Nursing Interventions for a Patient with Sepsis

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Chamberlain College of Nursing

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Nursing Interventions for a Patient with Sepsis

Nursing generally involves offering primary care for a sick individual. In collaboration with other healthcare workers from different disciplines, nurses must continuously observe their patients and provide them with a high level of care for the best outcomes. This paper focuses on a patient who is very likely suffering from sepsis and the interventions made by a medical team to improve his condition.

Background Information

The patient’s name is Eric Swehla, a 19-year-old male brought into the emergency department in fair condition. He is 183 cm and 80 kg. He has no known allergies or medical history but has had one outpatient surgery on his right Achilles tendon (repair). The patient has been immunized according to CDC guidelines and has no physical concerns. He was brought in for pain in his right foot.

The patient cut his foot playing football barefoot four days before he sought hospital services. After he got the 3.2 cm laceration on his right foot, he allegedly poured bottled water on it before rejoining the football. The affected area around his foot reddened and grew swollen. Moreover, it is hot to the touch and had some drainage. On the day, he came to the hospital at about 1145 in a personal vehicle accompanied by his boyfriend after reportedly feeling pain in his leg. He also reported feeling weak and having a temperature.

The patient has no visible, palpable masses, depressions, or scaring. He is slightly pale in appearance. His eyes are PERRLA: conjunctivae pink and sclerae white. His external auditory canals are clear, and his hearing is intact. His nose does not have any external lesions, and mucosa is non-inflamed. His throat has no mucosal lesions, and the mucous membranes are moist. The cardiovascular rate is regular; no murmurs, gallops, or rubs. No edema was observed. His respiration is unlabored, and lungs are clear to all fields. His bowel sounds are normal, and there is no organomegaly. He has a full range of musculoskeletal motion to all extremities and is neurological aware of self, place, time, and situation.

Labs and Diagnostic Tests

The results of the first physical tests administered to a patient are important because they signify which lab tests should be done. Blood pressure was at 88/64, which is normal, whereas pulse was 110 at 1230 and 114 at 1245, which borders on tachycardia. The high heart rate could have been caused by anemia, possibly in this case where the patient had a laceration and may have lost a lot of blood. Also, it is one of the symptoms of sepsis. His respiratory rate was also quite high, at 26. The patient’s temperature at 38.6 was also shockingly high. A fever is another symptom of sepsis.

The complete blood count was one of the lab tests taken. It assesses the number of red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. This test is significant, especially considering the patient had a high pulse rate and perhaps underlying anemia. Another test carried out was the lactic acid/serum test. It is especially useful when diagnosing sepsis, suspected to be the infection afflicting the patient by the emergency department doctor. A type one lactic acidosis diagnosis, which implies high levels of lactic acid, is a telltale sign of sepsis.

Another lab test ordered for was the Basic metabolic panel (BMP). It is a set of tests administered to evaluate several body functions, such as creatinine and albumin levels. A high level of blood albumin indicates that the liver is impaired and blood filtration is not taking place normally. According to Putzu et al., sepsis patients suffer from improper blood filtration, and as such, auxiliary blood filtration interventions can be used to treat the infection (2019).

The wound and soft tissue culture from the wound was another crucial test for this patient. In the lab, the tissue can be cultured for germs, bacteria, and fungi. Moreover, the tests can facilitate a better understanding of the type of infection. For instance, is it anaerobic bacteria or aerobic bacteria contributing to the rot in the wound? Also, the culture will be crucial in determining the particular infection’s sensitivity to a specific type of treatment. Quite similar to this is the blood culture and sensitivity tests. It checks for the presence of pathogens such as yeast, bacteria, and fungi in blood samples. A high load of the same, particularly bacteria, indicates sepsis and an increased risk of getting blood clots in one’s blood vessels.

Arterial blood gases (ABG) measures the oxygen and Carbon dioxide levels in the blood. It is used to test respiratory activity and informs the medic on whether the patient may require extra oxygen. D-dimer is a test that evaluates the flow of flood. The presence of blood clots is a serious symptom of sepsis and indicates that immediate intervention is necessary to prevent the patient from going into septic shock. The liver function test (LFT) monitors the liver’s functioning by assessing the level of enzymes in the blood. It can reveal liver damage in response to damage and disease.

Medications

The first medication administered to the patient was normal saline at 1145 through IV over one hour. It is isotonic to serum and is used to replace the level of blood electrolytes. At 1200, the patient received 750mg IV levofloxacin over 24 hours. It is an antibacterial (Dewi et al., 2018). Its side effects include tendon problems, nerve damage, and mood swings. The patient was treated using 25mg/kg of vancomycin intravenously over 24 hours. It is also an antibacterial. The use of vancomycin must be carefully regulated to avoid clearing useful hemoglobin in a patient’s blood (Chuma, 2019). Its side effects include dizziness, temporary loss of hearing, and diarrhea.

Ketorolac 30 mg was given to the patient in IV for six hours. Ketorolac is used as a pain relief drug for patients in the emergency department or who have undergone some type of trauma. In this case, the patient reported pain as two on a scale of 10, which is within the range for which ketorolac is most effective (1-5) (Baratloo, 2016). Ketorolac IV solution is only applicable for short term use, after which a patient may ingest ketorolac pills orally when necessary. Excessive use of ketorolac is linked to cardiovascular thrombotic disease. It also ceases to alleviate pain at higher doses. Potential side effects include skin rash, high blood pressure, and swelling. Another medication used on the patient is ondansetron (4mg IV for 4hours). It was applied to the patient for nausea, which he reported. Nausea is common in sepsis patients and may deteriorate to vomiting and extreme abdominal discomfort. The drug is highly effective in inhibiting the agents of nausea in the body (Saberi et al., 2019). It is important for the care provider to establish whether the patient has allergies before administering the drug. There is also a range of medications that cannot be used together with ondansetron. Side effects of ondansetron include hallucination, increased heart rate, blurred vision, and headache.

Nursing Diagnoses

Nursing diagnoses Nursing interventions Nursing outcomes Collaborative interventions

Pain Regular monitoring of the patient

The patient’s pain did not increase Regular monitoring

of the patient

IV application of ketorolac for six hours

Nausea Regular monitoring of the patient

IV application of normal saline The patient’s nausea did not increase. Regular monitoring of patient’s nausea

IV application of ondansetron for four hours

The risk for Vitals failure Regular monitoring.

Vitals check-up every 15 minutes.

His vitals condition worsened. Use of antibacterial treatment using IV

Nursing Interventions

According to Cardona-Morell (2016), ongoing monitoring is necessary for patients whose vital signs are not within an acceptable rate. The patient’s physical examination revealed a spike in the rate of respiration, pulse, and blood pressure. Therefore, there was a need for continuous monitoring to prevent the patient from getting too critical. Moreover, periodic monitoring facilitates a nurse to observe the patient for the manifestation of potential side effects to the treatment they may be receiving. Despite this particular patient not reporting any particular allergies, it was necessary to check them regularly, considering they were receiving multiple doses of medication simultaneously and may have had an adverse reaction to the same.

Another intervention was wound care. A wound patient requires continual cleaning with antiseptic and treatment using antibacterial IV doses (Singer, 1995). A laceration such as the one on the patient has to be regularly disinfected to prevent a bacterial infection. The patient reported brushing the injury off initially and playing barefoot despite having a gaping laceration in his foot. There was reason to believe that the wound was increasingly infected with bacteria and antibacterial disinfection of the wound was necessary to hinder the replication or festering of the wound. Moreover, the opening could have been infected by bacteria in the hospital environment at any time.

Lastly, another nursing intervention used on the patient was electrolyte monitoring. Avila et al. (2016) argue that fluids are necessary for sepsis patients to avoid an electrolyte imbalance in the blood, particularly if blood is infected. Avila et al. (2016) argue that sepsis mitigates against tissue hypoperfusion as a result of lactic acidosis, which is essentially serum and blood that is riddled with lactic acid. This was one of the tests done on the patient. An isotonic solution of 1 liter, intravenously was one of the major interventions for the patient. Where the patient does not respond favorably to an administration of normal IV in the ward, they may require to be transferred to the ICU. In this case, the patient was responsive to the intervention and improved within thirty minutes of arriving at the hospital.

Interdisciplinary Management

Collaborative Care Management

The primary healthcare provider is the doctor who diagnosed the patient as having sepsis and decided which medication should be administered. It is the physician’s responsibility to stabilize the patient’s condition through various interventions and decide whether the patient should be admitted. The emergency department doctor also assesses the patient’s condition and determines which department or specialist is best suited to handle the patient.

Lab personnel is also important. They received the samples formed the sick individual and carried out the tests specified by the primary healthcare giver. The test results are an important guiding factor to both the doctor and the nurses regarding the course of care and medication. Lab tests also often reveal the particular infection, thus affirm the doctor’s initial assumption or point out another possible infection.

Therapeutic Modalities

The main therapeutic modality for this individual is an antibacterial intervention. The patient must be continuously supplied with antibacterial drugs to prevent his wound from festering. Moreover, sepsis is synonymous with blood poisoning, and this can be prevented by a strong dose of antibiotics (Allen, 2019).

Nursing Role Reflection

Within the interdisciplinary team, communication was mainly one on one, verbal conversations. Also, notes were used to convey treatment and diagnosis outcomes between the doctor, the nurse, the lab personnel, and the doctor. The conversations were formal and respectful. As a nurse, my communication style was centered on communicating clearly and listening aptly to the physician’s advice. It resulted in the doctors offering in-depth analysis of the patient and facilitating my understanding of the patient’s condition and needs.

The organizational framework supported the quality of care for this patient. I would recommend the introduction of e-monitoring of patients using a series of interconnected cameras to the main room where stand-by nurses can watch the patients in addition to the nurses doing rounds in the hospital (Kazancigil, 2019).

Conclusion

In conclusion, nursing intervention is a key part of patient assistance and recovery. It is important that nurses’ work is appreciated more and facilitated to secure the best outcomes for all patients.

References Allen, C. (2019). How Do You Prevent Blood Poisoning?. Patient Safety, 1(1), 2-2.

Avila, A. A., Kinberg, E. C., Sherwin, N. K., & Taylor, R. D. (2016). The use of fluids in sepsis. Cureus, 8(3).

Baratloo, A., Amiri, M., Forouzanfar, M. M., Hasani, S., Fouda, S., & Negida, A. (2016). Efficacy measurement of ketorolac in reducing the severity of headache. Journal of Emergency Practice and Trauma, 2(1), 21-24.

Cardona-Morrell, M., Prgomet, M., Lake, R., Nicholson, M., Harrison, R., Long, J., … & Hillman, K. (2016). Vital signs monitoring and nurse–patient interaction: A qualitative observational study of hospital practice. International journal of nursing studies, 56, 9-16.

Chuma, M., Makishima, M., Imai, T., Tochikura, N., Suzuki, S., Kuwana, T., … & Sakaue, T. (2019). Relationship between hemoglobin levels and vancomycin clearance in patients with sepsis. European journal of clinical pharmacology, 75(7), 929-937.

Dewi, R. S., Radji, M., & Andalusia, R. (2018). Evaluation of antibiotic use among sepsis patients in an intensive care unit: a cross-sectional study at a referral hospital in Indonesia. Sultan Qaboos University Medical Journal, 18(3), e367.

Kazancigil, M. A. (2019, July). Innovations and convergence in mobile medical applications and cloud-based hospital information systems for the real-time monitoring of patients and early warning of diseases. In 2019 IEEE World Congress on Services (SERVICES) (Vol. 2642, pp. 301-306). IEEE.

Putzu, A., Schorer, R., Lopez-Delgado, J. C., Cassina, T., & Landoni, G. (2019). Blood purification and mortality in sepsis and septic ShockA systematic review and meta-analysis of randomized trials. Anesthesiology: The Journal of the American Society of Anesthesiologists, 131(3), 580-593.

Saberi, A., Pourshafie, S. H., Kazemnejad-Leili, E., Nemati, S., Sutohian, S., & Sayad-Fathi, S. (2019). Ondansetron or promethazine: which one is better for the treatment of acute peripheral vertigo?. American journal of otolaryngology, 40(1), 10-15.

Singer, A. J., Hollander, J. E., Cassara, G., Valentine, S. M., Thode Jr, H. C., & Henry, M. C. (1995). Level of training, wound care practices, and infection rates. The American journal of emergency medicine, 13(3), 265-268.