Mr King is a seventy-five-year-old male brought into the Acute Medical Ward via the rapid access clinic in University Hospital Waterford who alerted the Clinical Nurse Manager on the suspicion of sepsis and poor vital signs. The clinical nurse manager welcomed Mr. King reassured him and explained what was happening.
Mr King had Increasing shortness of breath and productive cough
Had Started five days ago, seen by GP and started on oral antibiotics two days ago. Became increasingly unwell despite antibiotics.
PMHx – COPD, T2DM, venous leg ulcer and HTN
DHx – salbutamol PRN, carbocysteine 375 mg TDS, tiotropium BD, metformin 1g BD, amlodipine 5mg OD, Ramipril 2.5mg OD. No known drug allergies.
O/E – Speaking in short sentences
Accessory muscle use
No obvious deficits in chest expansion
Global wheeze and crackles mid to base on right-hand side. Dullness on percussion to mid and lower right side.
Observations: BP 90/45 HR 130 CRT 6s SpO2 82% on air, respiratory rate 32, temperature 38.6 degrees.
This patient clearly meets the SIRS criteria being pyrexic, tachycardic and tachypnoeic. The purulent green sputum suggests the chest as a focus of infection, this is reinforced by the previous treatment and diagnosis of a lower respiratory tract infection by the patient’s GP.
Assessment of The Septic Patient
As with any critically ill patient, follow the ABCDE framework. A quick hello and how are you can give you an idea of a patient’s ABCDE state. I do this to tell me is this patient going to arrest on me in the next thirty seconds and do I have enough time to go into a more detailed assessment following handover? During my secondary assessment I can then take more time and be more thorough.thenar em
I also document my assessment in the ABCDE framework. It’s logical, allows you time to think and makes it harder for you to omit details in both examination and documentation of findings.
A – patent
B – Tachypnoeic with respiratory rate 32, SpO2 84% on air, equal chest expansion. Global wheeze and crackles mid to base on right side. Dullness on percussion to mid and lower right side.
C – BP 90/45 HR 130 CRT 6s, cold to touch.
D – Alert, blood glucose on venous blood gas 14.5 mmol/l
E – temperature 38.6 degrees
Basic investigations – blood cultures, clotting screen, full blood count, urea and electrolytes, liver function, C-reactive protein and a venous blood gas. Urinalysis and send for culture. Are they confused? Measuring of urine output is needed. Often a catheter is required for an accurate fluid balance
Use Irish references as much as you can. Use the Sepsis 6
Have an appendix with case presentation, nursing documentation, charts,