Recognizing the signposts for sepsis NursingCenter识别路标对脓毒症nursingcenter.pptVIP

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Recognizing the signposts for sepsis NursingCenter识别路标对脓毒症nursingcenter.ppt

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Recognizing the signposts for sepsis NursingCenter识别路标对脓毒症nursingcenter

Recognizing the Signposts for Sepsis By Margaret J. McCormick, RN, MS Nursing made Incredibly Easy! May/June 2009 2.5 ANCC contact hours Online: ? 2009 by Lippincott Williams Wilkins. All world rights reserved. Sepsis = Serious Systemic inflammatory response to the presence of infection Can progress to circulatory systemic dysfunction, multiple organ system dysfunction, and death High morbidity and mortality Older persons, infants, and immunocompromised patients are at increased risk Incidence is 3 cases per 1,000 people; in hospitalized patients, the incidence is 2% Reasons for Increased Incidence Growing number of immunocompromised patients Greater number of invasive procedures Increased number of resistant organisms Rise in number of older patients with critical illnesses A Complex Cascade A Complex Cascade Inflammation is the body’s response to a chemical, traumatic, or infectious insult The inflammatory cascade is a complex process that involves humoral and cellular responses Following an insult, local cytokines are produced and released Unregulated release of proinflammatory mediators (cytokines) can elicit toxic reactions and promote cellular adhesion Cell damaging proteases are released (prostaglandins), leading to fever, tachycardia, ventilation/perfusion abnormalities, acidosis, and activation of the clotting cascade Pinning Down the Culprit 64.9% of all sepsis cases are patients over age 65 Causes of sepsis include: pneumonia, UTI, diarrhea, meningitis, cellulitis, arthritis, wound infection,endocarditis, and catheter-related infection Sepsis may start as systemic inflammatory response syndrome (SIRS) Diagnosis of SIRS Requires two or more of the following: ? Body temperature greater than 100.4° F or less than 96.8° F ? Heart rate greater than 90 beats/minute ? Respiratory rate greater than 20 breaths/minute ? Partial pressure of carbon dioxide less than 32 mm Hg ? White blood cell count greater than 12,000/mm3 or less than 4,000/