Sepsis

The other day, I got a call from the nursing home where my loved one resides. The nurse told me that she was congested, the doc was called, and a z-pack was ordered. I asked the vital signs: elevated temp, elevated respiration rate, and satting 92% on 2L NC. I asked for the doc’s number and called him.

He threw the nurse under the bus. “Oh, she didn’t tell me the vital signs!” He repeated it x 3 throughout our conversation, and I asked for her to be sent to the hospital.

When we got to the hospital, her work of breathing was noticeable to even my non-medical husband. Within a couple hours, we watched her get worse—she went from “congested” to severe sepsis right before our eyes—and she was transferred to ICU.

After confirming her DNR/DNI status and our wish to give her a chance with only fluid resuscitation and antibiotics and possible NIV, if necessary, she made a very nice turnaround within 24 hours. She received a short stint on BiPAP overnight. The day dawned to her satting well on 2L NC, work of breathing nearly nil, and almost back to her baseline mental status.

According to Kaplan (2014), definitions for Systemic Inflammatory Response Syndrome (SIRS), sepsis, severe sepsis, septic shock, and Multiple Organ Dysfunction Syndrome (MODS) were developed. SIRS has the same initial s/s of sepsis, but is nonspecific and unrelated to infection.

The first symptoms are an acutely elevated respiratory rate, fever, tachycardia > 90 BPM, and abnormal WBCs (Kaplan, 2014). Two of the four need to be present to diagnose SIRS. In the presence of a suspected or known source of infection, sepsis can be diagnosed, as an infectious source is the key difference between SIRS and sepsis. Of course, a nurse or doctor has to look at the whole picture of the person. For example, tachycardia with elevated RR could be cardiac in origin, and, in that case, the patient fits the criteria of SIRS; however, many acute care protocols use the above s/s as a sepsis screening tool.

Once sepsis has been diagnosed, severe sepsis and septic shock are additive diagnoses as more s/s begin to occur. That’s why sepsis survival is improved with quick action. “The goal is to treat sepsis during its mild stage, before it becomes more dangerous” (Mayo Clinic, 2014).

In non-hospital settings, it is extremely important for nurses to be knowledgeable of SIRS and sepsis signs and symptoms in order to advocate appropriately for patients. Due to the lack of medical resources and the expectation that nurses are the eyes and ears of distant doctors, a complete picture of the patient should be communicated, including all vital signs, nursing interventions done, and evaluation of those interventions.

The Surviving Sepsis Campaign website is a good place to start. While geared toward acute care facilities, much information can be gleaned from the website for use in other care environments. Please see http://www.survivingsepsis.org/Pages/default.aspx.

References

Mayo Clinic. (2014). Sepsis symptoms. Retrieved from http://www.mayoclinic.org/diseases-conditions/sepsis/basics/symptoms/con-20031900

Kaplan, L. J. (2014). Systemic inflammatory response syndrome. Retrieved from http://emedicine.medscape.com/article/168943-overview#showall