Care of the patient in severe sepsis septic shock nursing inservice 2012

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