Simulation: Caring for a Septic Patient Essay

Simulation: Caring for a Septic Patient Essay

Montgomery College School of Nursing- Simulation

Sepsis

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James Daniels-

Came to the emergency room with complaints of fatigue, fever, and malaise for 1 week.  He reports he was alternating Acetaminophen and Ibuprofen every 4-6 hours for the fevers. Simulation: Caring for a Septic Patient Essay

Past Medical History:

Pre-hypertension, Raynaud’s syndrome

 

He has not received any medications while in the hospital.  He is currently waiting for his ride.

 

When the nurse obtains vital signs, what are your concerns?  Does anything jump out at you that the nurse should be paying close attention to?

 

Temperature at 101

Blood pressure at 113/80

Respiratory rate – 101 beats per minute

The patient is fatigued and wants to sleep.

 

Of concern are the persisting fevers and the low blood pressure. He has prehypertension and his blood pressure usually it’s between 130-140.

The patient has all signs of sepsis.

What would you say differently to the Nurse Practitioner to get a more positive response?

 

 

I would ask the nurse to nurse to assess Mr. Daniel before she considers the patient for discharge.

The CNA comes to the nurse and reports James sat up to void and said he felt like he wants to pass out. 

 

The nurse and the Nurse Practitioner immediately go into the room.
What interventions should be performed at this time? The patient should be given a 1-liter bolus of normal saline. Monitor the vitals every 5- 15 minutes

 

The Nurse Practitioner order labs: Simulation: Caring for a Septic Patient Essay

 

Lactate

CBC

Chem 7

Blood Cultures

ABGs

 

What labs would we want to look at that are specific to infection?

Dehydration?

Acute Kidney Injury?

Sepsis?

Why do we obtain blood cultures?  How long does it take to result in a blood culture?

Infection? Complete blood count shows elevated white blood cells count.

 

Dehydration?

 

Dehydration is determined by the renal function test that has elevated creatinine, BUN, and sodium.

 

 

Acute Kidney Injury?  Chem 7 evaluates the kidney function and acid-base balance in the blood. The renal function test shows elevated creatinine in acute kidney injury.

 

 

Sepsis? CBC evaluates the white blood cells, platelets, and red blood cells. The white blood cells are elevated in sepsis.

Increased lactate levels lead to lactate acidosis and metabolic acidosis that indicates organ dysfunction.

Blood gas evaluates the acid-base balance in the blood. It also shows oxygen circulation.

Why do we obtain blood cultures? 

 

How long does it take to result in a blood culture?

 

 

 

At what point in inpatient care does the blood culture need to be obtained?

Blood cultures are performed in the lab where there is a good environment for the growth of the bacteria. A blood culture takes around 2-3 days while others take about 10 days.

Blood cultures are used to detect the kind of bacteria or fungi that is causing sepsis. A blood culture should be collected immediately after the onset of the symptoms and before the administration of antibiotics.

What does a Lactate of 7 mean to this patient? Lactate of 7 means there is lactic acidosis and metabolic acidosis. It is a sign of severe sepsis or septic shock.

 

 

 

 

 

 

 

 

 

 

 

360o Simulation: Caring for a Septic Patient

 

Mr. Jerry Smith, 59 y/o male, arrives via ambulance at the emergency department.  He reportedly has a fever. EMS inserted a 22 g IV into the left hand and Normal Saline is infusing.

 

Hx- Paraplegia, HTN

 

EMS Vital Signs:

 

BP 140/80

HR 110

RR 16

SpO2 98% Room Air

The patient is met by the ED team.  He reports a fever since the morning, the staff gave him one ES Tylenol and he says “I think it helped a little”.

 

Currently, the patient denies pain.

He has an indwelling urinary catheter.

He reports that his paraplegia starts at the level of his umbilicus.

 

What are the initial assessment findings by the nurse?  Doctor Barker?

 

 

 

Are you concerned about this patient upon arrival at the ED? Please explain your rationale.

 

The nurse got a brief history fever for one day that was slightly relieved by Tylenol. There were no associated symptoms. The patient’s vitals were still the same at the time of admission. There was a normal finding on examination

Doctor Backer

The patient presents with a fever with no other associating symptoms. He has an indwelling catheter for one month. He has a septic wound in the back.

The main concern of the patient on arrival is the persisting fevers for over two weeks, tachycardia, and tachypnea. These are signs of sepsis

 

The nurse is attempting to insert an IV, but the patient has poor vascular access.  After a couple of attempts, the nurse was able to obtain some of the blood for labs. Simulation: Caring for a Septic Patient Essay

 

What problems can poor vascular access or inability to obtain blood samples lead to?

 

Lack of IV access hinders the administration of fluids and medicine hence worsening the effect of the disease. Inability to draw the sample makes it difficult for the practitioner to make a diagnosis and hence inconveniencing treatment.

 

 

Mr. Smith has reported that he was hospitalized for a UTI about one year ago.  He has had the indwelling urinary catheter in place since his accident about 5 years ago.  His current catheter has been in place for one month.

 

How often should a urinary catheter be changed?

 

How do you obtain a urine sample from the catheter?

 

A urinary catheter should be changed at least every three months. A urine sample from a catheter is collected by; explain the procedure to the client, assemble the appropriate equipment, clamp off the drainage to allow accumulation of urine. Once the urine has accumulated, sterilize the drainage and push the syringe to draw the urine.

 

 

Dr. Barker states the patient has SIRS criteria and has ordered the following:

CBC

CMP

Lactate

Blood cultures

Urinalysis and urine culture

Chest X-ray

 

What would you expect to find that is consistent with infection?

 

The expected findings in a complete blood count are elevated white blood cells above 12000 mm, lactate was elevated above 2 Mmol, blood cultures shows numerous bacteria, urinalysis shows elevated leucocytes, urine culture shows a bacterial infection, and CMP was deranged.  For example, the kidney function test shows elevated creatine, BUN, and sodium. The chest x-ray was normal.
Since this is a small hospital, they utilize eICU nursing. The patient is started on Zosyn 3.375 Gm for the UTI and previous history of pseudomonas. They added Vancomycin one gram for antibiotic coverage for the sacral wound.

 

Staff still have not been able to obtain additional IV access, so Dr. Barker places an intraosseous line in the left humerus.  The patient is given IV fluids at 30 mL/kg.  The patient weighs 100kg. 

How much IV fluid should he receive? 

Over what period of time?

 

The patient received 3 liters of fluid within one hour

 

 

 

 

 

 

 

 

 

While monitoring the patient, the ICU nurse alerts the staff to a change in the patient’s mental status.  After his IV fluids have been infused his BP remains low.  Dr. Barker has ordered the patient to be transferred to the larger hospital. 

Additionally ordered Norepinephrine 4 mcg/min, and titrate to keep the MAP > 65 mmHg.

 

Calculate the infusion rate for the Norepinephrine 4 mcg/min.

 

Available is 8mg in 250 mL % Dextrose.

 

The patient received 1 ml of norepinephrine infused in dextrose normal saline in one minute.

 

 

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Sepsis

James Daniels-

Came to the emergency room with complaints of fatigue, fever and malaise for 1 week.  He reports he was alternating Acetaminophen and Ibuprofen every 4-6 hours for the fevers. 

Past Medical History:

Pre-hypertension, Raynaud’s syndrome

 

He has not received any medications while in the hospital.  He is currently waiting for his ride.

 

When the nurse obtains vital signs, what are your concerns?  Does anything jump out at you that the nurse should be paying close attention to?

 

 

 

 

 

 

 

 

 

 

 

What would you say differently to the Nurse Practitioner to get a more positive response?

 

 

 

 

 

 

 

 

 

The CNA comes to the nurse and reports James sat up to void and said he felt like he wants to pass out. 

 

The nurse and the Nurse Practitioner immediately go into the room.
What interventions should be performed at this time?  

 

 

 

 

 

 

 

 

 

The Nurse Practitioner order labs: Simulation: Caring for a Septic Patient Essay

 

Lactate

CBC

Chem 7

Blood Cultures

ABGs

 

What labs would we want to look at that are specific to infection?

Dehydration?

Acute Kidney Injury?

Sepsis?

Why do we obtain blood cultures?  How long does it take to result a blood culture?

Infection?  

 

 

 

 

 

 

Dehydration?

 

 

 

 

 

 

 

 

 

Acute Kidney Injury?  

 

 

 

 

 

 

 

Sepsis?  

 

 

 

 

 

 

Why do we obtain blood cultures? 

 

How long does it take to result a blood culture? 

 

 

 

At what point in the patient care does the blood culture need to be obtained?

 

 

 

 

 

 

 

 

 

 

What does a Lactate of 7 mean to this patient?  

 

 

 

 

 

 

 

 

 

Simulation: Caring for a Septic Patient Essay

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