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1. SALALE UNIVERSITY COLLEGE OF HEALTH SCIENCE
DEPARTMENT OF ADULT HEALTH NURSE MASTERS
PROGRAM
PRESENTATION ON: CARE OF THE PATIENT WITH SEPSIS.
SUB TO: Mr. TADELE. K (BSC, MSC, Ass.Professor)
SUB BY :MESFIN SHIFARA … ID 185/15
Date: July 3
Fitche, Ethiopia
10/4/2023 1
2. Objectives
• At the end of these presentation student well
be able :
• Explain about care the patients of sepsis.
• Identify the definition of sepsis and the type
of sepsis.
10/4/2023 2
3. Introduction
• Sepsis is a syndrome, with a poorly understood pathogenesis,
causing life-threatening organ dysfunction.
• Sepsis occurs when the body's response to this infection is
overwhelming, potentially leading to organ failure and septic shock.
• It is associated with high morbidity and mortality rates, being a final
common pathway to death from many infectious diseases
worldwide.
• Sepsis needs urgent treatment as it can quickly worsen.
10/4/2023 3
4. Defining Sepsis
• Sepsis is caused when the body’s immune system
becomes overactive in response to an infection,
causing inflammation which can affect how well other tissues
and organs work.”
Sepsis is a syndrome
– A group of body dysfunctions found together
– Dysfunctions that progress together in a predictable way
– High mortality rate, variable clinical presentations
10/4/2023 4
5. Epidemiology
• The worldwide burden of sepsis is hard to establish.
• A 2017 study estimated sepsis accounted for almost 20% of all
global deaths, with 48.9 million cases and 11 million sepsis-related
deaths worldwide (twice that thought previously).
• Almost half of all global sepsis cases occurred among children in
2017.
• Roughly 85% of sepsis cases and sepsis-related deaths worldwide
occur in low- and middle-income countries.
• In the United States approximately 270,000 deaths annually.
10/4/2023 5
6. Etiology
• Sepsis occurs when the body's response to this infection
turns on the body, potentially leading to organ failure and
septic shock.
• The 2009 European Prevalence of Infection in Intensive
Care (EPIC II study) determined that gram-
negative bacterial infections far exceed other etiologies as
the most common cause of sepsis syndromes with a
frequency of 62%, followed by gram-positive infections at
47%
10/4/2023 6
10. Infected Vascular Graft
• Inguinal incision is independent risk factor
• Length of case and blood loss
• Prosthetic grafts 10%-20%
• S. Aureus
10/4/2023 10
11. Gas gangrene
• Beta hemolytic strept
• Clostridial perfringes (gram pos rods) rare
• 50% polymicrobial
• Rapid lysis of tissues with relatively little response from host
• Endotoxin
• Aggressive debridement & antibiotics
• Repeat antibiotics
10/4/2023 11
12. Catheter Sepsis
• 80% of cases, colonized catheters had been inserted by
inexperienced and experienced residents
• Key is to identify before sepsis develops
• Stapylococcus epidermis, S. Aureus, yeast
10/4/2023 12
13. Burn Infections
• Necrotic tissue readily colonized
• High bacteria counts are NOT
a reliable indication of an infected burn
• Histological examination to determine invasiveness
• TX: debridement and antibiotics
10/4/2023 13
19. Causes of sepsis cont.….
• There are several factors that can put the patient at risk for
septic shock, and these include:
• Patients with immunosuppression have greater chances of
acquiring septic shock because they have decreased immune
system, making it easier for microorganisms to invade the
body tissues.
• Extremes of age. Elderly people and infants are
more prone to septic shock because of their weak immune
system.
10/4/2023 19
20. Causes of sepsis cont.….
• Malnourishment. Malnourishment can lower the body’s
defenses, making it susceptible to the invasion of pathogens.
• Chronic illness. Patients with a longstanding illness are put at
risk for sepsis because the body’s immune system is already
weakened by the existing pathogens.
• Invasive procedures. Invasive procedures can introduce
microorganisms inside the body that could lead to sepsis
10/4/2023 20
21. Sepsis Spectrum
• HR>90
• RR>20
• T > 100.4 F
or < 96.8 F
• Abnormal
WBC count
• Low pCO2
SIRS
• 2 SIRS criteria
• +
• Infection
Sepsis • Sepsis
• +
• -Hypotension
• -End organ
damage
• -Elevated
lactate
Severe
Sepsis
• Severe sepsis
and
persistent
signs of end
organ
dysfunction
• Mortality 50%
Septic
Shock
MORTALITY
10/4/2023 21
22. Normal Response to Infection
• Local infection
• Non-specific inflammatory response
• 3 phases
– Vasodilation - increased blood flow to site, infusion of
antibodies and cells to fight infection
– Vessel permeability - antibodies and cells exit
bloodstream and enter infected tissue
– Once infection is controlled, tissue repairs itself
10/4/2023 22
23. Risk Populations
• Babies younger than 1 year
• Older People
• Frail people
• Diabetics
• Immunocompromised
• Perinatal women
• People who have recently had surgery
• People who have recently had a serious illness.
• 80% of sepsis cases are the result of the following infections:
• Chest (e.g. pneumonia)
• Abdomen
• Genitourinary system
• Primary bloodstream
10/4/2023 23
24. Increased Risk for Sepsis
• Chemotherapy
• Post-organ transplant (bone marrow, solid organ)
• Chronic steroid use
• Recent antibiotic use
• Indwelling catheters of any kind (dialysis, Foley, IV, PICC,
PEG tubes, etc)
10/4/2023 24
25. Pathological Process
• Sepsis results when an infectious insult precipitates a
localized inflammatory reaction that goes on to cause
systemic symptoms of fever or hypothermia, tachycardia,
tachypnea, and leukocytosis or leukopenia (a clinical
symptom called systemic inflammatory response
syndrome).
10/4/2023 25
26. Pathological Process Cont…
• The inflammatory reaction is mediated by the release
of cytokines which activate the extrinsic coagulation
cascade and inhibit fibrinolysis
• This upshot is microvascular thrombosis, a potential
factor producing organ dysfunction.
• Sepsis is a complex syndrome involving activation of a
variety of systems.
10/4/2023 26
27. Pathophysiology of Sepsis ….
• Uncontrolled, exaggerated immune response
• Endothelium damage, cell mediator activation,
disruption of coagulation system homeostasis
• Vasodilation and capillary permeability
• Systemic inflammatory response
• End-organ damage, death
10/4/2023 27
28. Clinical Presentation
• Symptoms of sepsis: non-specific and may
include:
• Localising symptoms of infection (e.g. productive
cough, vomiting, diarrhoea, dysuria)
• Drowsiness
• Confusion
• Dizziness
• Malaise
10/4/2023 28
31. Prognosis
• Septic shock is a serious illness and despite all the
advances in medicine, it still carries high mortality which
can exceed 40%.
• Mortality does depend on many factors including the type
of organism, antibiotic sensitivity, number of organs
affected, and patient age.
• The more factors that match SIRS, the higher the
mortality.
10/4/2023 31
32. Prognosis cont.…
• Data suggest that tachypnea and altered mental status
are excellent predictors of poor outcomes.
• Prolonged use of inotropes to maintain blood pressure is
also associated with adverse outcomes.
• Those who survive are left with significant functional and
cognitive deficits
10/4/2023 32
33. Diagnostic Procedures
• Prompt recognition and escalation to a senior
medical officer improves sepsis outcomes.
• The guidelines recommend the Sequential Organ
Failure Assessment (original and quick versions)
as an important tool for early diagnosis.
• Blood tests : test for proof of infection; clotting
issues; abnormal liver or kidney function;
impaired oxygen
availability; electrolyte imbalances
10/4/2023 33
34. Diagnostic Procedures…..
• Other lab tests may be used to help identify the source of
the infection: Urine; wound secretion; respiratory
secretions
• If the site of infection is not readily found other imaging
tests including X-ray. CT, MRI and ultrasounds may be
ordered.
10/4/2023 34
35. EMS Role in Sepsis
Decreased time to intravenous fluids
Decreased time to antibiotics
Decreased mortality
Shorter hospital stay
• Look for and ask about infection
Did you look at all the skin???
• Look for and ask about risk factors for infection
• Check a temperature accurately
> 38°C (100.4°F)
< 36°C (96°F) more dangerous
Identifying the Sepsis Patient
10/4/2023 35
36. Medical Management
• Identifying and recognising the signs and symptoms of
sepsis, along with the awareness of some biomarkers
(eg C reactive protein), are critical elements for
diagnosing sepsis and instituting appropriate
management.
• After early recognition and diagnostics, identifying a
causal pathogen of infection targeted antimicrobial
treatment can commence.
10/4/2023 36
37. Medical Management …..
• Prompt fluid resuscitation will improve volume status.
Vasopressors may be needed to help maintain tissue
perfusion.
• Repeated exams and assessments, including monitoring
vital signs, guide the appropriate management of sepsis
over time.
10/4/2023 37
38. Physiotherapy Management
• See the page for the role of physiotherapy in the ICU.
• Physiotherapy interventions in the ICU setting normally
consist of respiratory physiotherapy focusing on airway
clearance techniques and early mobilization.
• During acute sepsis or septic shock, patients are often too
unstable for physiotherapy intervention, which only starts
when the patient is haemodynamically stable.
• Positioning plays a big role in the management of patients
with sepsis.
10/4/2023 38
39. Physiotherapy Management cont.…
• A heads-up position of 30-45 degrees is recommended to decrease
the risk of aspiration pneumonia and ventilator-associated
pneumonia, where prone positioning is recommended in sepsis
induced ARDS with a PF ratio of less than 150.
• A common result of these is critical illness neuropathy, and
extensive rehabilitation should then be incorporated in the ICU,
after discharge to the ward, as well as in the out-patient setting with
the aim of getting the patient back to his baseline level of function
and participation as per the ICF model.
10/4/2023 39
40. Treating the Sepsis Patient
• Airway/breathing
Get sats > 92% NRB, CPAP, invasive airway
• Circulation
2 large bore IV, consider IO ,20 cc/kg NS bolus
May repeat if lungs remain clear
10/4/2023 40
41. antibiotics
• Broad spectrum antibiotic or “anchor” antibiotic should always be
administered first
– Cefepime 1g, Cetriaxone 2g, or Levofloxacin 750mg
• Stocked in all Pyxis machines at BMC
• Vancomycin is not broad spectrum and can lead to delay in getting
the most important antibiotic
• Anchor Antibiotic
– Effective against rapidly lethal organisms
• Gram negative rods
• S. pneumoniae
– Long half-life
– Can be infused quickly
– Low incidence of allergy
10/4/2023 41
42. Complications
• Complications could happen in a patient with sepsis if it is not
properly treated or not treated at all.
• Severe sepsis. Sepsis could progress to severe sepsis with symptoms
of organ dysfunction, hypotension or hypoperfusion, lactic acidosis,
oliguria, altered level of consciousness, coagulation disorders, and
altered hepatic functions.
• Multiple organ dysfunction syndrome. This refers to the presence of
altered function of one or more organs in an acutely ill patient
requiring intervention and support of organs to achieve physiologic
10/4/2023 42
43. Prevention
• Before sepsis could invade a patient’s body, it is better to
prevent its occurrence here are some ways to prevent sepsis
and septic shock.
• Strict infection control practices. To prevent the invasion of
microorganisms inside the body, infection must be put at bay
through effective aseptic techniques and interventions.
• Prevent central line infections. Hospitals must implement
efficient programs to prevent central line infections, which is
the most dangerous route that can be involved in sepsis.
10/4/2023 43
44. Prevention…..
• Early debriding of wounds. Wounds should be debrided
early so that necrotic tissue would be removed.
• Equipment cleanliness. Equipment used for the patient,
especially the ones involved in invasive procedures, must
be properly cleaned and maintained to avoid harboring
harmful microorganisms that can enter the body.
10/4/2023 44
45. Nursing Management
• Nurses must keep in mind that the risks of
sepsis and the high mortality rate associated
with sepsis, severe sepsis, and septic shock.
10/4/2023 45
46. Nursing Assessment
• Assessment is one of the nurse’s primary responsibilities,
and this must be done precisely and diligently.
• Signs and symptoms. Assess if the patient has positive
blood culture, currently receiving antibiotics, had an
examination or chest x-ray, or has a suspected infected
wound.
• Signs of acute organ dysfunction. Assess for presence of
hypotension, tachypnea, tachycardia, decreased urine
output, clotting disorder, and hepatic abnormalities.
10/4/2023 46
47. Diagnosis
• Sepsis can affect a lot of body systems and even cause
their failure, so diagnosis is an important part of the
process to establish the presence of sepsis.
• Risk for deficient fluid volume related to massive
vasodilation.
• Risk for decreased cardiac output related to decreased
preload.
• Impaired gas exchange related to interference with
oxygen delivery.
• Risk for shock related to infection.
10/4/2023 47
48. Planning & Goals
• Healthcare team members should be prepared with a
care plan for the patient for a more systematic and
detailed achievement of the goals.
• Patient will display hemodynamic stability.
• Patient will verbalize understanding of the disease
process.
• Patient will achieve timely wound healing.
10/4/2023 48
49. Nursing Interventions
• Nursing interventions pertaining to sepsis should be done
timely and appropriately to maximize its effectivity.
• Infection control. All invasive procedures must be carried
out with aseptic technique after careful hand hygiene.
• Collaboration. The nurse must collaborate with the other
members of the healthcare team to identify the site and
source of sepsis and specific organisms involved.
• Management of fever. The nurse must monitor the
patient closely for shivering.
10/4/2023 49
50. Nursing Interventions…..
• Pharmacologic therapy. The nurse should administer
prescribed IV fluids and medications including antibiotic
agents and vasoactive medications.
• Monitor blood levels. The nurse must monitor antibiotic
toxicity, BUN, creatinine, WBC, hemoglobin, hematocrit,
platelet levels, and coagulation studies.
• Assess physiologic status. The nurse should assess the
patient’s hemodynamic status, fluid intake and output,
and nutritional status.
10/4/2023 50
51. Evaluation
• After implementation of the interventions, the nurse
must evaluate their effectiveness.
• Patient displayed hemodynamic stability.
• Patient verbalized understanding of the disease process.
• Patient achieved timely wound healing.
10/4/2023 51
52. Discharge and Home Care Guidelines
• Even after discharge, the patient must still be taught how
to establish home and community care regimen.
• Prevent shock episodes. The nurse should instruct the
patient and the family strategies to prevent shock
episodes through identifying the factors implicated in the
initial episodes.
10/4/2023 52
53. Discharge and Home Care Guidelines….
• Instructions on assessment. The patient and the family
should be taught about assessments needed to identify
the complications that may occur after discharge.
• Treatment modalities. The nurse must teach the patient
and the family about treatment modalities such as
emergency administration of medications, IV therapy,
parenteral or enteral nutrition, skin care, exercise, and
ambulation.
10/4/2023 53
54. References
• Surviving Sepsis Guidelines and Bundles
• Hospital Toolkit for Adult Sepsis Surveillance
• Centers for Medicare and Medicaid. (2018). Specifications Manual for National Hospital
Inpatient Quality Measures.
• Gupta, S., Sakhuja, A., Kumar, G., McGrath, E., Nanchal, R. S., & Kashani, K. B. (2016). Culture
negative severe sepsis: nationwide trends and outcomes. Chest, 150(6), 1251-1259.
• Kumar, A., Roberts, D., Wood, K. E., Light, B,. Parrillo, J.E., Sharma, S., …& Gurka, D. (2006).
Duration of hypotension before initiation of effective antimicrobial therapy is the critical
determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596.
Sepsis occurs when the inflammatory processes of the body in response to an infection exceed the boundaries of the local environment. The immune response becomes more global, more generalized to all parts of the body. It becomes uncontrolled, unregulated, and self-sustaining (domino-effect). This generalized inflammation causes wide-spread cellular injury. Cells are unable to perform their functions efficiently, leading to organ dysfunction. Tissue ischemia (low blood flow) results from a mismatch in available oxygen to changing tissue oxygen needs. The body responds by secreting catecholamine (fight or flight) hormones like epinephrine to compensate. The body produces lactic acid as it uses epinephrine to help jump start energy production.
Mortality is high in septic patients with elevated lactic acid levels.
Different criteria of what constitutes organ dysfunction have been defined for each organ system. These criteria are used in many ways when treating sepsis, primarily in identifying the severity and progression of sepsis.
