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Stephanie Swanson RN, BSN

Philosophy
Through staff education early signs of sepsis can be identified and aggressive treatment implemented. Safe and effective management will improve patient survival rates.

(Pickard, 2006)

Mission To educate floor staff on sepsis. Providing them with the knowledge of the process. signs for early identification and treatment plans. systemic inflammatory response syndrome (SIRS). multi-organ dysfunction (MOD’s). .

Learning outcomes  To have an understanding of the infective process as it       relates to sepsis Understand SIRS as it relates to MOD’s Identify early signs of sepsis Identify the four indicators of patient advancement toward SIRS Know when and how to initiate non-ICU sepsis protocol Know your role in the non-ICU sepsis protocol Identify when patient may not be appropriate for non-ICU setting .

2009) . SIRS and MODS   Sepsis + organ dysfunction Sepsis + organ dysfunction + volume resistant hypotension  Mortality rate  Who goes septic?  Patient presentation (what’s my septic patient look like?) (Gunthrie-Chu.Course sequence  Part one  What is sepsis  Understanding possible sources  Progression of sepsis.

negative and gram positive aerobes. exogenous sources and endogenous sources. fungi.Course one description  Microorganisms invade a body system and initiate systemic inflammatory response (SIRS)  Gram. Lough. (Urden. anaerobes. 2010) .  SIRS wide spread inflammatory response to severe infective process progresses to multiple organ system dysfunction syndrome (MODS). Stacey.

59 % (Urden. Lough.S.000 patients in the U. Stacey.Course descripton  Severe sepsis occurs in > 750. annually  Leading cause of death in non-coronary critical care units  Mortality rate of 38. 2010) .

2010) . Lough. we all go…  every patient with a severe infection have potential to become septic.  Consider coexisting health conditions  Source of infection  Patient presentation  PNA and UTI are most commonly associated with sepsis (Urden. you go. Stacey.Course description  I go.

Lough.  Remember not everyone is septic  Age does not predict sepsis – anyone can go septic (Urden.Course description  Look at holistic picture  Don’t get tunnel vision  Look for worsening trends  Skin color. LOC. 2010) . Stacey. orientation  Changes in vital signs.

septic shock .Objectives part one  RN will be able to provide early identification of patients with potential of progression to sepsis  RN will report assessment finding to physician and request initiation of non-ICU sepsis protocol.  Identify SIRS score  Severe sepsis vs.

Part two  SIRS criteria  Vital signs  What to watch for  Lab values  Blood cultures  Lactate  WBC’s  Neutrophils (Matthews & Harsh. 2010) .

2010) .Part two  The plan  Know when to act  Be prepared with what to expect  Understanding nursing action on sepsis protocol (Matthews & Harsh.

Course description  Identify SIRS criteria rating of patient  Report patients with two of the following parameters to physician  Temp < 98.4  Pulse > 90/min  Resp >20 or pCO2 < 32  WBC <4000 or >12000 or bands > 10% neutrophils (Matthews & Harsh 2010) .6 or > 100.

2010) . hyperglycemia protocol. (Matthews & Harsh.Course description  RN monitoring of septic patients will increase  Strict Q2hr I & O – report output of < 30ml/hr after 6hr. and DVT prophylaxis. Q4hr x 24 – frequency may be increased based upon nursing judgement  Give antibiotics as ordered  Treat fever > 101F. Q2hr x 2.  Vitals signs – Q1hr x 4 hr.

Objectives part two  The RN will identify and report patients with any 2 of 4 SIRS criteria to physician  RN will request non-ICU sepsis protocol and initiate  RN monitoring will increase .

 When to know a higher level of care is required    Trends in vital signs to watch for Urinary output Skin color (Matthews & Harsh 2010.Part three  Using the protocol outside the ICU  Treatment of hypotension with fluids.) .

existing conditions may require a more reserved fluid resuscitation efforts. (Matthews & Harsh 2010) . repeat x1 for systolic < 90  Notify physician if systolic BP < 90 or HR > 100 after 2 boluses. pre.Course description  Please look at past medical history.  Give 500 mL of NS over 30 min.  If unresponsive to initial fluid bolus be prepared to begin aggressive resuscitation with 500 mL bolus of NS Q 30 min (parameters will be established by physician on volumes)  Remember this is an intravascular depletion and volume resuscitation can exceed 6L for the severely septic patient.

Course description  Worsening trend in vital signs  Temp > 103  Systolic blood pressure < 60  Heart rate > 140  Respiratory rate > 35  Urine output of < 30mL/hr  Increased O2 needs or decreasing O2 sats  Mottled skin  Acute mental status changes (Matthews & Harsh 2010) .

 End goal is adequate end organ tissue perfusion. (Urden. Stacy. Lough 2010) .Course description  Patient requires a higher level of care!  Unsuccessful volume resuscitation may require pressors for vascular support.

.Part three objectives  The nurse will implement sepsis management bundle  Administer IV antibiotics as ordered  Begin fluid challenge  Increase monitoring by RN maintained.

Content will include definition of sepsis Risk factors Identification of organisms responsible for sepsis Identification of when to report Case study Score > 90% required for completion and advancement to course 2 . Exam will include multiple choice. fill in the blank.Course one evaluation  Evaluation of content will be assessed through written       exam.

Course two Evaluation  Written exam that includes  SIRS criteria  Identification of at risk patient  Identification of expected nursing interventions  Exam will be multiple choice and fill in the blank  Case study  Score > 90% required for completion and advancement to course 2 .

 Evaluation will require a written evaluation of 3 separate case studies. clinical presentation of patient and individualized plan of care for all 3 cases. .Course three evaluation  Each participant will receive 3 different case studies at end of part 3 for completion in 1 hour. lab interpretation. Case studies will include assessment of patient.

 Survey will address:  Course content  Applicability in clinical setting  Instructor knowledge of content  Strengths and weakness of course content  Strengths and weakness of instruction method  Suggestions. .Instructor Evaluation  Upon course completion please complete survey received with case studies.

References Matthews.. 16(2). Development and implementation of multi-disciplinary sepsis protocol. Identifying your septic patient. 23(3). (2009). C. H. . Stacy. 43-54. Sepsis and septic shock. K. Critical care nursing diagnosis and management. Department of Nursing Educaton. Critical Care Nurse. Exempla Health system Guthrie-Chu. Larson. St. Urden. (2010). Informally published manuscript. American Journal of Critical Care Nursing. & Lough. (2010). M. 110-119. J. L. (2007). & Harsh. E.: Mosby. Mo. Louis..

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