What do you know/have you been taught about Sepsis?

SuesquatchRN, BSN, RN · Apr 21, 2010

I know that almost always, when I have a resident at end-of-life, they end up with a "fever of unknown origin" for which no organism can be identified and the cause of death is sepsis.

Low-grade fever, no s/s of infection otherwise, old person = sepsis. IME.

TigerGalLE, BSN, RN · Apr 21, 2010

Increased WBC, Fever, tacycardia, hypotension (obviously)

I have a lot of patients complain of leg pain

restlessness

respiratory distress

PostOpPrincess, BSN, RN · Apr 21, 2010

It's the pre-hospital area that needs the emphasis.

Over the past seventeen, almost eighteen years, I've seen them come in various stages, most never making it, some, by whatever miracle, surviving minus some limbs, digits, what have you.

I wish you the best in your endeavor. It will be a HUGE undertaking.

Sonjailana · Apr 21, 2010

-high or low temp

-change in LOC

-urinary retention/low UO

-hypotension

-tachycardia

-increased RR for about 24 hours before (like 18-20 resps/min)

GilaRRT · Apr 21, 2010

No need to reinvent the wheel. The surviving sepsis consensus statement and campaign is a good framework already in place:

Surviving Sepsis Campaign

Dinith88 · Apr 21, 2010

Hi all,
I am working on a big (BIG) project on sepsis. It's an international endeavor to reduce the number of sepsis deaths world wide. Surprisingly, in the United States, more people die of sepsis than you can imagine, because frequently, the cause of death isn't written as sepsis or septic shock, but as infection due to XYZ or organ failure due to ABC.
I have been speaking with the founders and bosses of this project about the importance of bringing the nurses on board for recognizing sepsis and teaching about it to patients and families. They agree, they know that the nurses are the front line. :)
So, I need to know from you, on the floors, in the units, in the homes, wherever else - what do you know about sepsis? What did you learn about sepsis that you didn't know until something happened? Have you ever had a patient who you knew was going septic but it wasn't picked up in time.
I'm looking for insight as to what we need to focus on in terms of teaching nurses, perhaps developing CME.
Any help would be great.
Many thanks,
Marijke

International project? Have you been talking with Xigris reps/Eli Lily? :)

LouisVRN, RN · Apr 21, 2010

Honestly, the biggest thing on my floor where I work (Med-Surg) we have a lot of patients that meet the criteria for SIRS, however no one seems to look at the big picture, elevation of blood glucose in a non DM patient? Get an order for sliding scale insulin. Hypertension? Get a beta blocker, or anti-hypertensive. Hypotension - give a fluid bolus. Leukocytosis - consult ID. Temperature - give tylenol/motrin. Tachycardia? Give pain meds. ALOC institute safety precautions. Sometimes I want to scream, you need to look at the whole picture to see what the possible causes may be.

clemmm78, RN · Apr 21, 2010

No need to reinvent the wheel. The surviving sepsis consensus statement and campaign is a good framework already in place:
Surviving Sepsis Campaign

Hi, I do know about that site. We're not reinventing the wheel. The problem is despite the presence, the *awareness* still isn't there. The goal of the Sepsis Alliance is world-wide awareness of the issue and a true definition of sepsis.

As of right now, there is no universal definition of the problem.

At this point, I am trying to find out what nurses know about the issue.

International project? Have you been talking with Xigris reps/Eli Lily? :)

We do know about Xigris, but this project is independent of pharma.

Honestly, the biggest thing on my floor where I work (Med-Surg) we have a lot of patients that meet the criteria for SIRS, however no one seems to look at the big picture, elevation of blood glucose in a non DM patient? Get an order for sliding scale insulin. Hypertension? Get a beta blocker, or anti-hypertensive. Hypotension - give a fluid bolus. Leukocytosis - consult ID. Temperature - give tylenol/motrin. Tachycardia? Give pain meds. ALOC institute safety precautions. Sometimes I want to scream, you need to look at the whole picture to see what the possible causes may be.

Thank you. This is exactly what I mean. No-one seems to be looking at the overall picture and this is why sepsis is being missed so much.

Zookeeper3 · Apr 23, 2010

we have a sepsis screening tool that is done each shift and only takes a moment, two parts

1. vital signs temp .100.4, less than 98.6, HR>90, RR>24 or >24 on vent, SBP

2. AMS, Burns, Infection in (CNS, lung, abdomin, UTI, wound). Trauma, indwelling catheters or immunocompromised. Each one is worth a certain set of points and if they add up we initiate a sepsis orderset.

and finally, we have the standard oral care every 4 hours, peridex on vent patients each shift, HOB>30 on all vents, turn every two and early ambulation. Foleys require MD documentation over 72 hours unless vented or on pressors.

Hope that helps

crystalchen · Apr 23, 2010

I learn that antibiotic is extremely important for the first 24 hours, and it needs to be given after the labs, right? keep them hydrated.

clemmm78, RN · Apr 23, 2010

Thank you for your input, it's a big help. crystalchen, the antibx are needed even more quickly. Every hour the patient waits increases his risk of mortality significantly. One of the issues is how to get the antibx into the patient faster.