Sepsis, commonly referred to as blood poisoning, is a debilitating, common, and deadly disease. Sepsis is a Greek word for putrefaction, decayed, and rotten flesh. From a clinical perspective, the term sepsis is used to refer to the system inflammatory response due to microbial infection associated with organ dysfunction. According to the World Sepsis Day (2015), sepsis has a higher probability to cause death compared to cancer and heart attack. The most susceptible and vulnerable populous include older adults and young children with issues of immunology. It is the key contributor to the increased mortality rate of the older population in the U.S.
The project will be guided by this PICOT Question: In adult patients with septic shock requiring vasopressors (P), will a target mean arterial pressure (MAP) of 65 mmHg (I) vs. higher MAP (C) improve mortality (O) within the first 24-48 hours of diagnosis(T)?
Several literature studies have been conducted as an attempt to understand sepsis, as well as septic shock. Angus et al. (2015) conducted a systematic review of sepsis to determine the effect of early-directed therapy on mortality rate in comparison to resuscitating patients suffering from septic shock (Asfar et al., 2014). According to this study, the early goal-directed therapy does not have any form of superiority to care for emergency department patients suffering from septic shock. Research holds that implementing protocols is insufficient (Banerjee et al., 2015). There is a need to take into consideration other open-minded approaches. Such sepsis interventions should have the capacity to cause long-term effects on survivors and restore their functionality level (Zhou, Mao, Zeng, Kang, Liu, Pan, & Hou, 2015).
It is the responsibility of nurses to ensure awareness in regard to sepsis. A lack of awareness has made it difficult to diagnose sepsis at its lowest level, during which any aggressive treatment would solve the issue. Early interventions can improve the outcome by influencing the inflammatory response (Harrison, Gajic, Pickering, & Herasevich, 2016). In addition, nurses are supposed to ensure consistency during the implementation of the system to ensure improved recommendations. Hence, nurses and health providers ought to use EMR, assessments, and clinical judgments to identify a patient’s clinical laboratory values and vital signs with the aim of identifying a dysfunctional organ (Long, Capan, Mascioli, Weldon, Arnold, & Miller, 2018).
Sepsis shock and sepsis have become a serious health condition in the U.S. It is usually advisable to consider administering early and aggressive sepsis treatment for the purpose of improving the survivability of the patient. In most cases, the patient is treated with vasopressors, antibiotic administration, and intravenous fluids. Immediately after the patient is taken to the ICU, the following assessment must be carried out; blood culture, administered 30ml/kg crystalloid, lactate level measured and administered antibiotics. In patients, they are supposed to utilize the quick sequential organ failure assessment (Qsofa) to determine the presence of sepsis-related organ dysfunction, as well as the level of risk due to clinical decline (Singer et al., 2016).
The inherent challenges in the healthcare environment such as insufficient staffing, inadequate facilities, and funding gaps prompted the government of the United States to interfere. The Agency for Healthcare Research and Quality (AHRQ) is, therefore, responsible for issues related to the provision of high-quality healthcare through research. The agency is responsible for establishing and running health-related facilities such as intensive care units where health conditions such as sepsis are addressed.
Nurses and advanced practice nurses are usually authorized, educated, and competent enough to offer professional help in the ICU and any other healthcare related environment. Nursing practice is fundamental in improving the relationship between a patient with septic health problem and nurses. It guides that such a relationship should be founded on trust, communication, kindness, and understanding. Nursing practice is, therefore, essential towards ascertaining that the implementation of a Sepsis protocol in the ICU is efficient and meets threshold requirements.
Angus, D. C., Barnato, A. E., Bell, D., Bellomo, R., Chong, C. R., Coats, T. J., … & Howe, B. (2015). A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. Intensive care medicine, 41(9), 1549-1560.
Asfar, P., Meziani, F., Hamel, J. F., Grelon, F., Megarbane, B., Anguel, N., … & Legay, F. (2014). High versus low blood-pressure target in patients with septic shock. New England Journal of Medicine, 370(17), 1583-1593. doi/full/10.1056/NEJMoa1312173
Banerjee, R., Teng, C. B., Cunningham, S. A., Ihde, S. M., Steckelberg, J. M., Moriarty, J. P., … & Patel, R. (2015). Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing. Clinical Infectious Diseases, 61(7), 1071-1080.
Harrison, A. M., Gajic, O., Pickering, B. W., & Herasevich, V. (2016). Development and implementation of sepsis alert systems. Clinics in chest medicine, 37(2), 219-229.
Singer, M., Deutschman, C. S., Seymour, C., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., … Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3). Jama – Journal of the American Medical Association, 315(8), 801-810.
Zhou, F., Mao, Z., Zeng, X., Kang, H., Liu, H., Pan, L., & Hou, P. C. (2015). Vasopressors in septic shock: a systematic review and network meta-analysis. Therapeutics and clinical risk management, 11, 1047.
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