Good Example Of Essay On The Pathophysiology Of Sepsis

Introduction

Sepsis is one of the major causes of morbidity and mortality, specifically in the Intensive Care Units (ICU) of hospitals. Every year, more than 750,000 patients die from complications of sepsis (Angus 2001). These statistics translate into a mortality rate of between 30% and 60% of patient diagnosed with sepsis (Angus 2001). It is expected that these numbers will continue to rise there are serious characteristics of our population that are on the rise that put patients at increased risk for sepsis and death, including an aging population, increased patients with co-morbidities, increased bacterial resistance and opportunistic infections, increased use of invasive devices for monitoring and therapy, and the increased use of immunosuppressive medications (Mayo Clinic).

Pathophysiology on the tissue level with the presence of biochemical agents

Sepsis begins with the body’s inflammatory process, in which the body recognizes there has been a breach in its immune defenses and an infection is starting somewhere throughout the body. When the microorganisms that are causing the infection enter the bloodstream, the patient becomes septic (Ignatavicius 2012). With the increasing number of infiltrates, the body initiates the inflammatory response, systemic inflammatory response syndrome (SIRS). During this response, the body’s chemical mediators (interleukins, chemokines, tumor necrosis factor receptors) develop a system-wide response to the infection. However, the inflammatory mediators have an uncontrolled response leading to compensatory anti-inflammatory response syndrome (CARS). The body’s response leads to excessive hormonal, tissue, and vascular changes and oxidative stress that further impairs oxygenation and perfusion to the body’s tissues. The patient also experiences vasodilatation and blood pooling, causing coagulopathies. When SIRS and CARS develop, multiple organ dysfunction syndrome (MODS) occurs and death results (Ignatavicius 2012).

Signs and Symptoms

During sepsis, the body’s tissues are reacting to the infection, to prevent its spread from the blood into the tissue. These widespread changes lead to various symptoms, including fever (core body temperature above 38.3 degrees Celsius) or hypothermia (core body temperature below 36 degrees Celsius), a heart rate above 90 beats per minute, a respiratory rate above 20 breaths per minute, an arterial blood gas level of carbon dioxide less than 32, and a white blood cell count either above 12,000/mm3 or below 4,000/mm3 (May Clinic). As the symptoms increase and the body’s tissues react, systemic involvement can include hypotension, pulmonary edema, hypoxemia, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), coagulopathy, and deep vein thrombosis (DVT) (McCance and Huether 2014).

Diagnosis and Treatment

Sepsis can be diagnosed through multiple laboratory tests, including a complete blood count, coagulation profile, electrolyte levels, creatinine and BUN levels, urinalysis and culture, blood culture and blood stain, culture of the primary infection site, and an MRI to localize the infectious etiology (MedlinePlus). It is very important to monitor the patient for early signs and symptoms of sepsis, as an earlier prognosis can lead to earlier treatments and a better outcome. Treatment therapies include antibiotics, fluid therapy, vasopressors, and corticosteroids (McCance and Huether 2014). Antibiotics work to destroy the pathogenic organisms, fluid therapy decreases the risk of hypovolemia and hypotension, vasopressors work when fluid therapy does not, and corticosteroids work to decrease the inflammatory process. If untreated, sepsis develops into severe sepsis, then into septic shock, which will most likely result in death of the patient (McCance and Huether 2014).

References

Angus DC, et al., Epidemiology of severe sepsis in the United States: Analysis of incidence,
outcome, and associated costs of care. Critical Care Medicine, 2001; 29:1303-1310
Donna D. Ignatavicius MS RN ANEF. (2012) Medical-Surgical Nursing: Patient-Centered
Collaborative Care, Single Volume, 7e (Ignatavicius, Medical-Surgical Nursing, Single Vol). 7 Edition. Saunders. p. 820.
McCance, K.L., Huether, S.E. (2014) Pathophysiology: The Biologic Basis for Disease in Adults
and Children, 7th edn., St. Louis, Missouri: Elsevier.
Sepsis - Mayo Clinic . 2014. Sepsis Causes - Diseases and Conditions - Mayo Clinic . [ONLINE]
Available at: http://www.mayoclinic.org/diseases-conditions/sepsis/basics/causes/con-20031900. [Accessed 02 March 2015].
Sepsis: MedlinePlus Medical Encyclopedia. 2014. Sepsis: MedlinePlus Medical Encyclopedia.
[ONLINE] Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000666.htm. [Accessed 02 March 2015].