Infection+and+Sepsis

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= = =Infection and Sepsis =

An **infection** is an invasion of the body by a pathogen (any micro-organism that causes disease) and the resulting signs and symptoms that develop in response to the invasion. Infections can be divided into two categories: localized and systemic. A localized infection is limited to a small area. Systemic infections are wide spread throughout the body and are often spread via the blood. 1

** Sepsis ** – is a diffuse inflammatory systemic response to a chemical, mechanical, bacterial or microbial assault; if untreated, it can lead to shock. 2

** Etiology and Pathophysiology ** 1) A bodily insult leads to an inflammatory response, which is intended to protect the body from further injury and promote healing. 2) Vascular response consists of a massive release of histamine, prostaglandin, bradykinin, and other mediators, which cause vasodilation and increased capillary membrane permeability and inititiation of the clotting cascade. 3) This maldistribution of circulating blood volume causes decreased cellular O2 supply, impaired tissue perfusion and impaired cellular metabolism; impaired perfusion can be monitored by increasing saturation of central venous oxygenation (ScvO2) and level less than 70% indicates significant problem with systemic O2 delivery. 4) Severe sepsis, which is characterized by hypoperfusion, organ dysfunction, and hypotension, can lead to septic shock and death caused by multiple organ system failure. 5) In early sepsis (the hyperdynamic phase), the body attempts to compensate for the decreasing oxygenation at the cellular level; the heart rate and respiratory rate increase and urine output decreases because of shunting of blood to vital organs, the body temperature increases as the metabolic activity increases, and the skin becomes warm and flushed because of vasodilation. 6) In the late stage of sepsis, compensatory mechanisms begin to fail; SNS compensatory mechanisms cause extreme tachycardia but CO is low because of vasoconstriction and poor stroke volume; peripheral pulses become weak or absent and skin becomes cool, pale, and cyanotic (vasoconstriction); respirations becomes labored and decreased because of toxin accumulation and hypoxia in the CNS; the LOC decreases to coma because of severe hypoxia. 2

** Signs and Symptoms ** 2

** Early Signs: **
 * Fever >38°C (100.4°F) or <36°C (96.8°F)
 * Tachypnea
 * Hypocarbia
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">ScvO2 <70%
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Tachycardia
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Restlessness
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Hyperglycemia

<span style="font-family: Arial,Helvetica,sans-serif;">** Late Signs: **
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Diminished LOC
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Coma
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Respiratory failure
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Heart Failure
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Oliguria


 * <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif; line-height: 24px;">Medications for Infection: **
 * Prophylactic Medications:
 * Antibiotics when person's ANC is very low
 * Antibiotic therapy is started right away at the first sign of infection.
 * When the specific germ is identified, the antibiotic may be continued or changed depending on the the type.
 * Colony Stimulating Factors (CSF)
 * Used when the infection is not responding to antibiotic therapy
 * Boost WBCs so patient can fight infection.
 * Bacterial Infection:
 * Broad Spectrum Antibiotics
 * Viral Infections:
 * Anti-viral drugs
 * Acyclovir
 * Valganciclovir
 * Fungal Infections:
 * Anti-fungal
 * nystatin (oral)

**Nursing Interventions for Infection:**
 * Monitor temperature frequently
 * Monitor BP, apical pulse, and respirations frequently.
 * Draw and send CBC, blood
 * Obtain specimens
 * blood
 * urine
 * wound drainage or pus
 * sputum
 * Management of Fever:
 * administer antipyretic medications
 * monitor VS
 * monitor I & O
 * Encourage increase of fluids
 * Administer IV fluids, as appropriate
 * cover patient with a sheet only.
 * Teach patients about preventing Infections.

**Preventing Infections:**
 * Avoid crowds or large gathers, or people that may be ill
 * Do not share utensils or personal hygiene items
 * WASH YOUR HANDS frequently/good personal hygiene habbits
 * Get immunizations (not live virus if immune system is compromised)
 * Consume a low bacteria diet, avoid under-cooked meat and raw fruits and vegetables
 * Be aware of signs and symptoms of infection.


 * <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Medications for Sepsis: **
 * <span style="font-family: Arial,Helvetica,sans-serif;">Combat sepsis
 * <span style="font-family: Arial,Helvetica,sans-serif;">Antibiotic therapy must begin before organism is identified, so multiple drugs are prescribed
 * <span style="font-family: Arial,Helvetica,sans-serif;">Common ones include vancomycin, aminoglycosides, systemic penicillin or cephalosporins, macrolides, and quinolones
 * <span style="font-family: Arial,Helvetica,sans-serif;">When bacteria is identified, IV antibiotics are given specific to cause
 * <span style="font-family: Arial,Helvetica,sans-serif;">Adrenal insufficiency
 * <span style="font-family: Arial,Helvetica,sans-serif;">Low-dose corticosteroids for at least 7 days
 * <span style="font-family: Arial,Helvetica,sans-serif;">Usually IV hydrocortisone and oral fludrocortisone
 * <span style="font-family: Arial,Helvetica,sans-serif;">Hyperglycemia
 * <span style="font-family: Arial,Helvetica,sans-serif;">Insulin therapy to maintain blood glucose lower than 150 mg/dL
 * <span style="font-family: Arial,Helvetica,sans-serif;">Clotting problems
 * <span style="font-family: Arial,Helvetica,sans-serif;">Heparin therapy
 * <span style="font-family: Arial,Helvetica,sans-serif;">Activated protein C to manage microvascular abnormalities/prevent bleeding
 * <span style="font-family: Arial,Helvetica,sans-serif;">Blood replacement therapy
 * <span style="font-family: Arial,Helvetica,sans-serif;">If septic shock progresses to hemorrhage

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">**Nursing Interventions for Sepsis:**
 * <span style="font-family: Arial,Helvetica,sans-serif;">Maintain airway, oxygen therapy
 * <span style="font-family: Arial,Helvetica,sans-serif;">Draw and send CBC, blood cultures, tests to lab per physicians order
 * <span style="font-family: Arial,Helvetica,sans-serif;">Find cause of decreased perfusion
 * <span style="font-family: Arial,Helvetica,sans-serif;">Protect organs from dysfunction
 * <span style="font-family: Arial,Helvetica,sans-serif;">Fluid replacement
 * <span style="font-family: Arial,Helvetica,sans-serif;">Drug therapy as prescribed
 * <span style="font-family: Arial,Helvetica,sans-serif;">Medications for sepsis, adrenal insufficiency, hyperglycemia, and clotting problems
 * <span style="font-family: Arial,Helvetica,sans-serif;">Nutritional therapy
 * <span style="font-family: Arial,Helvetica,sans-serif;">Monitor and maintain line access
 * <span style="font-family: Arial,Helvetica,sans-serif;">Monitor vital signs
 * <span style="font-family: Arial,Helvetica,sans-serif;">Monitor for signs of septic shock
 * <span style="font-family: Arial,Helvetica,sans-serif;">HOB at 30 degrees unless contraindicated

<span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">**Nursing Journal** – “Managing Sepsis” by Sarah Holling <span style="font-family: Arial,Helvetica,sans-serif;">[]

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif; font-size: 16px;">**References:**

<span style="background-color: white; font-family: Arial,Helvetica,sans-serif;">American Cancer Society. // Infections in People With Cancer. // Retrieved 21 January 2012 from

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<span style="font-family: Arial,Helvetica,sans-serif;">Hogan, M.A., Davenport, J., Estridge, S., Zygmont, D. //<span style="font-family: Arial,sans-serif;">Medical-Surgical Nursing //. 2nd Ed. pp.672-673. Pearson Prentice Hall. (2008)

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 13.3333px;">Lewis, S.L., Heitkemper, M. M., Dirksen, S.R., O’Brien, P.G., Bucher, L. //Medical-Surgical Nursing//. 7th Ed. p243. Mosby Elsevier.(2007).

<span style="background-color: white; font-family: Arial,Helvetica,sans-serif;">Ignatavicius, Donna D., and M. Linda. Workman. //Medical-surgical Nursing: Patient-centered Collaborative Care//. St. Louis, MO: Saunders/Elsevier, 2010. 838-44. Print.

<span style="background-color: #ffffff; color: #000000; font-family: Arial,Helvetica,sans-serif;">Ignatavicius, Donna D., and M. Linda. Workman. //Medical-surgical Nursing: Patient-centered Collaborative Care//. St. Louis, MO: Saunders/Elsevier, 2010. 451-452. Print.

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