Advances in Sepsis Diagnosis And Management
For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.
The Assignment:
- Using the required admission orders template found under the Learning Resources: Required Reading.
- Develop a set of orders as the admitting provider.
- Be sure to address each aspect of the order template
- Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
- Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.
- Make sure the order is complete and applicable to the patient.
- Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This should be done at the end of the order set – not included with the order.
- Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.
- A minimum of three current (within the last 5 years), evidenced based references are required. Advances in Sepsis Diagnosis And Management
PLACE YOUR ORDER HERE NOW
Admission Order
Primary Diagnosis: Septic Shock, most likely from Urinary Tract Infection (UTI)
Status/Condition (Critical, Guarded, Stable, etc.): Critical
Code Status: Full code
Allergies: None known
Admit to Unit: Intensive Care Unit ICU
Activity Level: Bed rest initially, frequent position changes as tolerated with gradual mobilization as tolerated
Diet: Nil per oral
IV Fluids:
- Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.):
- Levophed 0.1mcg/kg/min to start in 4mg/250ml NS solution — titrate up or down by 0.05mcg/kg/min to maintain MAP >65, for a max of 0.15mcg/kg/min.
- Consider initiation of septic shock resuscitation protocol with aggressive fluid resuscitation, e.g., lactated Ringer’s solution or balanced crystalloid (Marques et al., 2023).
- Antibiotic: IV Cefepime 2gm q 8 hours to start within one hour
Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings:
- Oxygen via nasal cannula at 2 L/min to maintain SpO2 > 95%
- Encourage coughing and deep breathing exercises every 2 hours while awake
Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose and route):
- Start empirical broad-spectrum antibiotics immediately (e.g., vancomycin and piperacillin-tazobactam) pending culture results. Adjust antibiotics based on culture and sensitivity results (Pant et al., 2021).
- Initiate vasopressor therapy for hemodynamic support (e.g., norepinephrine) to maintain mean arterial pressure (MAP) > 65 mmHg
- Acetaminophen 650 mg orally every 6 hours as needed for fever control
- Pantoprazole 40 mg IV once daily for gastrointestinal protection Advances in Sepsis Diagnosis And Management
Nursing Orders (vital signs, skin care, toileting, ambulation, etc.):
- Continuous cardiac monitoring
- Vital signs every 15 minutes initially, then hourly
- Neurological checks every hour
- Monitor urine output hourly
- Strict intake and output measurements
- Position changes every 2 hours to prevent pressure ulcers
- Administer pain medication as needed
Follow-Up Lab Tests:
- Repeat CBC, CMP, and blood cultures every 24 hours (Mahapatra & Heffner, 2022).
- Arterial blood gas (ABG), if clinically indicated
- Lactate levels every 6 hours initially, then as indicated
- Diagnostic testing (CXR, US, 2D Echo, etc.):
- Repeat chest X-ray (CXR) if clinically indicated
- Consider abdominal ultrasound if signs of abdominal pathology develop
- Continuous cardiac monitoring
- Arterial blood gas (ABG)
- Blood cultures prior to antibiotic administration and at 24 hours
Consults:
- Infectious Disease consult for further antibiotic management and infectious source identification
- Nephrology consult for renal function monitoring and management of acute kidney injury
- Critical Care Medicine consult for intensive care management and hemodynamic optimization
NOTE: (Do not defer management to a specialist. As an ACNP, you must manage the patient’s acute needs for at least 24 hours]. Include indication for consult. For example: “Cardiology consult for evaluation of new-onset atrial fibrillation” or “Nutrition consult for TPN recommendations.”
Patient Education and Health Promotion (address age-appropriate patient education. if applicable):
- Educate patient and family about the seriousness of septic shock and the need for aggressive treatment
- Discuss the importance of hand hygiene and infection control measures
- Provide information on the signs and symptoms of sepsis recurrence and when to seek medical attention (Mahapatra & Heffner, 2022)
- Discuss goals of care and address any concerns or questions
Discharge Planning and Required Follow-Up Care:
- Transfer to the medical-surgical unit once hemodynamically stable
- Arrange for physical therapy evaluation and rehabilitation as needed.
- If the patient continues to have altered mental status, feels burning when urinating, or has black, pungent urine, return.
- Schedule follow-up appointments with primary care physicians and specialists as appropriate
References
Mahapatra, S., & Heffner, A. C. (2022). Septic Shock. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430939/#:~:text=Sepsis%20is%20defined%20as%20systemic
Marques, A., Torre, C., Pinto, R., Sepodes, B., & Rocha, J. (2023). Treatment advances in sepsis and septic shock: Modulating pro- and anti-inflammatory mechanisms. Journal of Clinical Medicine, 12(8), 2892. https://doi.org/10.3390/jcm12082892
Pant, A., Mackraj, I., & Govender, T. (2021). Advances in sepsis diagnosis and management: A paradigm shift towards nanotechnology. Journal of Biomedical Science, 28(1). Advances in Sepsis Diagnosis And Management
