General Santos Doctors' Medical School Foundation

Incorporated,
Bulaong, General Santos City

Nursing Department

SEPSIS

In Partial Fulfillment of the Requirements in NCM 102 RLE

Pedia Ward Exposure

Submitted to:
Ms. Nelba Tangog, RN

Submitted by:
Macmuod, Amir Jabib K. SN
Valerio, Stephanie Z. SN

Sepsis is the presence of pathogenic organisms or their toxins in the blood and tissues or
the poisoned condition resulting from the presence of pathogens or their toxins as in septicemia
that has spread via the bloodstream (www.sepsisalliance.org). It is a life threatening condition
that arises when the bodys response to infection injures its own tissues and organs (Czura,
2011). The infection can originate in many body parts, including the lungs, intestines, urinary
tract, or skin (http://kidshealth.org/).
A bacterial infection anywhere in the body may set off the response that leads to sepsis.
Common places where an infection might start include. (http://nanda-diagnosis.blogspot.com)

The bloodstream
The bones (common in children)
The bowel (usually seen with peritonitis)
The kidneys (upper urinary tract infection or pyelonephritis)
The lining of the brain (meningitis)
The liver or gallbladder
The lungs (bacterial pneumonia)
The skin (cellulitis)

There are three stages of sepsis, according to its severity.

SIRS (Systemic Inflammatory Response Syndrome)
2 or more of the following:
Signs/Symptoms
o Temp >38C or <36C (hyperthermia or hypothermia)
o HR >90 beats/min for adult (tachycardia)
o RR >20 breaths/min or PaCO2 <32mmhg (<4.5kPa) (tachypnea or
hyperventilation)
o WBC >12,000 or <4000 cells/mm3, or >10% immature (band) forms
(leukocytosis or leukopenia)
Sepsis
SIRS + suspected or confirmed infection (documented via cultures or visualized
via physical exam/imaging)
Severe Sepsis
Sepsis + at least one sign of organ hypo-perfusion or dysfunction.
Signs/Symptoms
o
o
o
o

Lactic acidosis
Oliguria
Hypoxemia
Coagulation disorder

o
o
o
o

Acute alteration mental status

Areas of mottled skin
Capillary refill >3 secs
ALI (acute lung injury

Septic Shock - Severe sepsis plus one of the following conditions:

Signs/Symptoms
o MAP <60 mm Hg (<80 mm Hg if previous hypertension) after adequate fluid
resuscitation
o Need for pressors to maintain BP after fluid resuscitation
o Adequate fluid resuscitation = 40 to 60 mL/kg saline solution (NS 5L-10L)
o Lactate > 4mmol /L

https://my.vanderbilt.
edu

Other S/S:
o Fever and shaking chills or, alternatively, a very low body temperature
o Decreased urination
o Nausea and vomiting
o Diarrhea

Signs and Symptoms of sepsis in newborns and young babies include:

(http://kidshealth.org/)

disinterest or difficulty feeding, or vomiting

fever (above 100.4F [38C] or higher rectally) or sometimes low temperatures
irritability or increased crankiness
lethargy (not interacting and listless)
decreased tone (floppiness)
changes in heart rate either faster than normal (early sepsis) or significantly
slower than usual (late sepsis, usually associated with shock)
breathing very quickly or difficulty breathing
periods where the baby seems to stop breathing for more than 10 seconds (apnea)
change in skin color becoming pale, patchy, and/or blue
jaundice (when the skin and eyes look yellow)
rash
decreased amount of urine (pee)
bulging or fullness of the soft spot on the babys head

Pregnancy complications that can increase the risk of sepsis for a newborn include:
(http://kidshealth.org/)

maternal fever during labor

an infection in the uterus or placenta
premature rupture of the amniotic sac (before 37 weeks of gestation)
rupture of the amniotic sac very early in labor (18 hours or more before delivery)

{RISK FACTOR) Sepsis is more common in: (netce.com)

infants under 3 months, whose immune systems haven't developed enough to fight off
overwhelming infections
the elderly
people with chronic medical conditions
Those whose immune systems are compromised from conditions such as HIV. diabetes or
cancer (malignancy)
immunosuppressive treatments, such as cancer chemotherapy
ICU patients that are already very sick
patients exposed to invasive procedures or devices (such as intravenous catheters or
breathing tubes)

CAUSES of Sepsis
Sepsis can be cause by any type of infectionbacterial, fungal, or viral. Such as:
pneumonia
abdominal infection
kidney infection
bloodstream infection
nosocomial infection

PATHOPHYSIOLOGY of Sepsis

Sepsis starts as a local infection

Begins to spread into the blood stream

Bacteria start to multiply

Bacteria releases endotoxins

WBC reacts and releases inflammatory substances

Endotoxins plus inflammatory substances is referred to as sepsis that can injure the body
in many ways.

The blood vessels dilate, BP decreased

Causes small clots in the tiny blood vessels choking off the tissue

These effects lead to a series of harmful complications:

Bld flow decreases to vital organs (kidney, brain and heart)
The heart attempts to compensate by working harder, increasing the HR and the amt of
bld pumped. Eventually, the bacterial toxins and the increased work of pumping weaken
the heart. As a result, the heart pumps less blood and vital organs receive even less blood.
When tissues do not receive enough blood, they release excess lactic acid (a waste
product) into the bloodstream, making the blood more acidic.

All of these effects result in a vicious circle of worsening organ malfunction:

The kidneys excrete little or no urine, and metabolic waste products (such as urea
nitrogen) accumulate in the blood.
The walls of blood vessels may leak, allowing fluid to escape from the bloodstream into
tissues and cause swelling.
Lung function worsens because blood vessels in the lungs leak fluid, which accumulates,
making breathing difficult.

DIAGNOSIS

Laboratory studies that may be helpful include the following: (Medscape.com)

Complete blood count (CBC)
Measures of clotting function and coagulation parameters.
Electrolyte levels
Renal and liver function tests
Etiology-specific serologies
Urinalysis
Tests for inflammatory markers and acute-phase reactants
Culture of blood, urine, cerebrospinal fluid (CSF), or other tissues

Other studies that may be considered, depending on the clinical context, are as
follows: (Medscape.com)
Chest radiography
Computed tomography (CT)
Magnetic resonance imaging [MRI)
Echocardiography.
Lumbar puncture for CSF evaluation

Nursing Diagnosis
Hyperthermia / Hypothermia related to an increase in metabolic rate, vasoconstriction /
vasodilation of blood vessels.
Ineffective tissue perfusion related to the reduced supply of oxygen / breathing irregular.
Risk for fluid volume deficit related to fluid diarrhea, vomiting, fluid shifts from the
interstitial to the vascular tissue.
Imbalanced nutrition, less than body requirements related to nausea, vomiting, increased
metabolism.
Fluid volume deficit related to dehydration
Infection related to microorganism invasion into the body.
Decreased cardiac output related to abnormal inflammation.
Ineffective breathing pattern related to rapid respirations.

Nursing Management

The initial focus of treatment is on stabilization and correction of metabolic, circulatory,

and respiratory abnormalities, which may include the following:
Aggressive fluid resuscitation and support of cardiac output
Ventilatory support with supplemental oxygen therapy
Maintenance of adequate hemoglobin concentration
Correction of physiologic and metabolic derangements
Monitoring of urine output and other end-organ functioning
Newborns and infants in the first 6-8 weeks of life: Ampicillin and gentamicin,
ampicillin and cefotaxime, or ampicillin and ceftriaxone
Patients who have indwelling catheters or those who are at high risk for methicillinresistant Staphylococcus aureus (MRSA) infection: As above, with the addition of
vancomycin.
Encourage vaccination for it is the key for preventing infections.
Warn the travelers of the possibility of serious infections during travel.
Encourage the pregnant women for swab test between 35th and 37th week to determine
if they carry a bacteria. If positive the patient can receive intravenous (IV) antibiotics
during labor at least 4 hour before delivery.

REFERENCE

http://kidshealth.org
http://www.sepsisalliance.org
http://www.mayoclinic.org
http://www.webmd.com
http://www.healthline.com
http://www.netce.com

http://emedicine.medscape.com