______________________________ Infection Control for New York Health Care Professionals ‒ 2024 Update
The CDC provides guidance and examples for each element, including information for hospitals and healthcare systems to start a program. This includes strategies for identifying leader- ship, setting goals, obtaining resources, screening, treatment, and regulatory and reporting guidelines from the Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP-1). The Hospital Sepsis Pro- gram Core Elements PDF should be viewed in its entirety at https://www.cdc.gov/sepsis/pdfs/sepsis-core-elements-H.pdf. Mahapatra and Heffner published a study on the causes, diagnosis, treatment, and specifically nursing management of septic shock [37]. The sepsis syndrome can progress rapidly from severe to sepsis shock and is accompanied by clinical signs and symptoms. These must be identified and treated immediately to control the syndrome and stop the inflamma- tory cascade. The study provides the following key elements summarized below: Judicious and early antimicrobial administration, sepsis care bundle use, and early goal-directed therapies have significantly and positively impacted sepsis-related mortality. However, early identification remains the best therapeutic tool for sepsis treat-
• Oliguria or anuria (low urine output or no urine) • Hypoxia • Cyanosis • Ileus (gastrointestinal propulsion to eliminate waste is inhibited) 4. Nursing Management • Monitor vital signs • Assess neurovitals (neurologic functioning, con- sciousness) • Obtain cultures (blood, urine, sputum) • Administer antibiotics • Check labs for electrolytes, renal and liver function • Ensure patient has deep vein thrombosis (DVT) and pressure sore prophylaxis • Consult with dietitian regarding feeding • Assess oxygenation and ventilation • Provide oxygen if saturations lower than 92%
• Optimize fluid status • Measure Ins and outs • Weigh the patient • Assess lung sounds for rales, crackles • Encourage hand washing • Limit patient visitors • Educate the family about septic shock
ment and management. 1. Nursing Diagnosis
• Ineffective healing • Imbalance in body fluids
• Inadequate oxygenation and breathing • Impaired body defense mechanisms • Altered mental status
• Prevent aspiration by elevating the head of the bed • Check labs for culture results and antibiotic sensi- tivity • Check chest x-ray report for pneumonia or adult respiratory distress (ARDs) 5. When to Seek Help
2. Assessment
Early Signs and Symptoms Sepsis is a systemic inflammatory response syndrome plus an infectious source. Therefore, earlier on in the presentation of sepsis, patients present with the following vital sign changes: • Fever (temperature higher than 38 °C) or hypother- mia (temperature lower than 36 °C) • Tachycardia with a heart rate higher than 90 beats per minute in adult patients or less than two standard deviations for age in pediatric patients • Tachypnea with respiratory rate greater than 20 breaths per minute in adult patients or more than two standard deviations for age in pediatric patients 3. Signs and Symptoms of Severe Sepsis • Severe sepsis is defined as sepsis and end-organ dysfunction. At this stage, signs and symptoms may include: • Altered mental status
• Hypotension • Unresponsive • Anuria • Fever
The management of septic shock is best done with an inter- professional team that includes ICU nurses. The entire team should communicate with each other to ensure that the patient is receiving optimal care. This study contains other information on causation, risk factors, laboratory findings, medical management, and host response, so the entire study should be reviewed.
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