Sepsis Presentation
What does SIRS mean?
Systemic Inflammatory Response Syndrome
What lab specimen for sepsis should be drawn before Antibiotics?
Blood cultures
What are the 2 recommended Sepsis fluid Medications?
Lactated Ringers and Normal Saline
True or False - A Lactic Acid specimen be placed in ice after collection?
True
How can you prevent sepsis?
Good hygiene, Handwashing, vaccines, follow medications, early recognition
What are possible signs and symptoms of sepsis?
Temp >100.9 or<96.8 HR rate > 90; RR>20/ wbc > 12,000 or <4,000; BP Systolic <90; Chills; SOB; Confusion,disorientation; Pain, discomfort; N/V
Should antibiotics or a fluid bolus be given 1st when severe sepsis or septic shock is present?
Antibiotics
What is the recommended amount/rate for sepsis bolus fluids to be administered?
30 ml/kg/hr
True or False: Can Lactic acid specimen tube and Blood Culture bottles be transported to the Lab via the tube system?
Yes
What safety precautions should be done before drawing any lab specimens?
Pt ID (name, DOB and last 3 digits MRN) and print labels so that you can label specimens at bedside
Name 1 Organ Dysfunction for Sepsis?
↓ BP, ↑ creatine, ↑bilirubin, ↑lactic acid, ↑INR, ↓ platelets, ↓urine output, or new intubation (cpap, bipap, intubation)
What should be checked prior to giving antibiotics to a patient?
Patient ID and allergies
What are 2 indications that require a Sepsis Fluid Bolus?
Initial hypotension: 2 BPs systolic under 90 or Septic Shock initial lactic acid result 4.0 or greater
How many mls of blood is required to fill a blood culture bottle?
8-10 mls
What is the process for notifying the provider for a critical result?
The RN should notify the provider within 15 minutes of receiving the result and and document notification in EPIC (flowsheet)
Name 2 signs and symptoms of an infection?
↑temp, ↑HR, ↓BP, SOB, pain, clammy skin, confusion/disorientation
What is the time frame to administer antibiotics when Sepsis is suspected/known?
Best practice is within 1 hr of suspected/known sepsis
What sepsis fluid should NOT be administered together with piperacillin (Zosyn)?
Lactated Ringers
Which blood culture tube should be drawn 1st? Aerobic or anaerobic?
Aerobic - reason air may be in the collection set. Remember: E before N Aerobic Anaerobic
What should the clinician do if: There a possible/actual source of infection and the patient meet the SIRS criteria/organ dysfunction?
Notify provider of clinical concerns or activate an RRT
Check to see if the sepsis bundle completed
Identify 2 populations of patients that are most at risk for developing sepsis?
Older adults; Infants and young children,Pregnant; weakened immune systems: HIV, cancer, chronic medical conditions; IV catheters or other medical devices; Burns or other severe injuries
Where can the provider find the best selection for Sepsis Antibiotics?
Sepsis order set
When should the patient's BP be checked after the sepsis fluid bolus is administered?
2 BPs should be documented within 60 minutes after completion of the fluids bolus
When is a repeat lactic acid blood test required to be drawn?
If the initial lactic acid is over 2.0, the repeat lactic acid should be drawn within 6 hrs after Severe Sepsis Presentation
What documentation in EPIC supports the recognition and management of sepsis?
Provider/Resident uses the Sepsis Order Set and Navigator; Nurse documents EWS score every shift; starts an Adult Sepsis Admission Care Plan and Discharge Education (Life After Sepsis); ED RN gets a BPA in Narrator