8/3/2019 Sepsis Clc

1/25

Stephanie Swanson RN, BSN

8/3/2019 Sepsis Clc

2/25

PhilosophyThrough staff education early signs of sepsis can be

identified and aggressive treatment implemented. Safeand effective management will improve patientsurvival rates.

(Pickard, 2006)

8/3/2019 Sepsis Clc

3/25

MissionTo educate floor staff on sepsis, systemic inflammatory

response syndrome (SIRS), multi-organ dysfunction(MODs). Providing them with the knowledge of theprocess, signs for early identification and treatmentplans.

8/3/2019 Sepsis Clc

4/25

Learning outcomes To have an understanding of the infective process as it

relates to sepsis

Understand SIRS as it relates to MODs

Identify early signs of sepsis

Identify the four indicators of patient advancement towardSIRS

Know when and how to initiate non-ICU sepsis protocol Know your role in the non-ICU sepsis protocol

Identify when patient may not be appropriate for non-ICUsetting

8/3/2019 Sepsis Clc

5/25

Course sequence Part one

What is sepsis

Understanding possible sources

Progression of sepsis, SIRS and MODS Sepsis + organ dysfunction

Sepsis + organ dysfunction + volume resistant hypotension

Mortality rate

Who goes septic? Patient presentation (whats my septic patient look

like?)

(Gunthrie-Chu,2009)

8/3/2019 Sepsis Clc

6/25

Course one description Microorganisms invade a body system and initiate

systemic inflammatory response (SIRS)

Gram- negative and gram positive aerobes, anaerobes,fungi, exogenous sources and endogenous sources.

SIRS wide spread inflammatory response to severeinfective process progresses to multiple organ systemdysfunction syndrome (MODS). (Urden, Stacey, Lough, 2010)

8/3/2019 Sepsis Clc

7/25

Course descripton Severe sepsis occurs in > 750,000 patients in the U.S.

annually

Leading cause of death in non-coronary critical careunits

Mortality rate of 38- 59 %(Urden, Stacey, Lough, 2010)

8/3/2019 Sepsis Clc

8/25

Course description I go, you go, we all go

every patient with a severe infection have potential tobecome septic.

Consider coexisting health conditions

Source of infection

Patient presentation

PNA and UTI are most commonly associated with sepsis(Urden, Stacey, Lough, 2010)

8/3/2019 Sepsis Clc

9/25

Course description Look at holistic picture

Dont get tunnel vision

Look for worsening trends Skin color, LOC, orientation

Changes in vital signs.

Remember not everyone is septic

Age does not predict sepsis anyone can go septic(Urden, Stacey, Lough, 2010)

8/3/2019 Sepsis Clc

10/25

Objectives part one RN will be able to provide early identification of

patients with potential of progression to sepsis

RN will report assessment finding to physician andrequest initiation of non-ICU sepsis protocol.

Identify SIRS score Severe sepsis vs. septic shock

8/3/2019 Sepsis Clc

11/25

Part two SIRS criteria

Vital signs

What to watch for Lab values

Blood cultures

Lactate

WBCs Neutrophils (Matthews & Harsh, 2010)

8/3/2019 Sepsis Clc

12/25

Part two The plan

Know when to act

Be prepared with what to expect

Understanding nursing action on sepsis protocol

(Matthews & Harsh, 2010)

8/3/2019 Sepsis Clc

13/25

Course description Identify SIRS criteria rating of patient

Report patients with two of the following parametersto physician

Temp < 98.6 or > 100.4

Pulse > 90/min

Resp >20 or pCO2 < 32 WBC 12000 or bands > 10% neutrophils

(Matthews & Harsh 2010)

8/3/2019 Sepsis Clc

14/25

Course description RN monitoring of septic patients will increase

Strict Q2hr I & O report output of < 30ml/hr after

6hr.Vitals signs Q1hr x 4 hr, Q2hr x 2, Q4hr x 24

frequency may be increased based upon nursingjudgement

Give antibiotics as ordered Treat fever > 101F, hyperglycemia protocol, and DVT

prophylaxis. (Matthews & Harsh, 2010)

8/3/2019 Sepsis Clc

15/25

Objectives part two

The RN will identify and report patients with any 2 of

4 SIRS criteria to physician

RN will request non-ICU sepsis protocol and initiate

RN monitoring will increase

8/3/2019 Sepsis Clc

16/25

Part three Using the protocol outside the ICU

Treatment of hypotension with fluids.

When to know a higher level of care is required

Trends in vital signs to watch for

Urinary output Skin color (Matthews & Harsh 2010.)

8/3/2019 Sepsis Clc

17/25

Course description Please look at past medical history, pre- existing conditions

may require a more reserved fluid resuscitation efforts.

Give 500 mL of NS over 30 min, repeat x1 for systolic < 90

Notify physician if systolic BP < 90 or HR > 100 after 2boluses.

If unresponsive to initial fluid bolus be prepared to beginaggressive resuscitation with 500 mL bolus of NS Q 30 min

(parameters will be established by physician on volumes) Remember this is an intravascular depletion and volume

resuscitation can exceed 6L for the severely septic patient.(Matthews & Harsh 2010)

8/3/2019 Sepsis Clc

18/25

Course descriptionWorsening trend in vital signs

Temp > 103

Systolic blood pressure < 60 Heart rate > 140

Respiratory rate > 35

Urine output of < 30mL/hr

Increased O2 needs or decreasing O2 sats Mottled skin

Acute mental status changes (Matthews & Harsh 2010)

8/3/2019 Sepsis Clc

19/25

Course description Patient requires a higher level of care!

Unsuccessful volume resuscitation may requirepressors for vascular support.

End goal is adequate end organ tissue perfusion.(Urden, Stacy, Lough 2010)

8/3/2019 Sepsis Clc

20/25

Part three objectives The nurse will implement sepsis management bundle

Administer IV antibiotics as ordered

Begin fluid challenge

Increase monitoring by RN maintained.

8/3/2019 Sepsis Clc

21/25

Course one evaluation Evaluation of content will be assessed through written

exam. Exam will include multiple choice, fill in theblank.

Content will include definition of sepsis Risk factors

Identification of organisms responsible for sepsis

Identification of when to report

Case study

Score > 90% required for completion andadvancement to course 2

8/3/2019 Sepsis Clc

22/25

Course two EvaluationWritten exam that includes

SIRS criteria

Identification of at risk patient

Identification of expected nursing interventions

Exam will be multiple choice and fill in the blank

Case study

Score > 90% required for completion and advancementto course 2

8/3/2019 Sepsis Clc

23/25

Course three evaluation Each participant will receive 3 different case studies at

end of part 3 for completion in 1 hour.

Evaluation will require a written evaluation of 3separate case studies. Case studies will includeassessment of patient, lab interpretation, clinical

presentation of patient and individualized plan of carefor all 3 cases.

8/3/2019 Sepsis Clc

24/25

Instructor Evaluation Upon course completion please complete survey

received with case studies.

Survey will address:

Course content

Applicability in clinical setting

Instructor knowledge of content

Strengths and weakness of course content Strengths and weakness of instruction method

Suggestions.

8/3/2019 Sepsis Clc

25/25

ReferencesMatthews, J, & Harsh, H. (2010). Identifying your septic patient. Informally publishedmanuscript, Department of Nursing Educaton, Exempla Health system

Guthrie-Chu, C. (2009). Sepsis and septic shock.American Journal of Critical Care Nursing,16(2), 110-119.

Larson, E. (2007). Development and implementation of multi-disciplinary sepsis protocol.Critical Care Nurse,23(3), 43-54.

Urden, L., Stacy, K., & Lough, M. (2010). Critical care nursing diagnosis and management.St. Louis, Mo.: Mosby.