articles analyzing sepsis interventions, survival rates, and recovery time will be useful for predicting the outcomes of my intervention. Scholarly papers on sepsis causes, symptoms, and prevention will help to identify the ways of organizing a patient education plan.
Conclusion
Evidence-based practice presents a major source of finding the most effective methods of treatment. The ways of preventing and dealing with sepsis need thorough attention, as it is one of the most serious health conditions. The proposed intervention is aimed at analyzing the efficiency of diagnostic methods for elderly patients. Decreased mortality and morbidity levels are the ultimate purpose of the intervention.
References
Bate, J., Gibson, F., Johnson, E., Selwood, K., Skinner, R., & Chisholm, J. (2013). Neutropenic sepsis: Prevention and management of neutropenic sepsis in cancer patients (NICE guideline CG151). Archives of Disease in Childhood: Education and Practice Edition, 98(2), 73-75.
Cuthbertson, B. H., Elders, A., Hall, S., Taylor, J., MacLennan, G., Mackirdy, F., & Mackenzie, S. J. (2013). Mortality and quality of life in the five years after severe sepsis. Critical Care, 17(2), 1-8.
Ellis, P. (2016). Evidence-based practice in nursing (2nd ed.). Thousand Oaks, CA: SAGE.
Jawad, I., Lukšić, I., & Rafnsson, S. B. (2012). Assessing available information on the burden of sepsis: Global estimates of incidence, estimates, and mortality. Journal of Global Health, 2(1), 1-9.
Mohajer, M. A., & Darouiche, R. O. (2013). Sepsis syndrome, bloodstream infections, and device-related infections. Medical Clinics of North America, 96(6), 1203-1223.
Shebabi, Y., Sterba, M., Garrett, P. M., Rachakonda, K. S., Stephens, D., Harrigan, P., … the ANZICS Clinical Trials Group. (2014). Procalcitonin algorithm in critically ill adults with undifferentiated infection of suspected sepsis: A randomized control trial. American Journal of Respiratory and Critical Care Medicine, 190(10), 1102-1110.
Appropriate charts such as the Gantt chart and the Work-Breakdown Structure (WBS) help time-manage the project, creating not only an atmosphere of collective responsibility through task assignment but also setting clear due dates. The corresponding appendices A and B deal with the division of the WBS and the Gantt chart per the identified responsibilities. Identifying and visualizing the tasks and outputs of the project aimed at computerizing sepsis protocol at Northwell Health in this way permits the proper project management execution.
Project’s Tasks and Deliverables
Delivering a final product only becomes possible when the created plan deals with and meets smaller goals throughout its implementation. As deliverables may be “tangible or intangible part of the development process,” their apperception within the project went beyond the scope a list of instruments provided to nurses for sepsis computerization (Sipes, 2016, p. 86). The plan was therefore developed with the requirement for provision of services, such as nurse IT training and feedback lines, in mind.
Thus, the identified deliverables are the practicum project plan, project scope statement, project charter, hardware, software, training, lines of feedback, as well as qualitative and quantitative research results. Altogether, these deliverables align with the task of computerizing sepsis protocol and creating an electronic procedure of sepsis treatment. While the creation of the plan itself is the primary goal of the project, the second stage is related to the delivery of assigned outputs.
The tasks of the project closely mirror the outlined goals, resulting in a dependent relationship between them, with changes in one sphere resulting in changes in the other. An essential step in task assignment and deadline identification became their correspondence and alignment with the actual time possibilities within teams (Harris, 2016). Therefore, close communication of team leaders and inter-team communication are necessary for the efficient implementation of the project.
Work-Breakdown Structure
The WBS makes possible assigning those responsible and directly contacting those answerable for aspects of project development and avoiding unnecessary confusion concerning the assigned goals. Without breaking down bundles into smaller tasks, it is not possible to make teams responsible for result deliverance and thus puts the project at an executive disadvantage (Sipes, 2016). The roles and responsibilities assigned over the scope of the WBS become a crucial step to project execution.
Gantt Chart
A Gantt chart helps to envision the moments where the identified project tasks will overlap, creating possible drawbacks and issues. Sowan (2015) outlines it as “a project management bar chart that illustrates phases and activities of the change, resources required (e.g., cost, time), and personnel involved,” and additionally states its project significance (p. 20). Thus, the Gantt chart as a visual representation of the project deadlines becomes another stepping-stone in achieving project success.
Conclusion
While it is possible to execute a project without time-management charts, it is evident that their creation streamlines the project into achieving at least the appropriate tasks in the proper sequence. Deadlines and responsibilities become the core of the project, without which its application becomes impossible in a timely fashion. Thus, the WBS and Gantt chart become indispensable aides of the sepsis computerization project at Northwell Health.
References
Harris, J. (2016). Key foundations of successful project planning and management. In J. L. Harris, L. Roussel, P. L. Thomas, & C. Dearman (Eds.), Project planning and management: A guide for nurses and interprofessional teams (2nd ed.) (pp. 1-30). Burlington, MA: Jones & Bartlett Learning.
Sipes, C. (2016). Project management for the advanced practice nurse. New York, NY: Springer Publishing Company.
Sowan, A. K. (2015). Applying IT-related business process reengineering in an informatics course for graduate nursing programs. Archives of Nursing Practice and Care, 1(1), 16-24. Web.
Septic shock is a life-threatening health condition that occurs in septic patients when they develop metabolic complications and extreme hypotension. Elodie is a 14-year-old septic patient who has been diagnosed with acute lymphoblastic leukemia (ALL) and has undergone chemotherapy sessions and transplantation treatment recently. Her current medical problems include low SpO2 levels (91%) and tachypnea (21 breaths/min). Impaired gas exchange, which is Elodie’s priority health problem, is to be addressed using evidence-based nursing interventions, such as supplemental oxygen and proper positioning. The problem statement is as follows: impaired gas exchange related to sepsis (related factors) as evidenced by hypoxemia and abnormal breathing (defining characteristics). The paper’s objective is to delve into evidence-based care in the management of impaired gas exchange. The ability to do so can significantly increase the chances of success when solving complex cases.
Health Issues
Elodie faces multiple health issues apart from ALL, and her physical condition has deteriorated recently. In the majority of cases, adverse health events occur after a period of abnormal changes in vital signs (Mok, Wang, Cooper, Ang, & Liaw, 2015). Monitoring vital signs is the task of paramount importance when it comes to high-risk patients, but it is sometimes neglected. In Elodie’s medical case, the first symptom of clinical deterioration associated with her current problem (sepsis) is presented by increases in respiratory rate (21 breaths per minute) and the signs of abnormally increased efforts when breathing.
In patients diagnosed with severe sepsis and septic shock, lasting tachypnea or respiratory rate exceeding 20 breaths per minute is a common predictor of mortality rates (Seo et al., 2016). In sepsis, the occurrence of tachypnea is regarded as a compensatory mechanism linked with metabolic acidosis (Seo et al., 2016). Increased work of breathing in the cases of septic shock is often caused by tissue edema leading to impaired oxygenation (Russell, Rush, & Boyd, 2018). Checking the airway for foreign materials and keeping the patient’s airway open is critically important in the case. Since the discussed sign of deterioration is closely associated with mortality in sepsis, it should be closely monitored.
The second symptom of deterioration is the level of oxygen saturation. The human body’s normal functioning is strictly dependent on the balance of oxygen in the blood, and any abnormalities lead to a number of pathological conditions. According to the case details, Elodie’s SpO2 is 91% on 2L via NP. Importantly, normal levels of oxygen saturation vary between 95% and 100% (Ciklacandir, Mulayim, & Sahin, 2017). Elodie’s blood oxygen level is not extremely low to indicate the presence of severe hypoxemia. However, keeping its level within the normal range is a high-priority task for the healthcare team. In patients with sepsis, measures to normalize blood pressure and blood oxygenation levels are hypothesized to reduce the risks of developing multiple organ dysfunction syndromes (Ostergaard et al., 2015). Sepsis is the condition characterized by rapid decreases in blood pressure, causing reductions in tissue perfusion pressure (Perner et al., 2016). In its turn, abnormal tissue perfusion contributes to hypoxia, the condition that is also caused by hypoxemia. The low level of oxygen in the blood is indicative of clinical deterioration and needs to be addressed to prevent its detrimental outcomes.
Impaired Gas Exchange
The priority problem associated with Elodie’s health situation is impaired gas exchange. This dangerous condition is defined as “an excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane” (Pascoal et al., 2015, p. 492). The nursing diagnosis in question belongs to the number of respiratory health problems that affect different age cohorts. Elodie’s symptoms indicative of this problem include general weakness, confusion, diaphoresis or excessive sweating, and difficulty breathing (Pascoal et al., 2015; Pascoal et al., 2018). Other symptoms linked to the patient’s medical details are hypoxemia and breathing abnormalities, such as increased respiratory rates (Pascoal et al., 2015). The priority problem in question occurs in multiple cases, including respiratory infections and pulmonary diseases in extremely obese patients.
Impaired gas exchange can be defined as the clinical priority since this condition causes tissue hypoxia. Based on the case, the patient is extremely close to developing severe hypoxemia – it is diagnosed when SpO2 levels fall below 90% (Ottestad, Kasin, & Hoiseth, 2018). Just like hypoxemia that can become more pronounced in Elodie’s case, impaired gas exchange often results in severe hypoxia (Bar-Or et al., 2015; Ottestad et al., 2018). The latter is the condition in which there is an inadequate oxygen supply at the tissue organizational level. Since it causes tissue hypoxia, impaired gas exchange often contributes to impairments in different systems of organs (Ziesmann & Marshall, 2018). Multiple organ failure that occurs in septic patients due to hypoxia is specifically dangerous when it comes to individuals with cancer such as Elodie.
Continuing on the priority problem, the lack of efforts to address impaired gas exchange in the discussed situation may weaken Elodie’s immune system even more. Due to the risks of total organ failure, hypoxia, as has been shown in a variety of studies, is associated with more frequent fatal outcomes in intensive care units (Kiers et al., 2016). As a consequence of impaired gas exchange and hypoxemia, tissue hypoxia affects the immune system, whereas oxygenation is supposed to have favorable immunologic effects (Kiers et al., 2016). As is clear from the patient’s medical records, she has been diagnosed with ALL and undergone chemotherapy treatment. Apart from cancer-related fatigue, chemotherapy typically provides an immunosuppressive effect (Brandolini, D’Angelo, Antonosante, Allegretti, & Cimini, 2019). Due to Elodie’s cancer and treatment history, her immune system is likely to be stressed. For instance, several studies have found that hypoxia contributes to cancer cells’ capacity for survival and resistance to anti-cancer drugs in ALL (Petit et al., 2016). Thus, failure to prevent the adverse outcomes of impaired gas exchange can become the cause of further immune stress, which is particularly dangerous given the patient’s previous diagnosis.
Role of Nursing
The first nursing intervention that can be implemented into practice is oxygen therapy. Nurses deliver it in collaboration with other members of the healthcare team. In the majority of life-threatening conditions, hyperoxia caused by oxygen therapy tends to worsen damage to tissues and organs, but there are mixed findings showing the intervention’s negative results in sepsis (Vincent, Taccone, & He, 2017). To prevent rapid increases in blood oxygen levels, the team can adhere to a conservative protocol for the use of supplemental oxygen (Girardis et al., 2016). Thus, the target level of oxygen saturation will vary between 94% and 98% (Girardis et al., 2016).
Concerning nurses’ role, these specialists are not supposed to initiate the use of oxygen therapy without doctors’ request when it comes to emergency cases. The team will evaluate Elodie’s ability to breathe without help to choose between simple facial masks, nasal cannulas, and positive pressure devices for oxygen delivery (Rabbat, Blanc, Lefebvre, & Lorut, 2016). If delivered correctly, oxygen therapy allows normalizing blood oxygen saturation and reducing the risks of tissue hypoxia and further complications, which makes it the best option in the case (Tipping & Nicoll, 2018). In general, the intervention’s effectiveness will be measured with the help of regular blood gas tests. However, vital signs monitoring and visual assessment will also provide helpful information concerning the patient’s condition.
The use of therapeutic positions is the second intervention that can be helpful in Elodie’s case. The intervention involves nurse-initiated use of Fowler’s position for different purposes related to patient management. In critically ill patients, low- or semi-Fowler’s position (15-45 degrees) is associated with improvements in oxygen saturation and blood pressure (Anchala, 2016). Such outcomes result from increases in thoracic capacity and diaphragmatic descent (Anchala, 2016). High Fowler’s position (60-90 degrees) is beneficial to patients who receive oxygen treatment or experience breathing difficulties (Dirkes & Kozlowski, 2019). The position in question can also be helpful during feeding. In patients with respiratory issues, Fowler’s position is much more appropriate compared to the supine position (Kubota, Endo, Kubota, Ishizuka, & Furudate, 2015). There is a large body of evidence demonstrating strong associations between Fowler’s position and improvements in the quality of life in patients with serious health issues (Kubota et al., 2015). Judging from modern researchers’ claims, the selected intervention is likely to improve the positive outcomes of oxygen delivery and be helpful during the subsequent health management in Elodie’s situation.
To implement the mentioned intervention, the nurse will select the type of Fowler’s position depending on Elodie’s current needs and treatment methods being utilised. The ways to measure this intervention’s effectiveness are not widely discussed in modern academic literature since it is aimed at achieving a wide range of results. However, the physiological advantages of Fowler’s position discussed in modern studies can be taken into account (Anchala, 2016; Kubota et al., 2015). Thus, when working with Elodie, it will be possible to rely on beneficial changes in SpO2 levels and blood pressure to evaluate the results and take corrective action if needed.
Given Elodie’s current physical condition, the healthcare team is to concentrate on making timely and justified decisions to improve her ability to breathe and other health indicators. However, her and her family’s psychosocial issues should also be considered to implement humanitarian values into practice (Kocher & Ayanian, 2016). In particular, the patient-centred approach has to inform the healthcare team’s ethical decision-making (Kocher & Ayanian, 2016). Judging from the case, one of the main problems is the emotional condition of the patient’s mother. Given her daughter’s present health state and primary diagnosis, the woman’s anxiety is absolutely understandable. However, since Elodie’s physical and mental well-being are the main priorities at the moment, the girl’s emotional suffering is strongly discouraged. With that in mind, it is instrumental to talk to the patient’s mother and explain that everything is being done to improve Elodie’s condition. Her mother is also to be encouraged to conceal her negative feelings and stay as calm as possible when visiting Elodie. Therefore, the patient will be protected from stress and negative emotions impacting her mental well-being.
Conclusion
Finally, having analysed the signs of clinical deterioration, such as tachypnea and SpO2 levels indicating hypoxia, the healthcare team is to implement measures helping to address impaired gas exchange. The recommended interventions, including oxygen therapy and proper patient positioning, are expected to reduce the risks of tissue hypoxia and improve the girl’s general well-being. The use of the patient-centred approach to care provision should also involve educating Elodie’s relatives on how to protect her from anxiety.
References
Anchala, A. (2016). A study to assess the effect of therapeutic positions on hemodynamic parameters among critically ill patients in the intensive care unit at Sri Ramachandra Medical Centre. Journal of Nursing Care, 5(348), 2167-1168.
Bar-Or, D., Carrick, M. M., Mains, C. W., Rael, L. T., Slone, D., & Brody, E. N. (2015). Sepsis, oxidative stress, and hypoxia: Are there clues to better treatment? Redox Report, 20(5), 193-197.
Brandolini, L., D’Angelo, M., Antonosante, A., Allegretti, M., & Cimini, A. (2019). Chemokine signaling in chemotherapy-induced neuropathic pain. International Journal of Molecular Sciences, 20(12), 1-13.
Ciklacandir, S., Mulayim, N., & Sahin, S. (2017). Low cost real-time measurement of the ecg, spo2 and temperature signals in the Labview environment for biomedical technologies education. The Eurasia Proceedings of Educational & Social Sciences, 7, 162-168.
Dirkes, S. M., & Kozlowski, C. (2019). Early mobility in the intensive care unit: Evidence, barriers, and future directions. Critical Care Nurse, 39(3), 33-42.
**Girardis, M., Busani, S., Damiani, E., Donati, A., Rinaldi, L., Marudi, A.,… Singer, M. (2016). Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: The oxygen-ICU randomized clinical trial. JAMA, 316(15), 1583-1589.
The study compares the outcomes of two approaches to oxygen treatment. It proves that conservative therapy is associated with decreased mortality rates in ICU. Conservative therapy involves the SpO2 target levels of 94-98%.
Kiers, H. D., Scheffer, G. J., van der Hoeven, J. G., Eltzschig, H. K., Pickkers, P., & Kox, M. (2016). Immunologic consequences of hypoxia during critical illness. Anesthesiology: The Journal of the American Society of Anesthesiologists, 125(1), 237-249.
Kocher, K. E., & Ayanian, J. Z. (2016). Flipping the script – A patient-centered approach to fixing acute care. New England Journal of Medicine, 375(10), 915-917.
**Kubota, S., Endo, Y., Kubota, M., Ishizuka, Y., & Furudate, T. (2015). Effects of trunk posture in Fowler’s position on hemodynamics. Autonomic Neuroscience, 189, 56-59.
The article is significant since it contributes to knowledge on the benefits of Fowler’s position. The study proves the quality-of-life improvements resulting from the method. Its use is associated with differences in blood pressure and heart rate.
Mok, W., Wang, W., Cooper, S., Ang, E. N. K., & Liaw, S. Y. (2015). Attitudes towards vital signs monitoring in the detection of clinical deterioration: Scale development and survey of ward nurses. International Journal for Quality in Health Care, 27(3), 207-213.
Ostergaard, L., Granfeldt, A., Secher, N., Tietze, A., Iversen, N. K., Jensen, M. S.,… Jespersen, S. N. (2015). Microcirculatory dysfunction and tissue oxygenation in critical illness. Acta Anaesthesiologica Scandinavica, 59(10), 1246-1259.
Ottestad, W., Kasin, J. I., & Hoiseth, L. O. (2018). Arterial oxygen saturation, pulse oximetry, and cerebral and tissue oximetry in hypobaric hypoxia. Aerospace Medicine and Human Performance, 89(12), 1045-1049.
**Pascoal, L. M., de Oliveira Lopes, M. V., Chaves, D. B. R., Beltrão, B. A., Nunes, M. M., da Silva, V. M., & de Sousa Freire, V. E. C. (2018). Impaired gas exchange: prognostic clinical indicators of short-term survival in children with acute respiratory infection. International Journal of Nursing Knowledge, 30(2), 87-92.
The source establishes clear links between hypoxemia and impaired gas exchange (IGE). The consequences of hypoxemia are discussed in a detailed manner. IGE’s significant impact on mortality rates is thoroughly discussed.
**Pascoal, L. M., Lopes, M. V. D. O., Chaves, D. B. R., Beltrão, B. A., Silva, V. M. D., & Monteiro, F. P. M. (2015). Impaired gas exchange: Accuracy of defining characteristics in children with acute respiratory infection. Revista Latino-Americana de Enfermagem, 23(3), 491-499.
The study delves into the manifestations of impaired gas exchange in children. Hypoxemia’s critical role in making the diagnosis is established. In addition, diagnostic criteria are discussed in a detailed manner.
Perner, A., Gordon, A. C., De Backer, D., Dimopoulos, G., Russell, J. A., Lipman, J.,… Walsh, T. (2016). Sepsis: Frontiers in diagnosis, resuscitation and antibiotic therapy. Intensive Care Medicine, 42(12), 1958-1969.
**Petit, C., Gouel, F., Dubus, I., Heuclin, C., Roget, K., & Vannier, J. P. (2016). Hypoxia promotes chemoresistance in acute lymphoblastic leukemia cell lines by modulating death signaling pathways. BMC Cancer, 16(1), 1-17.
The study explains the links between hypoxia and cancer cells’ resistance to anti-leukaemia drugs. Hypoxia is demonstrated to contribute to such cells’ ability to survive. The findings have implications to measures to improve cancer treatment.
Rabbat, A., Blanc, K., Lefebvre, A., & Lorut, C. (2016). Nasal high flow oxygen therapy after extubation: The road is open but don’t drive too fast! Journal of Thoracic Disease, 8(12), e1620.
**Russell, J. A., Rush, B., & Boyd, J. (2018). Pathophysiology of septic shock. Critical Care Clinics, 34(1), 43-61.
The study explains the features of septic shock, including hypotension and heart issues. The condition’s pathophysiology and appropriate management options (heart rate normalisation) are discussed. Pathophysiologicial considerations are used to conceptualise new treatment goals and approaches.
**Seo, M. H., Choa, M., You, J. S., Lee, H. S., Hong, J. H., Park, Y. S.,… Park, I. (2016). Hypoalbuminemia, low base excess values, and tachypnea predict 28-day mortality in severe sepsis and septic shock patients in the emergency department. Yonsei Medical Journal, 57(6), 1361-1369.
The source sheds light on the health outcomes of sepsis. In particular, it proves tachypnea to be among the basic predictors of mortality in severe sepsis. The results indicate the need for urgent measures in septic patients with abnormal breathing.
Tipping, R., & Nicoll, A. (2018). Mechanisms of hypoxaemia and the interpretation of arterial blood gases. Surgery, 36(12), 675-681.
**Vincent, J. L., Taccone, F. S., & He, X. (2017). Harmful effects of hyperoxia in postcardiac arrest, sepsis, traumatic brain injury, or stroke: The importance of individualized oxygen therapy in critically ill patients. Canadian Respiratory Journal, 2017, 1-7.
The study is devoted to the unwanted effects of oxygen therapy. In patients with severe conditions, hyperoxia can lead to further complications. To avoid them, target blood oxygen levels are to be selected after complex case evaluations.
Ziesmann, M. T., & Marshall, J. C. (2018). Multiple organ dysfunction: The defining syndrome of sepsis. Surgical Infections, 19(2), 184-190.
Sepsis is a serious healthcare condition that affects many patients admitted in the emergency department. It arises from the body’s systematic response to infection. It is also defined as the organized inflammatory response initiated by an infection in the host (Kleinpell, Aitken & Schorr, 2013). It affects pediatric, neonatal, and adult patients. Severe sepsis is one of the health conditions characterized by complications arising from acute organ dysfunctions. In most cases, the patients require organ system support. The support is provided through vasopressin therapy and mechanical ventilation.
Severe and shock sepsis are associated with high mortality rates due to their high incidences and hospitalization rates. The situation persists in spite of improvements in the management of infections. There are various cellular actions that take place as a result of inflammation. One of them is weakened perfusion (Kleinpell & Schorr, 2014). The complications can lead to organ failure (Kleinpell & Schorr, 2014).
In this paper, the author will analyze the effective use of sepsis protocols in the emergency department. The analysis is carried out in the context of evidence-based practice in nursing and healthcare. To this end, the various protocols associated with sepsis will be reviewed. The impacts of this approach on nursing, delivery of care, expenditure, and outcomes will also be evaluated. Six articles will be reviewed to provide this information. The data in the six primary resources will be supported by information from other reports. Improving the effectiveness of the protocols put in place in the emergency department can help to save lives. In addition, the mortality rates associated with sepsis can be reduced (Czura & Distlerath, 2010).
Synthesis of Articles
Protocols in the Emergency Department
According to Patocka, Turner, Xue, and Segal (2014), there are a number of procedures used to manage sepsis in a healthcare setting. The view is supported by Sweet et al. (2010) in their study. The various protocols are highlighted in this research undertaking. According to Sweet et al. (2010), these elements touch on time, treatment, data collection, and monitoring of the affected patients. For example, when a patient first arrives in the hospital, operational procedures dictate the steps to be followed in diagnosing them. If the protocol is followed effectively, sepsis can be diagnosed at an early stage. As such, treatment can be started immediately.
At times, it is important to make changes to a given protocol to enhance its effectiveness. To achieve this, it is important to put in place an implementation plan to outline the changes to be made to the already existing protocols and sepsis care initiatives (Turi & Ah, 2013). The next step involves assembling key stakeholders responsible for the execution of the new procedures.
Sepsis Protocols and Evidence-Based Nursing in the Emergency Department
A synthesis of the 6 articles reveals the following as some of the procedures that can be used to manage sepsis in the emergency department:
Sepsis bundles
One of the protocols that can greatly reduce the mortality rates associated with this condition entails sepsis bundles. Effective adherence to the recommendations made in the bundles can significantly bring down the number of deaths attributed to sepsis. The phenomenon affects the quality of nursing care. The reason is that the practitioners are involved in the collection of blood samples from patients. Among others, the samples are used to measure levels of lactate in the body. In addition, nursing practitioners are involved in the collection and management of cultures, as well as the administration of antibiotics and vasopressor therapy (Patocka et al., 2014).
According to Turi and Ah (2013), the failure to adhere to the protocols laid down in the sepsis bundles can lead to a number of negative consequences. The view by Turi and Ah (2013) is supported by Wira, Dodge, Sather, and Dziura (2014). According to Wira et al. (2014), the negative impacts include failure to identify sepsis. If the condition is not diagnosed early enough, then the initiation of sepsis bundles is delayed. The situation may lead to the death of the patient or development of a severe form of sepsis.
Protocols followed in the emergency department in relation to bundles can be improved to include thorough and routine screening for potentially infected patients. Diagnosis of severe sepsis will help in the implementation of the correct therapy (grade IC). Sepsis bundles can be made more effective by ensuring that the entire control unit works as a multidisciplinary team to promote the achievement of interventional goals (Turi & Ah, 2013). The team is made up of physicians, nurses, pharmacists, respiratory experts, and dieticians.
Educational procedures
Another protocol that can be used to manage sepsis in the emergency department involves education. New and efficient ways and methods of doing things always emerge after a period of time. As such, it is wise to ensure the protocol on education is effectively implemented (Kleinpell & Schorr, 2014). The assertion is supported by Kleinpell et al. (2013), who state that education helps the caregivers and nurses to acquaint themselves with emerging processes and protocols.
Education may be delivered in various ways and forms. Such strategies of delivery include brief learning sessions, conferences, clubs, and other forms of interaction (Sweet et al., 2010). Turi and Ah (2013) support the opinions held by Sweet et al. (2010) with regards to education as a protocol. According to Turi and Ah (2013), the educational sessions should address such issues as the assessment process, management of care, and adherence to time sensitive clusters. Members of staff should be made to understand the negative outcomes associated with the failure to implement emerging ideas and technology, especially in relation to evidence-based practice (Melnyk & Fineout-Overholt, 2010). For education to be more effective, posters, pocket cards, and treatment algorithms should be provided to the learners.
Data collection
Sepsis can also be controlled more effectively by using data collected from previous exercises carried out to manage the condition. In their article, Kleinpell et al. (2013) argue that information on standard definitions can be accessed from various sepsis campaign websites. Kleinpell and Schorr (2014) agree with this assertion by stating that improving data collection protocols may lead to the availability of real-time information on how to deal with this condition.
For example, some hospitals work on feedback from patients after the individual has already been discharged. However, the information is made available to the stakeholders after a very long time. The procedure can be improved by collecting data and feedback from patients when they are still in the hospitals. The respondents can be interviewed during feeding time or when the nursing practitioner is doing bedside rounds (Wira et al., 2014).
Discussions with the clinical team while the patient is still in the hospital are effective in developing and understanding the process of care. The strategy can be used to improve the experiences of subsequent patients. Improving data collection protocols may help in the identification of process malfunctions (Sweet et al., 2010). As such, individuals in key leadership positions, together with members of the core team, can pool resources to discuss alternative interventions (Wira et al., 2014).
Support and adjunctive therapy
Different fluids can be used to resuscitate patients with severe sepsis. The recommended first line fluid for grade IB patients is crystalloids (Patocka et al., 2014). Albumin is used when patients require a substantial amount of crystalloids. To enhance the effectiveness of this protocol, clients who have being resuscitated should be closely monitored. The aim is to evaluate their responsiveness to fluid changes and administration (Lopez-Bushnell, Demaray & Jaco, 2014). Vitals signs, such as changes in pulse pressure and stroke volume should be monitored. Administration of fluids alone may not help the patient.
Nursing professionals optimize resuscitation by monitoring the reaction of the patient to the fluids administered (Sweet et al., 2010). If no improvements are noted, the administration of fluids should be discontinued with immediate effect. Alternative methods of improving hemodynamic function should be used. Wira et al. (2014) are in agreement with this view. According to Wira et al. (2014), optimization of hemodynamics is one of the factors informing the management of sepsis patients in emergency departments.
Effective Infection Control Protocols
Patients who are critically ill are at a high risk of acquiring hospital-associated infections (Kleinpell et al., 2013). The development is associated with, among others, the use of invasive catheters and tubing during interventions. Infection control practices should be promoted to stop further contamination of patients. Such protocols include washing hands, adopting barrier precautions, and enhanced care for catheters (Patocka et al., 2014).
The view is supported by Wira et al. (2014), who recommend the application of stringent measures to control infections. Such strict protocols include oral and selective digestive decontamination. Others include sanitization with oral chlorheidine gluconate. The latter is used to reduce the risk of ventilator-associated pneumonia among ICU patients with severe sepsis (Patocka et al., 2014).
Infection prevention measures should be a prime area of focus. Contamination control protocols should be adjusted to reflect accountability and improved knowledge. Nosocomical infections should also be averted. All these hygiene measures can significantly contribute to the speedy recovery of patients suffering from sepsis. The objective is achieved by mitigating the risk of infection in health institutions.
Sepsis Protocols in the Emergency Department and Technology
The use of technology in the emergency department helps in the treatment of sepsis. In addition, it improves the diagnosis of the disease (Patocka et al., 2014). The nursing practitioner can achieve this by using automatic sepsis alert applications. The system is integrated into the patient’s electronic medical records (Sweet et al., 2010). It is based on updated vitals and analysis of records to detect signs of severe sepsis.
The effective use of this technology by nurses in the emergency department can help in controlling sepsis. For instance, if a nurse responds in time to a positive diagnosis, sepsis can be arrested at an early stage. The technology available in hospitals should be used properly to improve outcomes. To this end, nurses and other health workers must be trained on the use of the effective use of the machines. The equipment used in the emergency department should be cleaned to ensure that patients are not re-infected.
Overall Impression: How Sepsis Protocols in the Emergency Department Impact on Nursing
Improving the efficiency of sepsis protocols used in the emergency department involves changing the routine and usual ways of doing things. Complacency and failure to embrace changes is one of the reasons why procedures may not work (Kleinpell et al., 2013). Alterations and review of conventional protocols involve a long and strenuous process (Lopez-Bushnell et al., 2014). For instance, one has to bring together all the key stakeholders responsible for the execution of the improved procedure. The process is especially critical if the protocol cuts across several departments with different clinical officers. Bringing these people together may be an uphill task, especially due to the busy work schedules found in hospitals.
One way of making sure that the new intervention works is by testing on a few patients (Kleinpell & Schorr, 2014). If promising results are achieved, the procedure can be used on other patients. To make other people understand the improved protocols, education should be provided. The education should touch on assessment processes, management of care, and adherence to the sepsis bundles.
Conclusion
Medicine alone cannot be used to manage sepsis. Many factors come into play during a patient’s stay in the hospital. Key among these elements is the critical role played by nurses in the process of identification, diagnosis, and treatment of severe sepsis in the emergency department. Protocols seek to offer guidelines to the individuals involved in the treatment and care of these patients. As such, the combination of several strategies may lead to an effective workforce. Consequently, patients are provided with improved care and health services. Ultimately, the nursing practitioner is able to reduce the mortality rates associated with sepsis.
References
Czura, C., & Distlerath, L. (2010). Sepsis poses life-threatening response to infection. Medical Laboratory Observer, 42(11), 14.
Kleinpell, R., & Schorr, C. (2014). Targeting sepsis as a performance improvement metric. AACN Advanced Critical Care, 25(2), 179-186.
Kleinpell, R., Aitken, L., & Schorr, C. (2013). Implications of the new International Sepsis Guidelines for Nursing Care. American Journal of Critical Care, 22(3), 212-223.
Lopez-Bushnell, K., Demaray, W., & Jaco, C. (2014). Reducing sepsis mortality. Medical Surgical Nursing, 4, 56.
Melnyk, B., & Fineout-Overholt, E. (2010). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd ed.). London: LWW.
Patocka, C., Turner, J., Xue, X., & Segal, E. (2014). Evaluation of an emergency department triage screening tool for suspected sepsis and septic shock. Journal for Healthcare Quality, 36(1), 52-61.
Sweet, D., Jaswal, D., Fu, W., Bouchard, M., Sivapalan, P., Jen, R., & Chittock, D. (2010). Effect of an emergency department sepsis protocol on the care of septic patients admitted to the intensive care unit. Canadian Journal of Emergency Medicine, 12(5), 414-420.
Turi, S., & Ah, D. (2013). Implementation of early goal-directed therapy for septic patients in the emergency department: A review of literature. Journal of Emergency Nursing, 39(1), 13-19.
Wira, C., Dodge, K., Sather, J., & Dziura, J. (2014). Meta-analysis of protocolized goal-directed hemodynamic optimization for the management of severe sepsis and septic shock in the emergency department. Western Journal of Emergency Medicine, 15(1), 51-59.