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Sepsis a Case Study
The aim of the essay is to analyse the care of a septic patient. While discussing the relevant
physiological changes and the rationale for the treatment the patient received, concentrating on fluid
intervention. I recognise there are other elements to the Surviving Sepsis Bundles, however due to
word limitation; the focus will be on fluid intervention. The essay will be written as a Case Study
format.
To maintain patient confidentiality any identifying features have been removed in keeping with the
Nursing and Midwifery Council (NMC) Code of Professional Conduct (NMC, 2008) the patient will
be referred to as Mr X.
Mr X was an 80–year–old male admitted to ITU, from the Medical Assessment Unit, with increasing
respiratory failure.
His...show more content...
Table 2Nutbeam et al 2009 mediators, causing increasing capillary permeability and widespread fluid
shift into the interstitial space, which was no longer functioning to maintain vascular volume
(known as third spacing) in addition, causing further vasodilation to occur.
This caused Mr X to become increasingly hypotensive and tachycardic.
Table 2 shows some of the chemical mediators involved in Mr X's inflammatory process, causing it
to become more severe and uncontrolled, resulting in a further decline in his clinical presentation.
His clinical observations were now: Blood Pressure: 80/50mmHg
MAP: 55mmHg
Heart Rate: 130 beats per minute
The patient was now diagnosed as being in septic shock. His skin was mottled with an increasing
capillary refill time. Schmidt and Mandel (2008) suggest this is a sign of hypoperfusion as the skin
is vasoconstricting due to the redirection of blood flow to the core organs.
I informed the doctor and expressed my concerns regarding the patient's hypotension.
A 250ml fluid bolus of colloid was given as an attempt to improve Mr X's blood pressure and MAP.
The early intravenous fluid administration for resuscitation of the critically ill hypovolemic patient is
the corner stone of shock therapy (Kruemer & Ensor 2012). The Surviving Sepsis recommends
early optimization in the first six hours, followed with fluid challenges in the case of persistent hypo
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Pursuing Nursing Essay
I decided to pursue nursing because most of my relatives from my father's side are nurses. I was
hesitant at first, but after starting the program and doing clinical in different hospitals, I felt really
happy being able to help people. I am currently not employed, but I used to work in Skilled
Nursing Facility before staring the Bachelor's Degree in Nursing (BSN) program. I decided to
pursue my BSN because I want to go further in my education and become a more competent nurse in
the future. I see it as a stepping stone to my higher educational goals One of the clinical rotations I
enjoyed the most during my Associate Degree in Nursing (AND) program is Mental Health
Nursing. I really want to help those people who are suffer from mental illness

What Is Nursing? Essay
Nursing is universal in the sense that nurses can be found almost in all countries around the world
(Henderson, 1978). They are in the hospitals, in school clinics, in the community centres, residential
homes and even play major roles in some of the popular soap operas in television. There are even
television shows that mainly revolve around nurses and which chronicles what they do at work –
both the positive and the negative. It is one of the most visible and easily identifiable occupations as
compared for example to other occupations such as engineers, managers or even pharmacists,
medical technologists and other health related occupations. This is partly because of what nurses do
and most especially how nurses look – with some still...show more content...
The salient point in Henderson's definition is describing the duty of a nurse as one that cares or
assists an individual whether sick or well in obtaining a state of health in order to live an
independent lifestyle (paraphrased). Henderson also described the independent and dependent role
of nurses and the importance of a collaborative work with the other members of the
multi–disciplinary health care team especially the doctors (Henderson, 1966). The Royal College
of Nursing, on the other hand, described nursing as the utilization of clinical judgement in
extending the care necessary for the people to maintain and achieve an optimum state of life
throughout their lifetime (RCN, 2003). Other significant definitions of nursing were those given
by the World Health Organization (WHO) and the American Nurses Association (ANA). The
roles and functions of nurses have a very fascinating history and have evolved since the 19th
century. Landale (1895), in her letter to the editor of the Nursing Record and Hospital World
gave us a glimpse of what a nurse should be during that period. Referring to a nurse as a woman
in uniform, it gave us an idea that nursing was a female dominated vocation and not to be treated
as an economical occupation for financial gain. Landale (1895) placed an emphasis on the
characteristic of being a servant and being devoted to service in order to be a nurse who was worthy
of the uniform. The

The nursing process Essay
The standards of practice describe a competent level of nursing care as exhibited by the critical
thinking model known as the nursing process. This practice includes the areas of assessment,
diagnosis, outcome identification, planning, implementation, and evaluation. The nursing process
includes significant actions taken by registered nurses (RN) and forms the foundation of the nurse's
decision–making ("American Nurses Association," 2010). Assessment is the accurate collection of
comprehensive data pertinent to the patient's health or the situation ("American Nurses Association,"
2010). Assessment is the first step in the nursing process and the most important. Assessment is the
accurate collection of the patient's health date...show more content...
It is during the second phase that the nurse must establish a nursing diagnosis. Only diagnosis
approved and listed through The North American Nursing Diagnosis Association (NANDA) may be
used. Ineffective airway clearance, risk for impaired skin integrity, risk for infection and ineffective
coping are just a few examples of NANDA approved diagnosis. A nursing diagnosis is a clinical
judgment about actual or potential individual, family, or community experiences/responses to health
problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions
to achieve outcomes for which the nurse has accountability (Defining the Knowledge," 2012). The
third standard of practice is outcomes identification. During this phase, the registered nurse identifies
expected outcomes for a plan individualized to the patient or the situation ("American Nurses
Association," 2010). During this step outcomes must be derived from the nursing diagnosis and must
be measurable, realistic and attainable by the patient. The registered nurse involves the patient,
family, heath care providers, and others in formulating expected outcomes when possible and
appropriate. The registered nurse must also consider associated risks, benefits, costs, current
scientific evidence, expected trajectory of the condition, and clinical expertise when formulating
outcomes ("American Nurses Association," 2010). Example of an

Narrative Essay Nursing
Nursing is all I've wanted to do since i was 8–years old. I was the little girl who would pretend to be
the nurse with a white sheet like it was my coat, and wearing my mother's stethoscope checking
heartbeats. My mother bought me a medical kit and everyday i'd check everyone's heartbeat, blood
pressure, and vitals. But at that age all I knew was i had to hold their wrist for a while not knowing
what i'm feeling for, writing random numbers in a notebook, and putting my ear against their chest
waiting for the "thump–thump" sound. They'd go along with me and I'd think to make the pain go
away is to give it a kiss and a band–aid. Until my mom said " Chanel stop using all the band–aids".
Then, I had to cut down on my practices. As the years

New Graduate Nurses Essay
Transitioning from nursing school to working in a hospital setting can be a challenging time for a
new graduate. Due to the nursing shortage, new graduate nurses are being hired with little to no
experience. This is overwhelming for new nurses, especially when they are not getting adequate
support or training from the hospital. The amount of stress, pressure, and lack of training is leading
to a high turnover rate for new graduate nurses. With patient acuity on the rise, new graduate nurses
that are filling these vacancies in the hospitals, need to be competent nurses to provide proper and
safe care to the patients. This article researched the competency of new graduate nurses. "Nursing
competence is not only a professional standard...show more content...
Communication includes verbal and written, as well as the ability to document data. One of the
most difficult transitions, and a main stress factor, is the new graduates' ability to communicate
with the physicians. Having the ability to be a leader is a key to success. "To be an effective leader, a
nurse must show collaborative teamwork, which is consistent with AACN core competencies. To
fulfill this competency, new graduates must be able to delegate to others to promote patient safety
and health" (Theisen & Sandau, 2013). Conflict resolution with team members and patients was a
noted as a skill that new graduates lacked. "Several new graduates expressed concern that they were
unprepared to deal with conflict appropriately and professionally" (Theisen & Sandau, 2013). Due to
the lack of experience, new graduates are unfamiliar with the proper ways to deal with conflict
successfully. Mentorship has been an effective way in improving new graduates confidence in
dealing with conflict, because they were guided through real situations. Organization, prioritization,
and time management was another identified problem. The ability to prioritize patient care, which
has a direct effect on patient safety, is a critical component of nursing. "Both new graduates and
employers have

A Career as a Registered Nurse Essay
A Registered Nurse is a person who enjoys helping other people. They practically have the
responsibility for many peoples lives. What's interesting about a Registered Nurse is that they get
to learn about all the parts of the human body. A Registered Nurse works in the medical field and
needs to be ready with anything that comes their way. There could be a sudden death, some kind
of medical issue that pops up, and even a patient just falls over and hurt themselves. As a
Registered Nurse they need to be able to deal with blood, snot, vomit etc. The main thing a
Registered Nurse has to be good at is being able, and wanting to help people in need. A Registered
Nurse typically tends to work in a clean and healthy work environment ("Registered...show more
content...
para. 1). Registered Nurses should be emotionally stable, so they can help the families through
rough times ("Registered Nurses" U.S. para. 47). An RN also needs to be organized, and to make
sure the patient gets what they need when needed ("Registered Nurses" U.S. para. 48). All RN's
will need to have the patients medical issues, and problems handy and to give the patients, and
their medicines when the patients need it ("Registered Nurses" U.S. para. 8). An RN will usually
records what the patient is doing, sometimes work with medical machinery, talk to doctors about
the patient, and help the patient and the patient's family on how to deal with their medical
problems ("Registered Nurses" U.S. para. 8). Another important thing that an RN will need is to
have the physical stamina and to be ready to lift or transfer patients ("Registered Nurses" U.S.
para. 49). An RN will have to be able to lift at least 10 pounds, maybe even 20 pounds ("Registered
Nurse" para. 4). A person in this career should have an energy level that is somewhat high, has a
skill that is interpersonal, and a knowledge that is a little scientific ("Career" para. 6). If you
happen to be an RN in a nursing home, an RN will watch over the LPN's and CNA's, may start
fluids for the patient, make plans for treatments, and manage the patients health

Eulogy For Nurse
Hello Stacy, Thank you for reading my post and responding as well. Yes a new practice is being
implemented in the place that I work. We just had a new Nurse Manager, and she has implemented a
15 minute huddle which every day before the start of any shift. All nursing staff is expected to attend
including the respiratory therapists. Being discussed are the areas that we are falling short,
especially on documentation. I have noticed a drastic change since the initiation of this practice.

Essay on Staffing Issues with Nurses
Nurse staffing refers to the ratio of nurses to patients in a particular unit. The current global
nursing shortage is simply wide spread and dangerous lace of skilled nurses who are needed to
care for individual patients and the population as a while. A study on the nursing shortage by Linda
Aiken of the University of Pennsylvania School of Nursing, fund that an estimated 20,000 people
die each year, because they have checked into a hospital with overworked nurses. (The American
Nurses Association, Inc., 2010). The study also found that Americans scheduled for routine
surgeries run a 31 percent greater risk of dying if they are admitted to a hospital with a severe
shortage of nurses. That's approximately one–fifth of the up to 98,000...show more content...
2010). On the Federal level, in 2002, congress passed the Nurse Reinvestment Act to improve the
recruitment and retention of nurses. The act establishes a service to give scholarships and loans
to nursing students if they are willing to serve in hospitals with critical shortages of nurses for a
two year period. It is also sets up a loan forgiveness program for nurses receiving advanced
degrees, who will teach at nursing schools. Just to reinterate, the reasons for these staffing issues is
not just the economy and inadequate support from financial institutions to train sufficient numbers
of nurses, but, it also includes a lack of respect by the physicians, poor work ethics amongst the
nursing workforce, lack of good quality recruitment and inadequate pay. Statistics indicate that in
Savannah, Ga., the pay scales for LPN (licensed practical nurses) and RN (registered nurses) are as
follows: LPN LOW AVERAGE HIGH $33,000 $42,000 $54,000 Nat'l $38,000 $47,000$61,000 Avg.
RN $48,000$64,000$80,000 Nat'l $54,000$72,000

Acute Care Nursing Essay
The aim of this assignment is to critically discuss the nursing assessment individualised care and
nursing interventions of the acutely ill patient. The patient discussed developed severe sepsis due to
a urinary tract infection and her condition deteriorated during the recovery process in the nurse's
care. Lovick (2009) defines sepsis 'as a known or suspected infection accompanied by evidence of
two or more of the SIRS criteria'. SIRS is outlined as a 'systemic inflammatory response' consisting
of two or more of the following symptoms 'temperature >38 degrees Celsius or 90 beats per minute,
respiratory rates greater than 20 breaths per minute and white blood count higher than 12,000 cells
per microliter or lower than 4000 cells per...show more content...
The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per
minute it was observed as being fast and it appeared that her accessory muscles were being used.
Mrs Smith's pallor also appeared flushed and her saturations were documented as 93%. The nurse
used the stethoscope to check for wheeze the patient's lungs were clear and chest rise was
symmetrical. Mrs Smith was commenced on 100% oxygen through a non–rebreathe mask, oxygen as
an intervention is necessary as Creed & Spiers (2010) highlight 'metabolic demand for oxygen
throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is
maximized' .The nurse monitored the patient closely because in her confused state the patient may
try to remove the oxygen mask.
An evaluation of Mrs Smith circulation was the next step carried out by the nurse, as in the
breathing assessment Mrs Smith pallor was noted as being flushed and the patient appeared
confused this could be associated with poor cardiac output. The nurse recorded the patient's blood
pressure using a dinamap it was measured at 88/50, it was then rechecked manually to ensure
accuracy. The pulse was checked manually for rate and rhythm it was recorded as 98 beats per
minute. Capillary refill was checked, was found to be normal.
The next step of the framework is disability. Mrs Smith's conscious level was measured

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