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Pulmonary Hyperventilation, respiratory alkalosis, shortness of breath, tachypnea, hypoxemia, acute lung injury Gastrointestinal & Genitourinary Nausea, vomiting, decreased albumin, jaundice, oliguria Hematologic Increased or decreased WBCs, increased INR, increased PTT, DIC, thrombocytopenia Metabolic/Endocrine Increased glucose production, insulin resistance, lactic acidosis, electrolyte abnormalities (Kaplow & Hardin, p. 622, 2007) Treatment Once sepsis is recognized, treatment needs to begin immediately. Four phases have been identified to help with diagnosis and treatment of sepsis (O’Brien et al, 2007). Stage one is the Resuscitation Phase which involves assessing the above mentioned signs and symptoms. Assessing vital signs, white blood cell count (WBC), and a differential are key steps in this first stage. Within one hour of the suspicion of sepsis, obtain appropriate cultures and administer broad spectrum antibiotics. Vasopressors should be administered if fluids do not improve hypotension. The airway should be evaluated and managed with intubation if necessary. The Resuscitation Phase should be completed within 6 hours (O’Brien et al, 2007). Initial Management is the next phase in the treatment of sepsis. This phase should be completed within 24 hours of the presentation of sepsis. Further diagnostic testing is performed to detect likely pathogens and sites of infection. Once the source is determined, it needs to be controlled. Some examples include removal of infected central lines and surgical debridement of wounds. The plan of care and outcomes also need to be discussed with the patient and family (O’Brien et al, 2007). The Maintenance Phase begins 24 hours after the presentation of sepsis. The goal of this phase is to prevent nosocomial complications and restore premorbid functioning. Avoid nososomial infections through good hand washing and restrictive transfusion practices. Review cultures and customize antibiotic therapy to improve outcomes and prevent antibiotic resistance. Apply appropriate stress ulcer and thromboembolism prophylaxis (O’Brien et. al, 2007). The Recovery Phase is the final stage. Goals of care should be discussed with the patient and family. Prevention measures such as immunizations and good hand washing should be instilled in the patient and family. The appropriate follow up services should be offered (O’Brien, 2007). Positive patient outcomes can be achieved by following the treatment guidelines and applying the Synergy Model to the plan of care. The Synergy Model The American Association of Critical-Care Nurses’ (AACN) created the Synergy Model. This model fosters the development of nurse competencies to optimally meet the individual needs of patients (Kaplow & Hardin, 2007). When the competencies and needs are met, improved outcomes result for the patient, family, and the healthcare system (Mullen, 2002). The model consists of eight patient characteristics and eight nurse characteristics. The patient characteristics exist on a continuum and the patient may fluctuate depending upon the illness (Curley, 1998). The following are the patient characteristics (Mullen, 2002): · Resiliency: Capacity to return to previous level of functioning · Stability: The ability to maintain a steady state · Complexity: The entanglement of 2 or more systems (body, family, therapies) · Predictability: Expecting a certain illness trajectory or outcome · Vulnerability: Susceptibility to stressors that may effect outcomes · Participation in Decision-Making: How much the patient and family participate in decision making · Participation in Care: How much the patient and family can participate in care · Resource Availability: Resources (personal, financial, social, etc) the patient and family bring to the current situation.
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