Sepsis is a huge healthcare problem world-wide with millions of people diagnosed every year. Sepsis and septic shock have a mortality rate of one in every four people and often can cause permanent disability in its survivors (Dellinger et al. 2013). The vastness of this number means the cost of sepsis is not only great in regards to mortality, but also on an economic and social scale.
What Is Sepsis?
Recently there has been updates regarding the definition of sepsis and septic shock which until now, had not been revised since 2001. “Sepsis is defined as life-threatening organ dysfunction caused by a deregulated host response to infection” (Singer et al. 2016).
Sepsis occurs as a complication of an infection and can be life threatening. When an individual has an infection, chemicals are released into the bloodstream to lead the inflammatory responses occurring in the body. This process can trigger changes which have the potential to cause damage and failure to multiple organs and their systems (Mayo Clinic 2016). It is the body’s own response to infection which causes sepsis and injury to its own tissues and organs (Singer et al. 2016).
Individuals who suffer from septic shock will experience persistent hypotension despite adequate fluid resuscitation (Singer et al. 2016). It occurs when the underlying circulatory and cellular abnormalities are excessive enough to significantly increase the individual’s risk of mortality. Specifically, Singer et al. defines septic shock occurring when there is “persisting hypotension requiring vasopressors to maintain MAP (mean arterial pressure) >65mmHg and having a serum lactate level >2mmol/L despite adequate volume resuscitation” (2016).
What Causes Sepsis?
Sepsis doesn’t discriminate; anyone from babies to older adults, males to females, can develop it. It is, however, more common and dangerous in those with weakened immune systems, older adults with multiple co-morbidities, the very young, and individuals who are already unwell (Mayo Clinic 2016).
Any type of infection can lead to sepsis, whether it’s bacterial, viral or fungal, however sepsis most commonly occurs following pneumonia, abdominal infection, kidney infections and bloodstream infections (Mayo Clinic 2016).
What Are The Signs and Symptoms Of Sepsis?
The many signs and symptoms of sepsis include abnormalities in the individual’s body temperature, heart rate, respiratory rate and white blood cell count, in addition with hypoxaemia, oliguria, lactic acidosis, elevated liver enzymes and altered cerebral function (Sepsis Alliance 2016).
Someone with sepsis will often display the following:
- S – Shivering, fever, or very cold
- E – Extreme pain or general discomfort
- P – Pale or discoloured skin
- S – Sleepy, difficult to rouse, confused
- I – ‘I feel like I might die’
- S – Short of breath
(Sepsis Alliance 2016).
Early and aggressive treatment of sepsis is essential to improve the individual’s chance of survival. This treatment usually consists of antibiotic administration, large amounts of intravenous fluids, and vasopressors if the patient remains hypotensive (Mayo Clinic 2016).
Within three hours of the individual’s presentation (In the emergency department, or otherwise from the earliest time in which their assessments are consistent with all elements of sepsis) they must have the following completed:
- Lactate level measured
- Blood cultures obtained prior to the administration of antibiotics
- Administration of broad spectrum antibiotics
- Administered 30mL/kg crystalloid for hypotension or lactate greater than 4mmol/L
(Society of Critical Care Medicine 2015)
The individual will also need supportive care such as oxygen supplementation and, as mentioned, large amounts of intravenous fluids. In the event of kidney failure, the patient may additionally require ventilation or dialysis (Mayo Clinic 2016).
What Are The Outcomes For A Patient Who Is Septic?
Fifty per cent of people who survive sepsis develop post-sepsis syndrome (Sepsis Alliance 2016). This can be caused by a variety of factors, including any resulting permanent disability from the sepsis and also the psychological effects of both the illness and their prolonged hospitalisation.
Symptoms Of Post-Sepsis Syndrome
- Nightmares, vivid hallucinations and panic attacks
- Disabling muscle and joint pains
- Extreme fatigue
- Poor concentration
- Decreased cognitive functioning
- Loss of self-esteem and self-belief
(Sepsis Alliance 2016).
Nursing Care For Someone Who Is Septic
Nurses need to be aware of when an individual is particularly at risk of developing sepsis, and monitor for any signs or symptoms.
Nurses are essential in the prompt identification and treatment of patients with sepsis. Early and immediate intervention decrease the patients risk of mortality substantially.
Following recovery from sepsis, nurses must ensure that the patient’s treatment takes an holistic approach. This is essential as the individual may be feeling not only the physical effects of being ill, but also the psychological and cognitive effects of having sepsis and social isolation following a prolonged stay in the ICU.
- Dellinger, RP, Angus, DC, Annane, D, Beale, RJ, Deutschman, CS, Douglas, IS, Gerlach, H, Jaeschke, R, Kleinpell, RM, Levy, MM, Machado, FR, Moreno, R,Nunnally, ME, Opal, SM, Osborn, TM, Reinhart, K, Rhodes, A, Rubenfeld, GD, Sevransky, JE, Sprung, CL, Townsend, SR, Vincent, JL, Webb, SA & Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup 2013, ‘Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012’, Critical Care Medicine, vol. 41, no. 2, pp. 580-637, viewed 29 June 2016, http://www.sccm.org/Documents/SSC-Guidelines.pdf
- Mayo Clinic 2016, Sepsis, USA, viewed 29 June 2016, http://www.mayoclinic.org/disease…784
- Sepsis Alliance 2016, Definition of Sepsis, San Diego, viewed 29 June 2016, http://www.sepsis.org/sepsis/definition/
- Singer, M, Angus, DC, Annane, D, Bauer, M, Bellomo, R, Bernard, GR, Chiche, JD, Coopersmith, CM, Deutschman, CS, Hotchkiss, RS, Levy, MM, Marshall, JC, Martin, GS, Opal, SM, Rubenfeld, GD, Seymour, CW, Shankar-Hari, M, van der Poll, T & Vincent, JL 2016, ‘The Third International Consensus Definitions For Sepsis and Septic Shock (Sepsis-3)’, The Journal of the American Medical Association, vol. 315, no. 8, viewed 29 June 2016, http://jama.jamanetwork.com/article.aspx?articleid=2492881
- Society of Critical Care Medicine 2015, ‘Updated bundles in response to new evidence,’ Surviving Sepsis Campaign, Mount Prospect, viewed 29 June 2016, http://survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf