Pediatric Sepsis: A Case Study | Article | NursingCenter

 

sepsis case studies

Sepsis Case Study. SECTION 1 DIRECTIONS: After watching the first segment of the video, work through this first section of the case study. Review Scenario: At noon, Jose Guerrero, a 17 year old high school student on the soccer team, arrives at the Emergency Department (ED) a few days after cutting his foot at practice. The area on his. The patient presented with clinical manifestations of sepsis, as well as a case of suspected child maltreatment (neglect). This case study displayed the signs and symptoms consistent with septic shock. The importance of thorough history taking and judicious physical assessment with rapid, definitive care were especially important in this case. Sep 07,  · Do clinical experiences with drotrecogin alfa (activated) parallel those of the published studies? In this session, to provide guidance from their personal experiences, several clinicians presented 3 "real world" case studies reflecting their use of drotrecogin alfa (activated). Case Study 2: Sepsis After Hernia Repair.


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A year-old woman with stage IV cervical carcinoma undergoes extensive pelvic surgery pelvic exenteration in order to remove the tumor. The surgical procedure involves removal of all pelvic organs, removal of a segment of the ileum to construct a new bladder, and a colostomy. At first, the patient appears to be recovering very nicely. During the evening of the third postoperative day, however, sepsis case studies, the nurse on the night shift notes that the patient's respiratory rate, which was per min, has increased to 26 per min.

The patient claims that she doesn't feel overly sick. She is not short of breath or in pain, and her temperature is actually slightly subnormal By the next morning, she has slight fever Her surgical wound shows no signs of infection, and her abdomen is no more tender than expected.

Later in the day, however, it becomes quite clear that the patient is in serious trouble. She is flushed, anxious, and restless. The tachypnea, elevated temperature, and hypotension all imply sepsis. Given that this patient has undergone a long and complicated surgical procedure, bacterial infection related to the surgery i. Blood cultures should be ordered to look for bacteremia and to identify the causative agent if possible.

Antibiotic treatment should be started immediately, using a regimen that is sepsis case studies to be effective against a broad range of Gram-positive and Sepsis case studies negative bacteria. Intravenous fluids can be introduced rapidly, in order to bring her blood pressure back up.

The patient's condition worsens despite your efforts. The following morning, she is short of breath and there is excess fluid throughout her lungs. Intravenous fluids are cut back, and a sepsis case studies is now required to maintain her blood pressure. Because of this, she is transferred to the SICU for monitoring.

To better assess her hemodynamic status, the superior vena cava Shiley catheter and one of the pulmonary arteries Swan-Ganz catheter are catheterized the latter via the jugular vein, sepsis case studies, right sepsis case studies, and right ventricle. The patient turns out to have a cardiac output nearly double the normal for a resting adult of her size. Over the next 24 hrs, the patient continues to do poorly. Her urine output decreases almost to zero, and she requires mechanical ventilation to maintain oxygenation.

She becomes increasingly edematous. The blood cultures taken earlier are negative. The patient continues to display signs of severe sepsis, which may be increasing in its severity, despite the continued administration of broad-spectrum antibiotics that are normally very effective in cases like this-a seemingly nonsensical situation. It is possible that the causative agent is just unusually resistant to these antibiotics, but that seems unlikely if they have a good "track record" sepsis case studies this sepsis case studies. Another possibility is that there is some unexpected ongoing source of bacteria or more likely, considering the negative blood cultures bacterial chemical substances that provoke a severe sepsis response.

She is going into multiple organ failure. The problem is most likely related in some way to the patient's complicated surgical procedure. Her external surgical wound does not appear to be infected, so the problem must be internal. As a result, exploratory surgery will be required to identify the specific source of bacteria or bacterial chemical compounds, if that is what's happening here.

In this case, the exploratory surgery shows that the suture line attaching the ileum to the colon is partially disrupted, with leakage of bowel contents, intense inflammation of the mesentery, and early abscess formation.

Appropriate repairs must be made during surgery. Drains should be inserted to clear out the abscessed areas. Antibiotic treatment should be continued as well. In this case, the patient recovered slowly but completely. Her blood cultures remained negative. This was probably a mixed infection, caused by a variety of Gram negative colonic bacteria like Escherichia coli and other Enterobacteriaceae, anaerobes such as Bacteroides fragilisetc.

This leads to "capillary leak" with increasing edema. The combination of very low blood pressure which is sepsis case studies as In protracted cases of sepsis, sepsis case studies, such as those complicating abdominal surgery, one organ after another may fail.

This condition is called multi-organ dysfunction syndrome MODS, sepsis case studies. Affected organs may include the following:. Heart: myocardial contractility is depressed; the heart compensates by dilating and beating faster, thereby increasing cardiac output. Compensatory mechanisms fail in some patients, and cardiac output drops to low levels shortly before death.

Clotting system: endothelial damage can lead to extensive microvascular thombosis DIC; disseminated intravascular coagulation. Lungs: the capillaries are generally leaky during sepsis, causing fluid to exude in the interstitium and alveolar spaces.

The lung becomes soggy and stiff, and adequate gas exchange is impossible adult respiratory distress syndrome; ARDS. GI tract: hemorrhagic necrosis of sepsis case studies mucosa occurs, probably in part because of ischemia. Loss of mucosal integrity can lead to hemorrhage. Endocrine and metabolic effects: sepsis is a catabolic state that involves massive lipolysis, proteolysis, and glycogenolysis. Stress hormones e, sepsis case studies. An abnormally high proportion of the oxygen sent to tissues is returned to the heart unused, either because some vascular beds are sepsis case studies perfused or because some of the cells are too impaired metabolically to use the oxygen they receive.

Either way, in the absence of a functioning Krebs Cycle, sepsis case studies, glycolysis occurs at a high rate and the pyruvic acid formed is reduced to lactic acid, which results in lactic acidosis. CASE 3: Nosocomial sepsis following surgery mixed infection. Question 3. The combination of very low blood pressure which is defined as Question 3, sepsis case studies. In protracted cases of sepsis, such as those complicating abdominal surgery, one organ after another may fail.

Affected organs may include the following: 1. Brain: patients are often confused, delirious, stuporous, or comatose.

Kidneys: acute renal failure occurs as a sepsis case studies of acute tubular necrosis. Liver: stasis of bile, focal necrosis, sepsis case studies, and jaundice are common. Vasculature: massive peripheral vasodilation, sepsis case studies, etc.

 

Sepsis case study | GPonline

 

sepsis case studies

 

Sepsis Case Study. SECTION 1 DIRECTIONS: After watching the first segment of the video, work through this first section of the case study. Review Scenario: At noon, Jose Guerrero, a 17 year old high school student on the soccer team, arrives at the Emergency Department (ED) a few days after cutting his foot at practice. The area on his. Read our case studies on using procalcitonin to determine which patients with overlapping symptoms are likely to suffer sepsis. Sepsis Case Studies | bodiereview-i.ml - bioMerieux Menu. Society of Critical Care Medicine sepsis-related videos are curated in the Surviving Sepsis Campaign playlist on YouTube. Recovery After a Hospitalization for Sepsis This video is intended for sepsis patients after hospitalization describing challenges with post sepsis .