Urosepsis With Subsequent Bacteremia Nursing Essay

Urosepsis With Subsequent Bacteremia Nursing Essay Sepsis is a clinical syndrome defined by a systemic, dysregulated inflammatory response to infection. Clinical features include either a culture-proven or visually identified infection along with two or more abnormalities in temperature, heart rate, respiration, or white blood count in the response to an infection. This case study will discuss the clinical presentation, diagnosis, and medical management of a patient with urosepsis and subsequent bacteremia in a 78-year-old male. KEY WORDS: Sepsis, abdominal pain, urinary tract infection, bacteremia INTRODUCTION: Sepsis is the clinical syndrome that results from a dysregulated inflammatory response to an infection. The definition of sepsis involves either a culture-proven or visually identified infection, along with two or more of the following: Temperature > 38.3Â °C or 90 beats/min Respiratory Rate >20 breaths/min or PaCO2 12,000 cells/mm3, 10 percent immature (band) forms (UPTODATE ARTICLE) Common sites of origin of sepsis include the following: Central nervous system: meningitis Lungs: pneumonia, empyema Abdomen: peritonitis, intraabdominal abscess, appendicitis, pancreatitis Genitourinary tract: indwelling catheters Skin and soft tissue: cellulitis, trauma, catheters (AM Journal of medicine: sepsis) Common bacteria causing sepsis are gram positive bacteria including staphylococci, streptococci, and enterococci, and gram negative bacteria including Escherichia coli, Proteus species, Pseudomonas, and Klebsiella species. (The American journal of medicine: SEPSIS) Predisposing factors of sepsis include trauma, burns, surgery (especially abdominal procedures), diabetes mellitus type 1 or type 2, chronic renal failure, immunosuppression (as with patients with AIDS, chronic steroid use, chemotherapy, neutropenia, post organ transplant), indwelling intravascular and urinary catheters, old age, infancy, and malnutrition. (first consult) To initiate appropriate supportive measures, it is important to identify the severity of the sepsis syndrome. The severity can be classified along a continuum of Systemic Inflammatory Response Syndrome (SIRS), sepsis, severe sepsis, or septic shock. Systemic Inflammatory Response Syndrome (SIRS) criteria involve a dysregulated inflammatory response to a noninfectious etiology. Possible noninfectious insults include autoimmune disorders, pancreatitis, thromboembolisms, or surgeries. These noninfectious processes must be present along with two or more of the abnormalities in temperature, heart rate, respiratory rate, and white blood count listed above. UPTODATE Sepsis, as mentioned above, is SIRS due to a suspected or confirmed infection (Sepsis The American journal of medicine). Two or more of the abnormalities mentioned above along with either a culture-proven or visually identified infection defines sepsis. UPTODATE Severe sepsis is sepsis with atleast one of the following signs of hypoperfusion, hypotension, or end organ dysfunction. Signs of end organ dysfunction include areas of mottled skin, delayed capillary refill of greater than 3 seconds, urine output of 2 mmol, change in mental status, abnormal electroencephalographic findings, platelet count 5mcg/kg per min, norepinephrine