care of the patient in severe sepsis septic shock nursing inservice 2012
TRANSCRIPT
Presented by: Angelica Lopez RN, BSN, CRRN
November 2012
• Sepsis can be defined as the body’s response to an infection
• The deteriorating septic patient:• Infection• Sepsis• Severe Sepsis
• 30-35% Mortality• Septic Shock
• 50% Mortality
• The very young or very old • Weakened immune system• Wounds or injuries• Addictive habits, such as alcohol or drugs • Those receiving certain treatments or examinations
• IV Catheters• Foley Catheters• Wound
Temperature > 100.4 Heart Rate > 90/min
Respiratory rate > 20 or PaCo2 <32
WBC > 12K or WBC < 4K Bands > 10%
SIRS + Suspected Infection
Sepsis + Acute Organ Dysfunction
• Arterial Hypoxemia• Acute Oliguria
• UO below 0.5mL/kg/hr• Acute Renal Injury
• Cr above 2• INR above 1.5• aPTT above 60 seconds
Platelets below 100,000
Lactate above 4
SBP < 90 or MAP <65Unresponsive to IV Fluids
Sepsis Nurse’s Responsibilities
July 30, 2012 DX: Presented to clinic with Rt. Toe Infection Vitals at 1448◦ 100.7◦ 96◦ 20◦ 145/70◦ 100% O2 Sat
What would you do?
WBC 17.4 Creatinine 2.06 INR 1.18 aPTT Not done Platelet Ct. 184,000 Lactate 2
Do you see signs of organ
dysfunction?
Do we declare?
• Blood Cx Sent • 1500
• Lactate Sent• 1500
• Antibiotics • 1700
• IV Bolus
No documentation found on IV infusion
• August 4, 2012• Dx – UTI / MRSA• Patient on Antibiotic Therapy x 24
hrs.• Patient wt. 70kg• Vitals at 0030
• 96.8• 82• 20• 88/58 (68)
Is this patient in Severe Sepsis or Septic
Shock?
What would you do?
Blood Cx Sent 8/4 0100
Lactate Sent8/4 0100
Antibiotics On antibiotics already
IV Bolus500 ml given
• August 18, 2012• Dx: MRSA & Pseudomonas• Patient on antibiotic therapy x 36 hrs.• Pt’s weight 65.9 kg.• Vitals 0200
• 97.6• 92• 22• 78/44 (55)
Is this patient in
Severe Sepsis or Septic Shock?
What would you do?
Blood Cx Sent 8/18 0600
Lactate Sent8/18 0600
Antibiotics On antibiotics already
IV Bolus 1300 mL 0235
Declaration time:0200
Improve Communication of abnormal vitals◦ Call the Sepsis nurse at
the beginning of each shift◦ Na Training◦ Use the V/S sheet
Increasing Awareness◦ Education◦ Add statement in
affinity◦ Orientation◦ Posters
Upcoming changes to protocol
RNs/LVNs carefully review vitals and report to the charge nurse
Unit charge contacts ICU within 2 hours to report the presence or absence of SIRS in any patients.
When you have Severe Sepsis/Shock go to…. ( 2 LA CA )2, 000 ml fluidLA Lactic AcidC CulturesA Antibiotics