Otterbein University Digital Commons @ Otterbein

Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work

Summer 2015

Identifying Acute Organ Dysfunction as a Marker of Severe Sepsis

Daniell McSweeney Otterbein University, [email protected]

Follow this and additional works at: https://digitalcommons.otterbein.edu/stu_msn

Part of the Bacterial Infections and Mycoses Commons, Medical Pathology Commons, and the Nursing Commons

Recommended Citation McSweeney, Daniell, "Identifying Acute Organ Dysfunction as a Marker of Severe Sepsis" (2015). Nursing Student Class Projects (Formerly MSN). 69. https://digitalcommons.otterbein.edu/stu_msn/69

This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact [email protected]. Identifying Acute Organ Dysfunction as a Marker of Severe Sepsis Daniell McSweeny RN,BSN Otterbein University, Westerville, Ohio

References Bruce, H. R., Maiden, J., Fedullo, P. F., & Kim, S. C. (2015). Impact of Nurse- Initiated ED Sepsis Protocol on Introduction: The current Signs and Underlying Significance of Pathophysiology: Nursing Compliance With Sepsis Bundles, Time Conclusion: to Initial Antibiotic Administration, and definition of sepsis is suspected or Understanding the pathophysiology of severe sepsis is significant to good patient In-Hospital Mortality. Journal Of documented infection plus at least one Symptoms: The individual Pathophysiology: outcomes. The number of septic cases in the United States exceeds 750,000 per year and Considerations: Despite advances in the development Emergency Nursing, (2), 130. systemic manifestation of infection. Severe patient response to severe sepsis is Sepsis, severe sepsis, and septic shock was recently reported to be rising. Sepsis is the 10th leading cause of death in the United Increased nursing knowledge of organ of numerous drugs and supportive care doi:10.1016/j.jen.2014.12.007 sepsis has been defined as sepsis plus dependent on characteristics of both the may be secondary to either community- States and the leading cause of death in non-cardiac ICUs. One patient in the United States dysfunction markers could improve severe therapies, severe sepsis remains an evidence of organ dysfunction. Identifying host (comorbidities and acquired, health care associated or presents to an emergency department every minute with severe sepsis and accounts for septic patient outcomes. The earlier the unconquered challenge for clinical Cawcutt, K. A., & Peters, S. G. (2014). acute organ dysfunction is a marker of immunosuppression) and the pathogen hospital-associated infections. The most 20% of all ICU admissions (Palleschi, Sirianni, O’Connor, Dunn, & Hasenau, 2014). patient is identified as severe sepsis, the investigators and physicians with an Severe sepsis and septic shock: clinical severe sepsis. This topic was chosen after (virulence and organism load). common underlying causes are Knowledge of organ dysfunction markers could help identify severe sepsis quickly which sooner that they can receive protocol unacceptable high mortality rate of overview and update on management. witnessing a number a patients fall into Coagulation abnormalities form from pneumonia, intra-abdominal infections, means that treatment protocol can be initiated earlier. Comprehending the etiologic origins treatment. Recent studies show that nurses 28% to 50%. Sepsis is the most common Mayo Clinic Proceedings, 89(11), 1572- septic shock before severe sepsis was severe sepsis, such as intravascular and urinary tract infections. Etiologic of sepsis and infectious process they take, means appropriate anti-infective measures can play a key role in the initial triage and care cause of death in the non-cardiac 1578. diagnosed and treatment initiated. coagulation and fibrinolysis that result in organisms cover the spectrum of be implemented and patient outcome improved. One example of the significance of of patients with potentially life-threatening intensive care unit (Mingming, Zhan, doi:10.1016/j.mayocp.2014.07.009 Diagnosis of severe sepsis is important for endothelial dysfunction, microvascular pathogens, with bacteria and fungi being pathophysiology of severe sepsis is the symptom of low oxygen extraction ratio. Recent sepsis. The research showed the impact of Mian, Jun, Zhi, Jin, & Zhenju, 2015). specific protocol to be implemented in a thrombi, and impaired tissue predominant. However, Staphylococcus research shows initial low OER(Oxygen Extraction Ratio) was associated with severe organ a nurse-initiated emergency department Treatment protocol differs when a Gaieski, D. F., Mikkelsen, M. E., Band, R. timely fashion. The current differentiation oxygenation. This impairment, combined aureus, Staphylococcus epidermidis, dysfunction that resulted in high mortality with severe sepsis and septic shock. When sepsis protocol to initial antibiotic patient is determined to have severe A., Pines, J. M., Massone, R., Furia, F. between sepsis and severe sepsis is with the systemic vasodilation and Enterococcus species, Streptococcus patients had initial abnormally low OER, their in-hospital mortality was higher than in administration, and had an impact on in- sepsis as opposed to sepsis. For this F., et al. (2010). Im-pact of time to evidence of organ dysfunction. There are hypotension, causes tissue hypo- pneumoniae, Escherichia coli, normal OER patients. Therefore, the OER should be considered when attempting to predict hospital sepsis mortality rates (Bruce, reason, it is significant that health care antibiotics on survival in patients many examples of organ dysfunction that perfusion and decreased tissue Pseudomonas aeru-ginosa, species the outcome of septic patients (Kim, Lee, Lee, Han, Moon, & Hong, 2015). Maiden, Fedullo, & Kim, 2015). A recent professionals be able to identify with severe sepsis or septic shock in are not commonly considered when doing oxygenation, further complicated by within the Klebsiella family, and Candida study by Gaieski and colleagues supports markers of organ dysfunction as a sign whom early goal-directed therapy was a patient workup. Increasing knowledge of impaired mitochondrial oxygen species account for most of the the nursing clinical relevance by showing of severe sepsis. Knowledge of these initiated in the emergency acute organ dysfunction markers could utilization secondary to oxidative stress. pathogens described (Cawcutt & Peters, that elapsed time from triage to markers and the pathophysiology department. Critical Care Medicine, potentially lead to earlier diagnosis of These mechanisms result in further 2014). Infection triggers both pro- administration of antimicrobials is a associated with severe sepsis can 38, 1045–1053. severe sepsis. The earlier it is diagnosed, tissue damage and ultimately contribute inflammatory and anti-inflammatory primary determinant of mortality of improve patient outcomes significantly. doi:10.1097/CCM.0b013e3181cc4824 the sooner treatment protocol can be to multi-organ failure. Signs and processes that ultimately contribute to patients with severe sepsis and septic initiated. Recent research showed that if symptoms of organ dysfunction the clearance of infection and the tissue shock (Gaieski et al., 2010). The knowledge Lin, X., Lee, D., & Wu, D. (2013). severe sepsis is diagnosed timely, commonly includes hypotension, acute damage that lead to organ failure. In of a severe sepsis screening tool Sabiporide improves cardiovascular administration of timely drugs improved respiratory distress syndrome, altered general, the pro-inflammatory processes significantly decreased the mean time to function and attenuates organ injury cardiovascular performance, lessened the mental status, acute kidney injury, ileus, are triggered by the infectious agent and Sepsis leading to antibiotics in patients presenting to the ED from severe sepsis. Journal Of Surgical inflammatory response, tissue hypo- hepatic dysfunction, disseminated are focused on the elimination of the with suspected severe sepsis or septic Research, perfusion and multi-organ injury, and most intravascular coagulation, adrenal pathogen, whereas the anti- shock (Patocka, Turner, Xue, & Segal, Organ Failure doi:10.1016/j.jss.2013.12.001 importantly reduced mortality (Lin, Lee, & dysfunction, and erythroid sick inflammatory processes are triggered by 2014). This research demonstrates that

Wu, 2013). syndrome. The patient will have multiple the host to promote tissue repair and increased nursing understanding of sepsis Mingming, X., Zhan, S., Mian, S., Jun, Y., indicators of organ dysfunction. healing. An imbalance of these and severe sepsis markers can significantly Zhi, D., Jin, Z., & ... Zhenju, S. (2015). Examples include: mechanisms lead to excess tissue improve patient care and outcomes. Diagnostic and prognostic utility of . altered consciousness, confusion damage. . tachypnea, SaO2 decreased, tissue factor for severe sepsis and decreased oxygen extraction ratio sepsis-induced acute lung injury. . tachycardia, hypotension Journal Of Translational Medicine, . jaundice, decreased hepatic 13(1), 1-8. doi:10.1186/s12967-015- function evidenced by increased 0518-9 bilirubin . oliguria, decreased platelets and Palleschi, M. T., Sirianni, S., O'Connor, N., reduced kidney function evidenced Dunn, D., & Hasenau, S. M. (2014). An by increased creatinine interprofessional process to improve . plasma IL-6 and IL-10 levels will early identification and treatment for show increase (Tutak, Ozer, sepsis. Journal For Healthcare Quality: Demirel & Bayar, 2014) Official Publication Of The National . Increased lactate/albumin ratio is Association For Healthcare Quality, another value that should be 36(4), 23-31. doi:10.1111/jhq.12006 considered because it correlates with the mortality in patients with severe sepsis and septic shock (Wang, Chen, Cao, Xue, Li, & Wu, 2015)

Additional References

Park, J., Kim, S., Lee, S., Lee, E., Han, K., Moon, S., & Hong, Y. (2015). Original Contribution: Initial Low Oxygen Extraction Ratio Is Related to Severe Organ Dysfunction and High In- Hospital Mortality in Severe Sepsis and Septic Shock Patients. Journal Of Emergency Medicine, doi:10.1016/j.jemermed.2015.02.038

Patocka, C., Turner, J., Xue, X., & Segal, E. (2014). Evaluation of an emergency department triage screening tool for suspected severe sepsis and septic shock. Journal For Healthcare Quality: Official Publication Of The National Association For Healthcare Quality, 36(1), 52-61. doi:10.1111/jhq.12055

Tutak, E., Ozer, A. B., Demirel, I., & Bayar, M. K. (2014). The relationship between serum bilirubin level with interleukin- 6, interleukin-10 and mortality scores in patients with sepsis. Nigerian Journal Of Clinical Practice, 17(4), 517- 522. doi:10.4103/1119-3077.134057

Wang, B., Chen, G., Cao, Y., Xue, J., Li, J., & Wu, Y. (2015). Sepsis: Correlation of lactate/albumin ratio level to organ failure and mortality in severe sepsis and septic shock. Journal Of Critical Care, 30271-275. doi:10.1016/j.jcrc.2014.10.030