Acute Care Nursing Essay Example

style="text-align: justify">When addressing exposure, the nurse carried out a head to toe assessment of Mrs Smith. Sepsis may be apparent by inflamed wounds or red swollen cannula sites. Mrs Smith had no skin breaks or wounds and triple care cream was applied regularly to prevent skin breakdown. No IV cannulas were present on the patient, thus a cannula site was not the cause of infection for Mrs Smith. The patient’s temperature was recorded as 38. 3OC, this was a huge deviation from the normal temperature range as per St. James’ Hospital Policy of 36. 5-37.

2OC. The patient was wearing no excess clothing and was covered by a sheet to maintain dignity and she required no blankets because she complained of feeling hot. The patient’s safety was paramount due to her confused state so side rails were raised and she was continuously monitored by a health care assistant and was not left unattended for any reason. The patient will undoubtedly be distressed and anxious therefore ‘appropriate psychological care to reduce anxiety and stress’ needs to be provided by the nurse. (Bench & Brown, 2011).

From this ABCDE assessment it was clear to the nurse that the patient was hypotensive, tachycardic, had a reduced respiratory function and had neurological disturbances. It was necessary for the medical team to be contacted to prescribe appropriate treatment for Mrs Smith promptly. The ISBAR Tool was used to communicate with the clinical nurse manager and medical team. The nurse identified herself, her position and what ward she was calling from on the phone to the SHO. The nurse explained her concerns about Mrs Smith stating that she believed

sepsis was present.

The SHO was informed of Mrs Smith’s reason for admission which was a UTI, laceration to forehead due to fall and awaiting long term care. The nurse stated Mrs Smith’s past medical history of chronic back pain, mild asthma and recurrent UTI’s. The medications prescribed to Mrs Smith were explained. The nurse highlighted the significant change in the patient’s vital signs and voiced her concern. It was recommended to the SHO to review the patient immediately as treatment was required to stop the progression of the severe sepsis into shock.

Lovick (2009) explains that the ‘first six hours after diagnosis present a small window of opportunity in which to reverse tissue hypoxia and prevent established organ failure’. The nurse clarified her expectations with the SHO and agreed with the nurse’s concerns. The SHO was on the ward within ten minutes to assess and provide medical interventions for Mrs Smith. On review of the patient and the nursing assessment Severe Sepsis was diagnosed by the SHO. Both Creed & Spiers (2010) and Daniels & Robson (2008) outline six main steps to follow in the treatment of sepsis. These steps coincide with the treatment prescribed by the SHO.

The first point outlined was the administration of 100% oxygen. As discussed earlier the metabolic demand is raised significantly due to the sepsis, resulting in a higher production of CO2 which in turn will raise the respiratory rate the nurse had already administered oxygen while carrying out the breathing assessment. The second step outlined was to take blood cultures to identify the cause of sepsis before the IV antibiotics are given. Thirdly the

use of broad spectrum antibiotics is recommended as soon as possible ‘to delay the giving of antibiotics increases a patient’s mortality by 7.

6% for every hour’s delay’ (Daniels & Robson 2008). The next step outlined is IV fluid therapy to correct the hypotension cause by severe sepsis. Lactate and haemoglobin levels need to be taken to ensure no blood transfusion is needed and that the patient is not entering septic shock and finally the insertion of a urinary catheter to assess kidney function is mutually suggested by Creed & Spiers (2010) and Daniels & Robson (2008) Due to Mrs Smith being tachypnoeic, low in saturations and having a high respiratory rate as outlined by the nurse, the SHO took an Arterial Blood Gas.

Arterial Blood Gases were taken to determine the patients CO2 levels in the blood, lactate levels and pH to determine her acid-base level. The ABG results would be monitored closely by the nurse as ‘metabolic acidosis is a common problem in patients with sepsis and other forms of critical illness and is associated with a poor outcome’ (Kellum 2004). To address the patient’s hypotension fluid resuscitation was prescribed by the SHO. Crystalloid fluids of 0. 9% sodium chloride was ordered by the medical team to re-establish circulatory volume, however ‘fluid resuscitation may consist of colloids or crystalloids.

There is no evidence based support for one type or the other’. (Dellinger at al 2004). During the first 24 hours patients often receive a high dose of fluids to restore their cardiac output and limit organ damage. ‘Fluid resuscitation is replacing some of the circulating volume that has been lost

because of capillary leak or oedema’. (Creed and Spiers 2010). Two IV cannulas were inserted by the nurse, they were flushed to ensure they were patent and while the fluids were infusing Mrs Smith was monitored for signs of fluid overload and oedema special attention would also be needed if Mrs Smith had a history cardiac or renal failure.

Mrs Smith cannulas were patent and checked regularly for any signs of infection. Usually the cannula would be removed 72hours after insertion to avoid infection. The SHO also ordered the insertion of a urinary catheter to record the urinary output accurately, also ‘urine output is a good measurement of blood flow to the kidneys and therefore an easily observable measure of cardiac output’ (Creed & Spiers, 2010). The nurse also has an important role in strict fluid intake and output monitoring.

Most patients in severe sepsis will develop oliguria. Brunner & Suddarth (2008) define oliguria as ‘diminished urine output, less than 400ml per 24hours’. Early detection by the nurse of poor urine output can ensure interventions are taken to avoid renal damage. The catheter was inserted by the nurse under strict aseptic technique in order to avoid introducing infection. The urine was measured hourly and the patient was found to have oliguria she voided.