Last quarter, as part of my critical care lecture, I had to choose a specific condition that one of my critical care patients had. I then had to research the topic and write 10 pages about it. I chose to write about sepsis, since it's surprisingly common in the ICU nowadays. Despite the length of this paper, I actually found the topic to be quite interesting and I included a few snippets from my paper (with citations included):
Angus , D.C.
Overview of Illness
Sepsis is a serious condition in which the body defends against a severe bloodstream infection (Balentine & Stoppler, 2010) as a result of a previous infection in a separate part of the body (Hall et al., 2011). Multiple types of microbes—bacterial, viral, parasitic, or fungal—can lead to sepsis in any part of the body, including the skin, lungs, or urinary tract (Society of Critical Care Medicine, 2007). Invasive medical procedures creating breaks in the skin, such as the insertion of vascular catheters, can also result in bloodstream infection and bring on sepsis.
To be diagnosed with sepsis, a patient must exhibit at least two of the following symptoms: fever above 101.3 F (38.5 C) or below 95 F (35 C), heart rate higher than 90 beats a minute, respiratory rate higher than 20 breaths a minute, and a probable or confirmed infection (Mayo Clinic, 2009). A patient will be diagnosed with severe sepsis if they exhibit at least one of the following signs and symptoms indicating organ dysfunction: areas of mottled skin, significantly decreased urine output, abrupt change in mental status, decrease in platelet count, difficulty breathing, and abnormal heart function. Lastly, the diagnosis of septic shock encompasses extremely low blood pressure in addition to the signs and symptoms of severe sepsis (Mayo Clinic, 2009).
Despite the gravity of the disease, severe sepsis is fairly common in the United States Europe were diagnosed with sepsis at one point during their ICU stay (Vincent, 2008). Regardless of the prevalence of the condition, sepsis treatment is costly and involves a prolonged stay in the ICU along with complex therapies. In the United States
Pathophysiology and Comorbidities
The pathophysiology of sepsis is rather complex. When first exposed to infection, the body releases immune chemicals responsible for triggering widespread inflammation and clotting (Society of Critical Care Medicine, 2007). Ultimately, the clotting impedes adequate blood flow, leading to a decreased amount of nutrients and oxygen from supplementing and nourishing the body’s organs. In severe sepsis, the condition is complicated by the acute dysfunction or failure of one or more organs (Hall et al., 2011). In the worst cases, the patients fight severe sepsis as the cardiovascular system begins to fail. Cardiovascular failure leads to a drop in blood pressure, a weakened heart, and inadequate oxygenation in the blood supply of vital organs; a state known as septic shock (Society of Critical Care Medicine, 2007).
Adding to the complexity of sepsis diagnosis, a number of comorbidities are associated with poorer outcomes for sepsis patients: cancer, cirrhosis, congestive heart failure, and HIV infection have been previously linked with an increased risk of sepsis progression and/or death. The risk of death doubles for sepsis patients with cancer compared to those without and can compare to the risk observed in sepsis patients with HIV infection. Awareness of these comorbidities along with risk factors, such as an age of less than 1 year or older than 65 years, malnutrition, hypothermia, central venous catheter use, endotracheal intubation or mechanical ventilation, aspiration, chronic illness, immunodeficiency, and surgery or invasive procedures can assist health care professionals in identifying patients at higher risk for the compromising condition of sepsis (Rivers & Ahrens, 2008).
Disease Course and Prognosis of the Patient
The course of sepsis follows a cascade of events. Normally, the body fights infection and heals itself through the use of agents known as immune modulators. In sepsis patients, the body is unable to heal itself; exposure to infection, bacteria, and toxins provokes an abundant release of immune regulators. This substantial immune response leads to inflammation of the blood vessel lining, activating the blood clotting process and stimulating further regulator release. This process prompts the formation of more blood clots. As part of the sepsis cascade, the body suppresses the ability to break down clots while a substance called activated protein C is decreased. Activated protein C is responsible for regulating blood clotting, controlling inflammation, and supporting "clotbusting”. As a result of the formation of blood clots and the inability to break down those clots, microscopic blood clots begin forming in vital organs, limiting blood flow and causing tissue damage, possibly ending in organ failure or gangrene (Society of Critical Care Medicine, 2007).
The prognosis of sepsis is dependent on various factors: age, medical history, overall health status, the time of diagnosis, and the type of pathogen causing the sepsis. In elderly patients or patients with compromised immune systems, the mortality rate due to sepsis may be as high as 80%. On the contrary, healthy patients with few complications prior to sepsis face a low mortality rate of about 5% (Balentine & Stoppler, 2010). As previously mentioned, the overall death rate of sepsis patients is about 28% to 50% (Wood & Angus, 2004). Nevertheless, the prognosis is also influenced by delays in diagnosis and treatment; the earlier the treatment begins, the better the outcome (Balentine & Stoppler, 2010).
Impact of Illness on Patient and Significant Others
To further help the family through the crisis of severe sepsis, the “ideal” nurse would consider the possibility of engaging the family in support groups in which the family can specifically state their concerns and feelings toward the condition of the affected person. The “ideal” nurse would also encourage the implementation and planning of end-of-life care, especially with the poor outcomes commonly seen in sepsis. The careful planning and conduction of end-of-life meetings for patients with sepsis has been demonstrated to reduce anxiety and depression in family members. These meetings included advance care planning, and relevant information about the illness: diagnosis, prognosis, and treatment (Dellinger et al., 2008). During these meetings, the family members can also discuss possible ways to alleviate suffering for the patient while implementing end-of-life care.
Though there is no such thing as a “perfect” nurse, we can do our best to implement appropriate care for the sepsis patient and all patients by not only assessing the physical factors involved in patient care; we must always consider the psychosocial factors as well. As part of our practice, we are called to ultimately give the best and most appropriate care possible to our patients, recognizing that many factors are involved in the care of one, single diagnosis.
References
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Balentine, J.R. & Stoppler, M.C. (2010). Sepsis. In eMedicine from WebMD. Retrieved from http://www.emedicinehealth.com/sepsis_blood_infection/article_em.htm
Dellinger, R.P. et al. (2008). Surviving sepsis campaign: international guidelines for
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Society of Critical Care Medicine. (2007). Sepsis: what you should know. Surviving Sepsis
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Vincent, J. et al. (2006). Sepsis in European intensive care units: results of the SOAP study.
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