Sepsis: Case Study Analysis

Sepsis: Case Study Analysis

At the molecular level, the healing process is a continuity of complicated interconnected physiological processes. The inflammatory phase begins when tissue integrity is disturbed by trauma; this initiates the clotting cascade to minimize bleeding. Platelets are the first biological elements to cluster to the injury, and their degranulation results in the production of many cytokines (Gyawali et al., 2019).

Sepsis: Case Study Analysis

Serotonin is also produced, which, together with histamine (from mast cells), causes a reversible reopening of the endothelial cell junctions, permitting macrophages to migrate to the site of damage (Jarczak et al., 2021). Once reaching the site of damage, cytokines and macrophages stimulate cellular migration to the site of harm. As a result, an inflammatory exudate containing blood cells fills the wound (Jarczak et al., 2021).

Alteration to this process leads to sepsis and wound infection. Infection is characterized by fever, redness, inflammation, pain, and fever that the patient experiences (Gyawali et al., 2019). In this case, the patient washed his wound with tap water which contains microorganisms and further wrapped the wound.

A range of microbial pathogens is frequently found in chronic wounds, although it is unclear why some bacteria are seen in some wound infections but not others. Tipton et al. (2020) likened the genetic differences of wound patients to the bacteria present in their infected wounds, and genetic variation in the TLN2 and ZNF521 genes were discovered to be related to both the number of microorganisms found in cuts and bruises and the abundance of pathogenic strains, largely Pseudomonas aeruginosa and Staphylococcus epidermidis.

Immunosuppression occurs when the body’s natural immune system cannot defend the body against infections (Rice, 2019). This can be caused by medications such as steroids, chronic diseases like cancer and diabetes, and some natural body physiology like pregnancy (Rice, 2019).

Immunosuppression predisposes a patient to infection. Immunosuppression can occur due to immune effector cell death or the disruption of intracellular pathways required for antigen detection or immune response. With T-cell depletion, sepsis has several immunosuppressive mechanisms same to cancer, such as the elevated release of the immunosuppressive cytokine interleukin 10, T regulatory cells, myeloid-derived suppressor cells, and PD-1 and PD-L1 (Hotchkiss et al., 2018).

Frequent illnesses followed by significant physiological symptoms such as high fevers, shivers, and fatigue are physical symptoms of a weakened immune system. In addition, taking many antibiotic treatment courses in a single year may indicate an underlying immune response issue.

Infections can arise and spread fast in those with weakened immune systems. A sore throat, for instance, has a higher risk of developing into a respiratory infection. Immunosuppressed individuals are prone to having a single infection spread throughout their body, causing septicemia and shock that can cause death.

Immunocompromised individuals appear to be at a greater risk of developing some forms of skin cancer. This includes squamous cell carcinoma (SCC), melanoma, and Kaposi’s sarcoma since the immune system aids in the destruction of sun-damaged skin cells (Rice, 2019).

If the immune system does not eliminate these cells, they can grow and develop cancer. It is also possible that if the immune system is inhibited, viruses (such as human papillomavirus (HPV) or herpes viruses) associated with certain malignancies are more likely to be present (Rice, 2019). Some immune-suppressing medications may directly damage skin cells, increasing their susceptibility to skin cancer.

References

  • Gyawali, B., Ramakrishna, K., & Dhamoon, A. S. (2019). Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Medicine7, 2050312119835043. https://doi.org/10.1177/2050312119835043
  • Hotchkiss, R. S., Monneret, G., & Payen, D. (2018). Immunosuppression in sepsis: a novel understanding of the disorder and a new therapeutic approach. The Lancet Infectious Diseases13(3), 260–268. https://doi.org/10.1016/S1473-3099(13)70001-X
  • Jarczak, D., Kluge, S., & Nierhaus, A. (2021). Sepsis-pathophysiology and therapeutic concepts. Frontiers in Medicine8, 628302. https://doi.org/10.3389/fmed.2021.628302
  • Rice, J. M. (2019). Immunosuppression. In Tumour Site Concordance and Mechanisms of Carcinogenesis. International Agency for Research on Cancer.
  • Tipton, C. D., Wolcott, R. D., Sanford, N. E., Miller, C., Pathak, G., Silzer, T. K., Sun, J., Fleming, D., Rumbaugh, K. P., Little, T. D., Phillips, N., & Phillips, C. D. (2020). Patient genetics is linked to chronic wound microbiome composition and healing. PLoS Pathogens16(6), e1008511. https://doi.org/10.1371/journal.ppat.1008511

Sepsis: Case Study Analysis Instructions

  • How has learning about the history of research ethics impacted your view of biomedical research?
  • In looking at the studies you reviewed for your PICOT question, do you feel that today’s researchers adequately protect the rights of human subjects? If not, what additional measures do you recommend?
  • PICOT below on Sepsis

PICOT Question Worksheet

1)            Identify and describe one practice-related issue or concern.

The practice-related concern is sepsis in older adults and its adverse effects on the at-risk population and healthcare systems, including long-term care facilities. Branco et al. (2020) define sepsis as “a systematic inflammatory response to the presence of inflammatory mediators, which the host produces in response to microbial agents” (p. 2). In this sense, infection exposure is one of sepsis’s most profound risk factors. Another issue is the immunity system’s failure to fight off foreign disease-causing microorganisms such as bacteria, viruses, and fungi.

Older adults in long-term care facilities grapple with multiple health conditions, including cardiovascular diseases (CVDs), diabetes, and chronic obstructive pulmonary disease (COPD). These diseases significantly affect their immune systems and exacerbate their susceptibility to hospital-acquired infections and their subsequent effects, such as comorbidities. Therefore, organizational factors like prolonged hospitalization, exposure to infections, and individual aspects like frailty and weak immune system increase sepsis in older adults in long-term care facilities (Mayo Clinic, 2018). While sepsis is a life-threatening condition, healthcare professionals are responsible for implementing clinical protocols and guidelines for addressing modifiable risk factors such as unhygienic invasive devices like intravenous catheters or breathing tubes that can facilitate hospital-acquired infections.

2)            Explain why the issue/concern is important to nurse practitioner practice and the issue’s impact on health outcomes.

Sepsis is a health concern of much significance to nursing practitioners due to its association with adverse health and economic ramifications. According to Lee & Levey (2019), sepsis accounts for approximately 30 million hospitalizations and over 5 million deaths annually. In the same breath, this condition occurs concurrently with other health concerns, including hospital-acquired pneumonia, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVDs), and diabetes. Undoubtedly, chronic diseases remain the leading cause of premature deaths, prolonged hospitalization, increased care costs, and compromised quality of life for patients.

Alongside increased mortality rates, intercepted sepsis leads to adverse health consequences, including multiple organ dysfunction and septic shock. These ramifications increase the likelihood of prolonged hospitalization, overreliance on pharmacological interventions, increased economic burden, and a poor quality of life. For instance, Paoli et al. (2018) contend that sepsis is an expensive healthcare problem in the United States due to its management and hospitalization costs. In the same breath, Mayo Clinic (2018) argues the condition leads to the impairment of essential biological structures such as the heart, kidneys, and brain. Although patients can recover from mild sepsis, the mortality rate for septic shock is about 40%, meaning it is a life-threatening condition.

Although the current knowledge of the pathophysiology of sepsis has significantly transformed clinical interventions, there are no molecular treatment options for the problem. As a result, healthcare professionals are responsible for implementing primary prevention strategies such as early sepsis screening and detection. According to Kim & Park (2018), care providers can screen vital signs, including temperature, heart rate, altered mentation, and respiration rate. Undoubtedly, early screening and management resonates with multiple benefits like reducing sepsis-related mortalities, reduced readmissions, and curtailed care costs.

3)            Define each element of your PICOT question in one or two sentences.

P-Population and problem (What is the nursing practice concern or issue, and whom does it affect?)

The at-risk population for sepsis in older adults in long-term care facilities. This patient population grapples with chronic conditions, exposure to hospital-acquired infections, and weak immune systems.

I–Intervention (What evidence-based solution for the problem would you like to apply?)

The viable intervention for preventing and managing sepsis is early screening and detection. This process entails assessing patients’ vital signs such as temperature, heart rate, altered mentation, and respiration rate.

C–Comparison (What is another solution for the problem? Note that this is typically the current practice, with no intervention at all or alternative solutions.)

It is essential to compare early sepsis screening protocols and the current clinical practice. This PICOT question compares early sepsis screening and the absence of such a protocol.

O–Outcome (Very specifically, how will you know that the intervention worked? How will you measure the outcome?)

The outcome of the intervention includes improving sepsis management and reducing prolonged hospitalization associated with sepsis. It is essential to assess the impact of the clinical intervention (early sepsis screening) within the stipulated timeframe.

T–Timeframe (Timeframe involved for the EBP initiative/target date of completion.)

Melnyk & Fineout-Overholt (2019) define timeframe as the time it takes for the intervention to achieve the desired outcomes or the time in which the researchers evaluate the population for results. The time for assessing the effectiveness of early sepsis screening is eight weeks, although adequate time would be necessary to realize the desired outcomes effectively.

Construct your PICOT question in the standard PICOT question format (narrative) and define each letter separately, such as:

o             P =Older adults in long-term care and sepsis

I = Early sepsis screening to determine the patient’s likelihood of becoming septic.

o             C = An absence of early sepsis screening protocol

O = improve sepsis management and reduce prolonged hospitalization

o             T = Eight weeks

o             PICOT Question written in full:

In adults in a long-term care facility (P), does the implementation of nurse-led early sepsis screening (I), compared to no early screening practices (C), improve sepsis management and reduce prolonged hospitalization (O) within eight weeks? (T)

Reflection

Although the PICOT format enables researchers to develop and pose foreground questions to aid the systematic literature search, multiple challenges compromise the process. For instance, I encountered a challenge in choosing the intervention, comparators, and outcomes. Another problem was the underlying fear of limited evidence to support the selected intervention. Regardless of these challenges, I developed a PICOT question that focused on contextualizing the clinical problem and intervention for addressing the identified issue.

Undeniably, I will apply the knowledge acquired when developing the PICOT question in my future practices. As Melnyk & Fineout-Overholt (2019) contend, the purpose of the PICOT question is to guide the systematic search of healthcare databases to find the best evidence to answer the question. Therefore, I will use this knowledge to cultivate a culture of clinical inquiry, familiarize myself with the tenets of identifying, selecting, and appraising evidence sources, and translate knowledge from external evidence sources to nursing practice.

Criteria

  1. Application of Course Knowledge: The student’s initial post contributes unique perspectives or insights gleaned from personal experience or examples from the healthcare field. The student must accurately and fully discuss the topic for the week in addition to providing personal or professional examples. The student must completely answer the entire initial question. Initial post due by Wednesday at 11:59pm MT. You must include two resources in your initial post: one from your lesson or weekly reading and one from an outside scholarly source.
  2. Engagement in Meaningful Dialogue: The student responds to a student peer and course faculty to further dialogue.
    1. Peer Response: The student responds substantively to at least one topic-related post by a student peer. A substantive post adds content or insights or asks a question that will add to the learning experience and/or generate discussion.
      • A post of “I agree” with a repeat of the other student’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.
      • The peer response must occur on a separate day from the initial posting.
      • The peer response must occur before Sunday, 11:59 p.m. MT.
      • The peer response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.
    2. Faculty Response: The student responds substantively to at least one question by course faculty. The faculty question may be directed to the student, to another student, or to the entire class.
      • A post of “I agree” with a repeat of the faculty’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.
      • The faculty response must occur on a separate day from the initial posting.
      • Responses to the faculty member must occur by Sunday, 11:59 p.m. MT.
      • This response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.
  3. Integration of Evidence: The student post provides support from a minimum of one scholarly in-text citation with a matching reference AND assigned readings OR online lessons, per discussion topic per week. Two resources total and to count must be an in-text citation.
    1. What is a scholarly resource? A scholarly resource is one that comes from a professional, peer-reviewed publication (e.g., journals and government reports such as those from the FDA or CDC).
      • Contains references for sources cited
      • Written by a professional or scholar in the field and indicates credentials of the author(s)
      • Is no more than 5 years old for clinical or research article
    2. What is not considered a scholarly resource?
      • Newspaper articles and layperson literature (e.g., Readers Digest, Healthy Life Magazine, Food, and Fitness)
      • Information from Wikipedia or any wiki
      • Textbooks
      • Website homepages
      • The weekly lesson
      • Articles in healthcare and nursing-oriented trade magazines, such as Nursing Made Incredibly Easy and RNMagazine (Source: What is a scholarly article.docx; Created 06/09 CK/CL Revised: 02/17/11, 09/02/11 nlh/clm)
    3. Can the lesson for the week be used as a scholarly source?
      • Information from the weekly lesson can be cited in a posting; however, it is not to be the sole source used in the post.
    4. Are resources provided from CU acceptable sources (e.g., the readings for the week)?
      • Not as a sole source within the post. The textbook and/or assigned (required) articles for the week can be used, but another outside source must be cited for full credit. Textbooks are not considered scholarly sources for the purpose of discussions.
    5. Are websites acceptable as scholarly resources for discussions?
      • Yes, if they are documents or data cited from credible websites. Credible websites usually end in .gov or .edu; however, some .org sites that belong to professional associations (e.g., American Heart Association, National League for Nursing, American Diabetes Association) are also considered credible websites. Websites ending with .com are not to be used as scholarly resources
  4. Professionalism in Communication: The post presents information in logical, meaningful, and understandable sequence, and is clearly relevant to the discussion topic. Grammar, spelling, and/or punctuation are accurate.

References

Branco, M. J. C., Lucas, A. P. M., Marques, R. M. D., & Sousa, P. P. (2020). The role of the nurse in caring for the critical patient with sepsis. Brazilian Journal of Nursing, 73(4), 1–7. https://doi.org/10.1590/0034-7167-2019-0031

Kim, H. I., & Park, S. (2018). Sepsis: Early recognition and optimized treatment. Tuberculosis and Respiratory Diseases, 82(1), 6–14. https://doi.org/10.4046/trd.2018.0041

Lee, J., & Levy, M. M. (2019). Treatment of patients with severe sepsis and septic shock: Current evidence-based practices. Rhode Island Medical Journal (2013), 102(10), 18–21. https://pubmed.ncbi.nlm.nih.gov/31795528/

Mayo Clinic. (2018). Sepsis – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214

Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A Guide to Best Practice (4th ed.). Wolters Kluwer

Paoli, C. J., Reynolds, M. A., Sinha, M., Gitlin, M., & Crouser, E. (2018). Epidemiology and costs of sepsis in the United States—an analysis based on the timing of diagnosis and severity level. Critical Care Medicine, 46(12), 1889–1897. https://doi.org/10.1097/ccm.0000000000003342